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85 Cards in this Set
- Front
- Back
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What is main muscle on pelvic floor that controls urinary continence?
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Levitor Ani, if stretched more than 1/4 woman at risk for urinary incontenance or if pudental nerve stretched. Levitor Ani supports bladder neck and urethra. closure pressure within urethra must exceed intraobdominal pressure during sneeze or cough. also depends on nerve innvervaton to muscle to transmit signal fast enough to muscle
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jHOw many women experience incontinence?
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58% of premenopausal women 42-50
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How does fluid intake affect UI?
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women may limit fluids, but this will irritate bladder and cause increased urge to void. Too much fluids puts great pressrue on bladder and can leak or have frequency.
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What drinks to avoid for someone with UI
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Caffiene increases s/s of UI avoid this. Alcohol, decafinated coffee or tea, carbonate beverages, artificial sweetners.
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HOw does constipation affect UI?
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increase stool in bowel can put pressone on bladder
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How does habitual prenentive emptying of bladder affect UI?
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if empty bladder too often can lead to urge sensations at increasingly lower bladder volumes. Need to go 3-4 hours between voiding. Can retrain bladder
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What other factors affect UI?
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age, fam hx, pregnancy and childbirth (increases with size of baby - loss of support structures from pushing), obesity increased UI, smoking, high intraabdominatl pressure with aerobic exercise, lifting, obesity
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Which meds are associated with UI
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diuretics estrogen, benzodiazepines, tranquilizers antidepressants, hypnotics, alxatives, antbiotics.
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What to ask when woman presents with UI?
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how often experience urinary leakage? HOw much irine do you lose?
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What types of UI are there ?
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stress incontence (involuntary leakage of urine witheffort or exertion), urge incontinence (a strong desire tourinate that is difficutl to postpone) adn mixed
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What is high within bladder pressure
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women who wait too long to empty bladder & they overfill lilke teachers, nurses or women who drink excessive fluids, or women who use restroom too much train bladder to empty when lower volume - known as detrusor instability - need to keep 3 day voiding diary to get better hx
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What is paper towel test?
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hold brown paper towel next to urethra and have pt cough - must have a full bladder - see how much comes out - is urethra working or weak
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What is hypermobility of urethra?
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levetor ani muscle damaged allowing movement of urethra thus cuasing UI
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WHat is first treatment of UI?
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behavioral interventions - pelvic muscle treatment The Knack - holding pelvic muscle in response to inc intrabdominal pressure, Kegals
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How to do bladder training
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Keep voiding & intake diary. Delay first urge sensation. Strick training waith for strick inteval between voids and increase this time each week. 1 cup every 3-4 hours
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What inserts can be used ot help iwth UI
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vaginal pessaries, tampons, or urethral inserts
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What meds are use for UI
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Urge Urinary incontenance: ditropan - anticholernic antimuscarinec agents reduces involuntary ccontractsion of detrusor muscle
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What are biologic risk factors for STI"s
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vagina has large amount of mucous membrane & mroe conductive to ifnections than penis, STI in women can be asymptomatic, vagina warm and moist great place for infectous organisms to live. "Younger women more susceptible to STI - cervix immature and more susceptible to STI, douching, increased sex with multiple partners, hormonal contraceptives
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What are social factors for STI's?
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poverty, lack of education, social inequity, inadequate access to health care
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What are other risk factors for STIs
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societal norms of women doing what men want, substance abuse - drugs, alcohol, depression, sexual abuse hx
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When shoudl screening for STI be done
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yearly for all women under 25, then dependent on risk factors and pregnancy - all pregnant womeon need screening for gonorrhea, syphyliss, chalmydia, hep B, HIV
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What important info to get before treating STIs
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Is woman pregnant? some meds contraindicated in pregnancy. If find postive for one STI alwasy check all others also. Must report all STI to health dept - gonorrhea, syphillis, AIDS, chalymdia in some states. Need to tell pt this case to be reported to state. Pt needs to notify partner as they need to be treated so disease does not get transfered again & avoid sex while beign treated
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What is HPV
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genital warts, virus, - not required ot report these, 60% adolescents may hve these. 30 types, most are subclinical and woman doesn't know she has them, 6--1 year probabtion, smokers greater risk. Lesions seen in mostly in introitus, but other places also, grouped papules, usually painless, can be infected with multiple strains, vag discharge, pruritis, dyspareunia, postcoital bleeding, always do PAP if find pos for HPV
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Which HPV associted with Cancer?
