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42 Cards in this Set

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Dysmenorrhea
painful menstruation
Can be primary or secondary
Dysmenorrhea
* Primary: no associated pathology, but can be associated with abnormally high levels of prostaglandins, poor hygiene, anxiety related to menstruation
* Secondary: pelvic disease present.
Common causes:
endometriosis, cervical os stenosis, fibroids, cancer
Menorrhagia
abnormally heavy menstrual flow, greater than 80cc per menses
Leukorrhea
any vaginal discharge than blood- often a symptom of vaginal or cervical infection
Endometrosis medical management
mild analgesics, NSAIDS, OCPs
Comfort measures: heating pads, relaxation, biofeedback
Menstruation
* Bleeding occurs in response to hormonal changes
* Average interval between cycles is 28 days (can range from 23-35 days)
* Average duration of flow is 2-7 days
* Average blood loss is 30-80cc
* Requires intact hypothalamus, pituitary gland, ovaries, and uterus
Amenorrhea
* Defined absence of menstrual flow
* What is the most common cause????
* Other causes: anxiety, fatigue, chronic illness, extreme dieting, strenuous exercise
Metorrhagia
bleeding between menstrual periods
Endometriosis
* Defined as abnormal growth of extra uterine endometrial cells, often in cul-de-sac of peritoneal cavity, the uterine ligaments, and the ovaries
* Results from excessive endometrial production and reflux of blood and tissue through the fallopian tubes during menstrual flow
* Causes intense pain
* Can lead to infertility
* Can lead to painful intercourse
* Treatment can be medical or surgical
Premenstrual Syndrome
* Symptoms occur during the luteal phase of menstrual cycle
* Affects women of all races, socioeconomic levels, and all educational levels
* Most common in 30-40 year olds
* Severity increases with age until menopause
PMS Emotional symptoms
irritability, easily induced crying spells, low self esteem, anxiety, and depression
PMS Risk factors
after pregnancy, childbirth, and tubal ligation; perimenopausal years, and during major life stresses
PMS Physical symptoms
breast tenderness, bloating, fluid retention, increased appetite and food cravings, insomnia, fatigue, hot flashes, headaches, and musculoskeletal discomfort
PMS Cognitive symptoms
short term memory problems, difficulty concentrating, and unclear thinking
PMS treatment
* Diet: eliminate caffeine; limit sodium intake
* Medications (most are controversial)
mild K+ sparing diuretics, progesterone, Parlodel, OCPs, antidepressants, prostaglandin inhibitors, and NSAIDS
Menopause
* Refers to the last menstrual period- the actual date cannot be determined until one year passes without menses
* FSH and LH levels increase
* Decreased estrogen levels affect the reproductive system, CV system, and bone density
Effects of Menopause
* Reproductive system: uterus, cervix, ovaries, labia, and clitoris shrink in size; vaginal mucosa becomes thin and dry; pelvic floor relaxes
* Bone density decreases, leading to osteoporosis
* During perimenopausal phase: hot flashes, emotional changes, and fatigue
Cervical Cancer
* Pap smears have decreased the death rate from cervical CA, because of the ability to detect pre-malignant changes
* Risk factors: low socioeconomic status, early age of 1st intercourse or 1st pregnancy, intrauterine exposure to DES, cigarette smoking, exposure to HSV/ cytomegalovirus, and HPV
* Classic symptom: painless vaginal bleeding (starts as spotting between menstrual periods or after sex– as malignancy grows, the bleeding increases in frequency, duration, and amount)
* Treatment varies on stage of cancer and includes many non-surgical and surgical techniques
Ovarian Cancer
* Leading cause of death from female reproductive malignancies
* Poor early stage detection rates= low survival rates
* Tumors grow and spread rapidly and are often bilateral
Ovarian Cancer Risk Factors
* Family history of ovarian cancer
* History of breast, bowel, or endometrial cancer
* Nulliparity
* Infertility
* History of dysmenorrhea or heavy bleeding
* Diets high in animal fat
* Age older than 40- peaks at age 50-55
Ovarian cancer symptoms
* abdominal pain or swelling; dyspepsia, indigestion, gas
* Hx of: ovarian imbalance AEB premenstrual tension, heavy menstrual flow, or dysfunctional bleeding
* The only sign may be an abdominal mass- may not be identifiable until size reaches 6 inches
* Pap only abnormal in 20-30%
* CA-125 may be elevated (not diagnostic- used to eval progress)
* USG and CT can be diagnostic tools
* Exploratory laparotomy used to dx and stage tumors
Treatment of Ovarian Cancer
* Similar to cervical cancer
* Tx depends on stage of cancer
* Chemotherapy
* Radiation
* Surgery
Breast Cancer
* Early detection is paramount to successful treatment
* If cancer is localized without metastasis, clinical cure rate 75-90%
* When axillary lymph nodes are involved, 5year survival rate 40-50% & 10year rate only 25%
Early detection methods
* Self breast exam needs to be done monthly in women over 20
* Mammography- begin age 40, then annually
* Yearly clinical breast exam- assess for symmetry and size, contour, skin changes (color, texture, venous patterns), nipple changes, and lesions; also assess axillary lymph nodes
Assessment of Breast Cancer
* Note location of mass (in clock face method), shape, size, consistency, and fixation to surrounding tissues
* Skin changes: peau d’ orange (dimpling or orange peel appearance), increased vascularity, nipple retraction or ulceration
