Women's Health Care

Front 1

Health History

Back 1

*Personal Hx - demographics, etc
*Menstrual Hx - what are cycles like, how long, pain, light/heavy, when did menopause occur, when did menses become irregular
*Obstetric Hx - Gravidas? Ectopic or living kids, Cerclage? (sew cervix shut )
*Sexual Hx - STD's? multiple partners?
*Family Hx - ask questions about lifestyle, Hx of med probs in family?
*Psychosocial Hx - marital status, educational background, employment, support system

Front 2

Physical Assessment

Back 2

baseline lab work, v/s, head-to-toe assessment

Front 3

Screening procedures

Back 3

*CBC - UA
*BSE (1/2 of women do own self exam)
*Clinical Breast Exam
*Mammogram
*Vulvar Exam
*pelvic exam
*pap test
*rectal exam

Front 4

Clinical Breast Exam

Back 4

*done every 3 years (20-39), yearly after 40
*any abnormal finding s/b described as a raisin, watermelon seed, or grape -nurse should document it by size & shape.
*Discharge of nipple when there is no lactaction can be indicative of Cancer
**Inspection: size, symmetry, color & skin changes
**Palpation: palpate lymph nodes

Front 5

Mammogram

Back 5

*Mammograms q 2 yrs and then yearly after 45-50
*at risk groups (family Hx of Breast Ca) should have by 35

Front 6

Vulvar Exam

Back 6

*done q month over the age of 18
*lesions, moles, bumps, discharge

Front 7

Pelvic Exam

Back 7

*not done while on menses
*s/b done 2 weeks after menses

Front 8

Pap Test

Back 8

*speculum should be warmed and should be the right size (virgin=small)
*vaginal blade inserted & opened to view cervix. Cyto brush (or spatula thing) used to get sample, place on slide, spray w/fixative & send to lab.
**NEVER USE A LUBRICANT
*manual exam can be done afterwards
**Test for abnormal cells - if present, then a biopsy will be done

Front 9

Rectal Exam

Back 9

*examining for hemmorhoids & examining the sphincters

Front 10

Primary Amenorrhea

Back 10

Cause: Turners Syndrome, incomplete dev of uterus/ovaries/fallopian tubes, hormonal imbalances, strenuous exercise, malnutrition, eating d/o
TX: counseling, psychological support
**if onset has not occurred by age 16 then suspect primary (breast development & puberty, then suspect primary amenorrhea)

Front 11

Secondary Amenorrhea

Back 11

Cause: systemic disease, hormonal imbalances, strenuous exercise, birth control, ovarian tumors, lactation, stress, PG
TX: ID and correct cause, PG test, hormone levels
**periods have stopped for 3 mos or have not had a normal period for 6 mos - do PG test, check hormones (consider woman's fears-PG, cancer, infertility)

Front 12

primary dysmenorrhea

Back 12

*S/S: pain/cramps w/o underlying disease
*Causes: endometrial prostaglandins - uterine muscle contractions or ischemia due to the lack of blood flow
*TX: birth control, naproxen (aleve), ibuprofen

Front 13

secondary dysmenorrhea

Back 13

*S/S: pain associated w/reproductive tract
*Causes: endometritis, uterine displacement, fibroids, PID, ovarian cysts
*TX: surgery, Vits B & E, heat & exercise

Front 14

Dysfunctional uterine bleeding

Back 14

*Menorrhagia & Metromenorrhagia
*PG complications (spont abs), anatomic lesions (benign or malignant) of the vagina, cervix, or uterus; drug-induced bleeding, breakthrough bleeding with birth control pills; systemic d/o (DM, uterine fibroids, hypothyroidism); failure to ovulate
*TX: Pg test, coagulation studies, hormone/liver function studies, US, hormone Tx, birth control pills
*Hysterectomy would be last option.