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16 (vaccine for 16), 18, 45, 56
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How to treat HPV
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Can remove genital warts or ccondylomata, but does nto cure of HPV, use cyro therapy, laster, surgical, tricholoracetic acid, need multiple treatments, must r/o dysplasia before treatment, treat s/s with oatmeal baths, warts can resolve on own, grow bigger or stay the same, imiquimod 5% cream
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What is HSV (herpes)
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women greater risk than men, recurrant incurable viral infection, HSV 1 transmitted non sexually, HSV 2 sexually, First infection last usually 3 weeks, fever, malaise, myalgia adn genital lesion appear on vulva - painful blisters last 4-15 days before crusting over, often has cervicitis, vag discharge, swollen lymph nodes Initial infection the worst. Recurrent infections usually minus systemic symptoms, has prodromal genital tingling. Recurrent lesions unilateral and less severe. Do culture to vonfirm diagnosis
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How to treat HSV?
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no cure. antiviral drugs partially control. or can be used daily to supress. Acyclovir 400 mg po tid x 7-10 days
. warmsizt baths, dry perinium with hair dryer on cool, witch hazel or aloe vera gel. Herbals: Kelp powder, sunflower seed oil L-lysine |
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What is chancroid?
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bacterial infection of GU tract. Found most often in Asia, Africa and South America and in sex trafficing areas of USA, Genital ulcer, see enlarged inguinal nodes & nodes can become ulcerous, Diagnosis can be made if no evidence of syphilis or HSV infection
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How to treat a chancroid
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azithromycin 1 gm, may take 2 weeks for complete healing
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What is pediculosis
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parasitic ifnections of lice
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How to treat pediculosis pubis
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permethrin 1% cream rinse or RID, must treat all bedding, clothing, towels wash in hot water and hot dryer
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What is trichononiasis?
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causes vaginitis transmitted during sex - protozoan, some asymptomatic, others haas yellow to green frothy mucopurlent copious malodorous discharge,inflammation of vulva and vagina, excoriation, erythema, ulcrations and lesions, petchia in vagina
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How to diagnose trichomoniasis?
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Wet prep visualization of one elled flagellate trichomonads
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HOw to manage trichomoniasis?
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2 g flagyl metronidazole once - antirprotozoal. Do not drink alcohol when on Flagyl causes acute abd distress
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What is chlamydia?
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most common bacterial STI often asymptomatic. Can have dysuria, purlent discharge, postcoital bleeding, uriinary frequency More commone in young and older women. can cause PID. If see guarding with abd exam, cervical pain with bimanual and adnexal fullness can have PID. All sexually active women to be screened annual for chlamydia.. Test used is NAAT endocervical sample. High incidence of reinfection
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HOw to treat chlamydia?
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Azithromycin 1 gm po once
or doxy |
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What is gonorrhea
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Oldest STI, young age under 20 risk factor, single act of sex 50% women get it from infected individual. Bacterial. Main complication is PID. Often asymptomatic, can have dyspareunia, change in vaginal discharge, unilateral labial pain & swelling, lower abd pain. Painful necrotic pustules on erythematous base. Can get in pharynx or oral cavity. Cultures Gold standard for diagnosis or NAAT or culture on Thayer Martin media. Should also test for chlamydia and trichomoniai, PID
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How to treat gonorrhea
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Cefiximen or cipro. ceftriaxone 250 mg IM once PCN no longer used d/t resistant strains
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What is PID (pelvic inflammatory disease)
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inflammaory disorder of uppoer femail genital tract, endometriitis salpingitis, tubo-ovarian obscess, and pelvic peritonitis. teens greatest risk, d/t decreased immunity and inc risk for gonorrhea nad chlamydia. mostly caused from gonorrhea or chlaymidia. bacteria ascend up vagina to cervix to upper genitals, Spread happens at end or after menses. constant pain, persistnet bilater severe in lower quad, fever, pain with cervical movement, abd pain, backache, inflammation Risk factors are young age at first intercourse, frerquent intercourse, multiple partners, hx STI's, smoking and douching, Can cause chronic pelvic infections, tubal scarrring, infertility.