* Psychosocial: fear of cancer; threats to body image, sexuality, intimate relationships, and survival; and decisional conflict about treatment
Treatment of Breast Cancer
* Nonsurgical (rarely done alone, except in inoperable cases): chemotherapy, radiation
* Surgical
1. Lumpectomy: local excision and resection
2. Partial mastectomy: removal of portion of breast that contains the tumor
3. Modified radical mastectomy: entire affected breast is removed (pectoral muscles and nerves left intact)
Benign Prostatic Hypertrophy
* Occurs in almost all men with aging
* Prostate tissue begins to have abnormal increase in number of cells which leads to enlargement of the gland
* Leads to narrowing of prostatic urethral channel
Symptoms of BPH
* Urinary frequency
* Nocturia
* Urinary hesitancy
* Hematuria
* Diminished force of urinary stream
* Post-void dribbling
* Bladder distention
* Possible renal insufficiency (edema, pallor, pruritis)
* Uniform, elastic, nontender palpable prostate
BPH Laboratory assessment
* CBC (infection or anemia)
* BUN & serum creatinine (eval renal function)
* Prostate specific antigen (PSA) to rule out malignancy
* Flowmetry- evaluates flow rate and residual urine
BPH Interventions
* Pharmacologic
1. finasteride (Proscar) shrinks prostate gland and improves urine flow by decreasing the level of dihydrotestosterone (DHT), which is responsible for prostate growth
2. alpha-adrenergic agonists (Cardura & Flomax) cause constriction of prostate gland, which urethral pressure, improves urine flow, and decreases residual mass
BPH Interventions
* Nonsurgical measures that minimize obstructive symptoms, by causing a release of prostatic fluid (prostatic massage, frequent sexual intercourse, and masturbation)
* Avoid large amounts of fluid in a short time
* Avoid alcohol, caffeine, and diuretics
* Void as soon as urge is felt
***Prevent overdistention of bladder, which leads to loss of tone
***Avoid meds that cause urinary retention: anticholinergics, antihistamines, and decongestants
Operative interventions
* Most common is transurethral resection of the prostate (TURP) to relieve obstruction caused by hypertrophy- only removes part of the enlarged prostate
Prostate Cancer
* Most common cancer among American men; second leading cause of cancer deaths in this population
* Screening is done with digital rectal exam (DRE) and PSA--annually after age 50
* If at risk (prostate CA in 1st degree relative or African American), need screening earlier
* DRE yields hard, irregular prostate
PSA
* Immunogenic glycoprotein secreted by the prostate
* Normal level is 4ng/mL
* Levels can be increased by prostate CA, BPH, prostatic infarction, and prostatitis
* PSA needs to be done in combination with DRE (25% of men with prostate CA have normal PSA)
Menarche
First menstrual period
Average age of onset 12 to 13 years old
Can range from 9-17 years old and still be within normal limits
Often anovulatory
Prostate Cancer screening
* Transrectal USG
* If malignancy suspected, need biopsy
* After dx made, need CT of pelvis to assess nodes
* Bone scan can determine metastasis
* Most pts with prostate CA have elevated serum acid phosphatase; and elevated serum alkaline phosphatase if mets to bone
Prostate Cancer Interventions
* Many similar to BPH
* Advanced cases require pelvic lymphadenectomy
* Radical Prostatectomy- removal of prostate gland, prostatic capsule, the cuff at the bladder neck, seminal vesicles, and regional lymph nodes
Radical Prostatectomy
* Patient is sterile, but ability to have erection and orgasm shouldn’t be permanently impaired
* May have erectile dysfunction if damage is done to pudendal nerve during surgery
* Urinary incontinence possible complication- need to learn perineal strengthening exercises after surgery and removal of foley
Prostate Cancer treatments
* Chemotherapy
* Radiation
* Hormonal therapies- can be accomplished by bilateral testicle removal, administering estrogens, or Depo-Provera
Erectile Dysfunction
* Inability to maintain an erection for sexual intercourse
* Can be organic or functional
Organic ED
* Gradual deterioration of function- first diminishing firmness, then decrease in frequency of erections
* Multiple causes: inflammation of prostate, urethra, or seminal vesicles; prostate surgeries; pelvic fx; HTN; DM; thyroid dysfunction; smoking; ETOH; certain medications
Functional ED
* Psychologic cause
* Have normal nocturnal and morning erections
* Usually precipitated by stress
ED Pharmacologic Treatment
Viagra can be used to treat both types of ED
-take the pill 1 hour before intercourse
-need stimulation to achieve erection
-must abstain from alcohol- can impair erectile ability
-common SE: HA, facial flushing, diarrhea
-men taking nitrates cannot take Viagra because of vasodilatation effects
Testicular Cancer
* Most common malignancy in men ages 15-35
* Risk is increased in men with undescended testes; having a brother or close male relative with testicular CA; hx of testicular trauma or infection
* Testicular CA rarely bilateral- if it is, usually metastatic
* Early detection aided by self exam
Diagnostic Assessment
* Primary tumor markers are alpha-fetoprotein and hCG
* Benign testicular tumors NEVER cause an increase in these markers
Patient education
* May wish to store sperm in sperm bank to preserve for future use
* Insurance may cover these expenses
* Also need counseling regarding anxiety and body image disturbances
* May be candidate for silicone prosthesis
* Need monthly TSE on remaining testicle
Estrogens inhibit the release of LH from the pituitary
*