Front 15

Menorrhagia

Back 15

excessive bleeding at the time of menstrual flow

Front 16

metromenorrhagia

Back 16

*bleeding from the uterus at anytime other than the time of menses.
****any vaginal bleeding in a woman past menopause is BAD and should be reported to MD immediately

Front 17

PMS

Back 17

*Cause unknown (thought to be an imbalance b/t estrogen & progesterone just before menses)
*TX: hormones (birth control), anti-depressants (prozac, zoloft, paxil) OR diet (reduce caffeine for breast symptoms; calcium, Mg, B6 for mood symptoms)

Front 18

PMS Symptoms

Back 18

*Cyclic, reoccurring
*must be severe enough to impact life, work, relationships
*Dx based on woman's perspective

Front 19

Menopause - Physiological changes

Back 19

*End of menses
*atrophy of ovaries occurs gradually - uterus & labia are thinner,more susceptible to vaginal/bladder infections, breasts shrink.
*FSH rises - in response to fewer periods
*Estrogen decreases
*Ovulation is sporadic
*Menstrual periods are irregular
*Hot flashes

Front 20

Menopause Tx

Back 20

HRT or ERT

Front 21

Osteoporosis

Back 21

*reduced bone density, leaves bones fragile & susceptible to fractures mainly in postmenopausal women

Front 22

Osteoporosis S/S

Back 22

back pain
"silent thief"
hump back
widow's hump
loss of height
vertebral collapse

Front 23

Osteoporosis Dx

Back 23

bone scan or bone density tests

Front 24

Osteoporosis Tx

Back 24

**Goal is to prevent/slow & stabilize remaining bone mass
*Drug Therapy - fosamax, actonel, evista, boniva
*Calcium & Vitamin D - 50+ needs 1200 mg/day; 65+ needs 1500 mg/day; must have Vit D to absorb Calcium
*Exercise - weight bearing, no high impact (dancing, hiking, weights)

Front 25

Hormone Replacement Therapy

Back 25

Estrogen with/without Progesterone

Front 26

HRT Benefits

Back 26

*aids in hot flashes, uninterrupted sleep, vaginal dryness
*effective in preventing osteoporosis
***if woman still has uterus, cannot have estrogen alone (Provera has both E & P)

Front 27

HRT Risks

Back 27

*long term use
*increased risk of breast CA & heart disease
*Contraindicated for people with:
>>Hx of cancer
>>rental disease
>>liver
>>cardiovascular (blood coagulation d/o)
>>DM
>>smokers
>>Hx of stroke

Front 28

Fibrocystic Breast Changes

Back 28

**fibrosis (early stage=thickening of normal breast tissue; late stage=water filled cysts that are not hard or fixed to wall, tender & movable)
**Caused by an imbalance in estrogen & progesterone
**affects women more as they approach menopause
**TX: NSAIDS, biopsy if Hx of CA, limit caffeine

Front 29

Fibroadenoma

Back 29

*Benign tumor in teen or women in 20s
*firm rubbery mobile nodules
*non tender & asymptomatic
*TX: Observation; if persistent then fine needle aspiration or excisional biopsy

Front 30

Intraductal Papilloma

Back 30

*more common in menopausal women
*typically benign but can become malignant
*develops in terminal portion of duct
*causes trauma & erosion in ducts & results in nipple discharge
*TX: excision of mass & ductal area, analysis of nipple discharge

Front 31

Ductal Ectasia

Back 31

*Dilation of collecting ducts, inflammation response, reults in mass (firm & irregular, enlarged axillary nodes, nipple retraction, nipple d/c, painful)
*S/S: similar to breast CA
*occurs in women approaching menopause
*TX: Biopsy (once performed & indicates duct ectasia, no further Tx is necessary).

Front 32

Diagnostic evaluation of breast disorders

Back 32

*benign or malignant?
*mammogram (not effective in younger women b/c their tissue is more dense)
*US - shows fluid filled areas better
*Biopsy

Front 33

Biopsy

Back 33

1. Fine needle - fluid & small tissue
2. Core needle - core tissue, cylinder of tissue
3. Open or surgical - removal of the lumps

Front 34

Benign Breast Disorders

Back 34

1. Fibrocystic Breast Changes
2. Fibroadenoma
3. Intraductal papilloma
4. ductal ectasia

Front 35

Symptoms of malignant breast disorders

Back 35

dimpling
retraction
changes in skin/shape
painless
**US/mammograms will show before palpation will

Front 36

Staging of malignant breast d/o

Back 36

Stage 1 - small tumor without lumphatic involvement or metastases

Stage 2 - spread to lymph nodes & metastises to other organs

Front 37

Tx for malignant breast d/o

Back 37

1. Surgical Tx
>>breast conservation surgery
>>lumpectomy - take out malignant tissue
>>quadrantectomy - removal of the whole section
>>simple mastectomy - remove breasts but not nodes
>>modified radical mastectomy - remove nodes/breast/muscle