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Treatment for PID
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cousleing of how to avoid STI. safe sex, b arrier methods. Need antibiotics some need hospitalized for IV antibiotics Ofloxacin or levofloxacin & flagyl
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What is syphilis
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1systemic disease. Rates higher in the South. More common in, older adults over 30, many also are HIV pos. Caused by spirochete. disease can be active or latent and can affect whole body. States as painless ulcer on genitals. Secondary syphillis see rash on palms and soles & lymphdenopathy. fevere, HA, malaise, may get warts also. If left untreated can cause tertiary syphilis,
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What tests are used to find syphilis?
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RPR or VDRL, seroconversion can take up to 6-8 weeks, if see chancre restest if initially neg
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How to treat syphilis
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Pen G primary:Benzathine penicillin G 2.4 million units IM once or Doxy if allergic
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What is Hep B?
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bld borne pathogen, semen, vaginal secretions drug use, multiple partners, tattoos, piercings, liver disease can be asymptomatic in 1/3 of cases, s/s arthralagias, n/v,, abd pain, clay colored stools & dark urine later, anorexia, arthritis, lassituede, fever, jaundice, taste adn small peculairities, weight loss, risk death d/t liver CA or cirrohosis
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Who should be vaccinated against Hep B
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multiple sex partners in last 6 months, prision inmates, prostitues, partners of IV drug users, anyone with STI, bisexual, women with high risk jobs. Vacccine should onlly be given in Deltoid muscle never gluteous or quadracep. NO cure for Hep B, high protien low fat diet, avoid meds metobolized in liver, increase fluids, avoid alcohol
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What is HIV
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3rd leading cuase of death in black women, 5th in women overall, decrease in T cells, leads to immunocomprised, younger women more susceptible for sexually transmitted HIV d/t increased exposed columnar epithelium. More susceptible to bleeding, women taking OCP adn pregnant have increased cervical columnar epithelium. women with STIs more susceptible to HIV d/t open sores, use of highly absorpbant tampons, Anal intercourse, and oral sex d/t peridontal disease. Counseling important with HIV testing. ELISA and Western BLot test used, may be initially neg, need ot retesst @ 3- & 6 months up to 1 year.
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Management of HIV
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Antiretroviral treatment, slows viral replication
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What hormone causes most vaginal secretions?
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estrogen, normal pH 3.8-4.2, with less estrogen at menopause pH rises to 6-7 and more susceptible to infection
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What is vaginitis
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inflammationo f hte vagina, inc vaginal discharge containing wBCs, caused by altered vaginal environment, douching, antibiotics, hormones, OCP, stress, sex, changes in sex partners
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What is vaginosis
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No WBC's seen, bacterila in orgin, pH > 4.5, wet prep clue cells seen, decreased lactobacilli, secretions thin, grayish white, adherent, fishy odor
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What is vulvovaginitis
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inlfammtion of hte vulva and vagina caused by vaginal infection or copious amount of leukorrhea
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Vulvovagiihnal candidiaisis
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pH < 4.5, wet pres yeast bud, discharge, thick or thin, white, curdk-like, adherant, itching, musty odor, skin cracks , burning. Treatment: miconazole 2% vaginal cream 5 gm intravaginally x 3 days
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What is bacterial vaginosis
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most common vaginitis. pH more alkaline >4.5 take sample from vaginal wall not cervix,not an STI, can cause PID, many asymptomatic, biggest sign fishy odor, wet prep with KOH (Potassium hydroxide and saline done see clue cells
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Treatment for bacterial vaginosis
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Flagyl, metronidazole 500 mg po bid x 7 days
orall and gel inserted into vagina |
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What are some alternative therapies for bacterial vaginosis
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in olive oil in vagina over night, goric acid powder, Vinegar douches
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What are some alternative therapies for vulvovaginal candidiasis
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gentian violet douhce, vinegar doughe, acidophilus culture douche, Vit C orally, yougut application to vulva, Sassafras Bark wash
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Risk for yeast infections
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antibiotics, diabetes, pregnancy, obesity, diet high in refined sugar, use of steroids, immunosuppressed states, local allergic reactions
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What is toxic shock syndrome?
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caused by staph associated with tampon use. Temp > 102, HA, rash, myalgia, n/v, profuse watery discharge, early edema, rash, redness of palms and soles,hospitalization often necessary for treatment
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What is a bartholins cyst or abcess
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mucous secreting glands with duct oeping posteolateral vulvar vestibule. Occulsio of duct r/t nontender mass 1-4 cm, can form an abcess, but most incidental findings
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Where are women most likely to be abused?