2. Adjuvant Therapy
>>radiation therapy
>>chemotherapy
>>hormonal therapy - tamoxifen - blocks estrogen & binds estrogen receptors
>>immunotherapy

Front 38

Breast reconstruction

Back 38

1. Timing (may be done at the same time or afterwards)
2. Methods
>>tissue expansion method - put expanders into the tissue
>>tissue flap procedure - breast replacement w/nipple reconstruction
>>nipple/areola reconstruction

Front 39

Psychosocial consequences of breast d/o

Back 39

stress
concerns
fears
*all r/t to the lack of breasts & possible death

Front 40

Endometriosis

Back 40

*Presence of endometrial tissue outside the endometrial cavity - most common in pelvis

Front 41

Endometriosis S/S

Back 41

Pelvis pain
dusparenunia
abnormal uterine bleeding
painful intercourse

Front 42

Endometriosis TX

Back 42

**Medical - birth control, depo-provera, micronor (used for 3-6 months)
**Surgical - if medical Tx doesn't work; lysis of adhesions (laparascope); hysterectomy is last chance tx.

Front 43

Ovarian Cysts

Back 43

*70-80% are benign, no relationship with ovarian cancer
*DX: made by palpable mass with/without tenderness

Front 44

Ovarian Cyst S/S

Back 44

may be asymptomatic
fullness
cramping
dysparenunia
irregular bleeding
delayed menses

Front 45

Ovarian Cyst TX

Back 45

*Observe for 1-2 months or prescribe O.C's or laparascopy is done if they do not go away

Front 46

Uterine Leiomyomas (fibroids)

Back 46

*CA potential is minimal
*vary in size from 1-2 cm to 10 week fetus
*DX: US reveals mass; observe for increase in size; pelvic exam every 3-6 mos

Front 47

Uterine Leiomyomas S/S

Back 47

may be asymptomatic
lower abdominal pain
fullness
increased dysmenorrhea with large tumors

Front 48

Uterine Leiomyomas Tx

Back 48

removal of the tumor

Front 49

Benign Reproductive D/O

Back 49

Ovarian Cysts
Uterine Leiomyomas

Front 50

Symptoms of Malignant Reproductive d/o

Back 50

*risks increase with age
*no symptoms in ovarian cancer until it is done

Front 51

Malignant Reproductive Disorder Dx

Back 51

screening tests
>pap smear
>US
Serum tests

Front 52

Malignant Reproductive Disorder Tx

Back 52

1. Cervical Cancer
>cryosurgery - destroys abnormal tissue thru lasering
>TAH, chemo, radiation if advanced
2. Endometrial Cancer
>Surgery
>radiation/chemo
3. Ovarian Cancer
>removal of one or both ovaries
>Chemo

Front 53

Pelvic Floor Dysfunction

Back 53

**Cause: muscles, ligaments, fascia that support pelvic organs becomes damaged or weakened; allowing pelvic organs to prolapse into & sometimes out of vagina

Front 54

Vaginal Wall Prolapse

Back 54

**Anterior or Posterior
*Cystocele
*Enterocele
*Rectocele

Front 55

Cystocele

Back 55

*bladder protrudes downward into vagina
*women are more prone to bladder infections & uterine prolapsed incontinence

Front 56

Enterocele

Back 56

prolapse of upper posterior vaginal wall between vagina and rectum

Front 57

Rectocele

Back 57

*posterior wall of vagina becomes weakened & thin
**probs with constipation, hemmorhoids, infections

Front 58

Uterine Prolapse

Back 58

**ligaments that support uterus & vagina are stretched during PG & do not return to normal

Front 59

S/S of uterine prolapse

Back 59

*pelvic fullness
*dragging sensation
*pelvic pressure
*fatigue
*low bachache

Front 60

uterine prolapse Tx

Back 60

*vaginal hysterectomy & tack bladder into place
*anterior or posterior colporrhaphy for cystocele

Front 61

Nursing considerations for uterine prolapse

Back 61

1. pelvic exercises
2. urinary incontinence (stress, urge, & mixed)

Front 62

Total Abdominal Hysterectomy (TAH)

Back 62

removal of the uterus

Front 63

bilateral salpingo oophorectomy (BSO)

Back 63

removal of both fallopian tubes & ovaries

Front 64

TVH

Back 64

total vaginal hysterectomy