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face, chest, abdomen, observe behavior and physical appearance
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What treatment is given after sexual assault
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pregnancy test, emergency contraception, Hep B vaccine, treat for STI's, single dose therapies, ceftiaxone, flagyl, azithromycin, antiretroviarl prophylaxis for HIV on case by case basis, psychological support
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What is overactive bladder
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involunatary contraction of hte detrusor muscle r/t in urinary frequency 8 or more visits to toilet in 24 hours, nocturis - 2 or more viists to BR during sleeping hours, 2) urgency - sudden strong desire to urinate (often when going from sitting to standing position) 3) urge incontinence: sudden and involuntary loss of urine
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When does stress incontenence occur?
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When bladder pressure overcomes uretheral pressure
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What is normal post void urine residule?
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100 cc
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Incontenince always symptom of other rmedical problem
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injury, menopause, fall, medication, weak muscles,
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What to ask women with incontenence History
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many ignore s/s, or try to hide problem, ask of s/s, nocturia, urgency adn frequency. Ask medical/surgical hx, hx of falls, accident (Hip or pelvic fx), pelvic trauma, ask about medications (if affect bowel then affects bladder - SSRI's), need urine culture with incontence
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What medications cause baldder problems
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diuretics, hypnotics, tricyclics, alpha blocker (stress incontenence), alpha agonists, laxativs, SSRI, pain meds, psychotropic meds
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History of incontenence S/S
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When symptoms start, did anything happen to initiate the s/s, describe symptoms, describe predictors
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What is bulbocavernosus reflex
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tap on clitors and see if anus twitches (women who could not do kegal exercises with instructions)
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What is Anal wink reflex
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lithotomy position. stoke anus at 10 and 2pm and should see contraction of anus (help show if pelvic flow working)
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What foods influence urinary problems?
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caffeine, carbonated beverages, chocolate, tomatoes, spicy foods, dairy, alcohol (CNS depressant relaxes pelvic floor)
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What is a bladder drill
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use timed voiding schedules, do kegel exercises to relax bladder
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Shoudl a pt with neg leukocytes and nitrites have a urine culture
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yes.This test has lots of false negatives
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What are risk factors for UTI'sin premenopausal women
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• History of urinary tract infection
• Frequent or recent sexual activity • Diaphragm contraception use • Use of spermicidal agents • Increasing parity • Diabetes mellitus • Obesity • Sickle cell trait • Anatomic congenital abnormalities • Urinary tract calculi • Neurologic disorders or medical conditions requiring indwelling or repetitive bladder catheterization |
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What are risk factors for UTI's in postmenopausal women?
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• Vaginal atrophy
• Incomplete bladder emptying • Poor perineal hygiene • Rectocele, cystocele, urethrocele, or uterovaginal prolapse • Lifetime history of urinary tract infection • Type 1 diabetes mellitus |
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What cheapest & best antibiotic for UTI
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trimethoprim -sulfamethoxazole - studies shown that 3 days of treatment just as good as 7-10days
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Can pyleonephritis be treated outpatient?
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yes
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when is a urine culture necessary
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not with initual lower UTI if no clinicial improvment with treatment then do a culture
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How to treat uncomplicated acute pyelonephritis
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IV fluids and oral antibiotics can treat outpatient after fluids, need urine culture
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HOw to prevent UTI's in women with recurrent infections?
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prophylactic or intermittant antibiotics. Things that have NOT shown to help with prevention: aggresive hydration, post coital voiding, douching or wiping techniques
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How does cranberry juice help with UTI
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proanthocyanidin-
inhibiting attachment of urinary pathogens to the urinary tract epithelial cells |
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When to treat asymptomatic bacteriuria?
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pregnancy, surgery or women who had indwelling catherter and bacteriuria persists after 48 hours
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What are hte 5 "P's" when asking about sexual history?
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Partners, Prevention of Pregnancy, Protection from STDs, Practices, and Past History of STDs
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What STDS are normally seen in somone who has been assualted?
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Trichomoniasis, BV, gonorrhea, and chlamydial
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How to treat a sexual assault victom?
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HBV vaccine, STD treatment, counseling, Give 1 time antibiotic treatments, f/u visits are poor so treat., give emergency contraception if could be pregnant
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