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64 Cards in this Set
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Health History
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*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 |
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Physical Assessment
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baseline lab work, v/s, head-to-toe assessment
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Screening procedures
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*CBC - UA
*BSE (1/2 of women do own self exam) *Clinical Breast Exam *Mammogram *Vulvar Exam *pelvic exam *pap test *rectal exam |
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Clinical Breast Exam
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*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 |
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Mammogram
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*Mammograms q 2 yrs and then yearly after 45-50
*at risk groups (family Hx of Breast Ca) should have by 35 |
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Vulvar Exam
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*done q month over the age of 18
*lesions, moles, bumps, discharge |
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Pelvic Exam
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*not done while on menses
*s/b done 2 weeks after menses |
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Pap Test
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*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 |
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Rectal Exam
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*examining for hemmorhoids & examining the sphincters
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Primary Amenorrhea
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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) |
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Secondary Amenorrhea
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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) |
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primary dysmenorrhea
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*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 |
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secondary dysmenorrhea
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*S/S: pain associated w/reproductive tract
*Causes: endometritis, uterine displacement, fibroids, PID, ovarian cysts *TX: surgery, Vits B & E, heat & exercise |
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Dysfunctional uterine bleeding
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*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. |
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Menorrhagia
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excessive bleeding at the time of menstrual flow
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metromenorrhagia
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*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 |
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PMS
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*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) |
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PMS Symptoms
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*Cyclic, reoccurring
*must be severe enough to impact life, work, relationships *Dx based on woman's perspective |
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Menopause - Physiological changes
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*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 |
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Menopause Tx
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HRT or ERT
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Osteoporosis
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*reduced bone density, leaves bones fragile & susceptible to fractures mainly in postmenopausal women
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Osteoporosis S/S
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back pain
"silent thief" hump back widow's hump loss of height vertebral collapse |
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Osteoporosis Dx
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bone scan or bone density tests
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Osteoporosis Tx
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**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) |
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Hormone Replacement Therapy
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Estrogen with/without Progesterone
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HRT Benefits
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*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) |
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HRT Risks
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*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 |
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Fibrocystic Breast Changes
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**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 |
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Fibroadenoma
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*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 |
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Intraductal Papilloma
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*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 |
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Ductal Ectasia
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*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). |
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Diagnostic evaluation of breast disorders
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*benign or malignant?
*mammogram (not effective in younger women b/c their tissue is more dense) *US - shows fluid filled areas better *Biopsy |
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Biopsy
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1. Fine needle - fluid & small tissue
2. Core needle - core tissue, cylinder of tissue 3. Open or surgical - removal of the lumps |
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Benign Breast Disorders
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1. Fibrocystic Breast Changes
2. Fibroadenoma 3. Intraductal papilloma 4. ductal ectasia |
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Symptoms of malignant breast disorders
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dimpling
retraction changes in skin/shape painless **US/mammograms will show before palpation will |
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Staging of malignant breast d/o
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Stage 1 - small tumor without lumphatic involvement or metastases
Stage 2 - spread to lymph nodes & metastises to other organs |
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Tx for malignant breast d/o
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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 |
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Breast reconstruction
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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 |
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Psychosocial consequences of breast d/o
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stress
concerns fears *all r/t to the lack of breasts & possible death |
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Endometriosis
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*Presence of endometrial tissue outside the endometrial cavity - most common in pelvis
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Endometriosis S/S
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Pelvis pain
dusparenunia abnormal uterine bleeding painful intercourse |
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Endometriosis TX
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**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. |
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Ovarian Cysts
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*70-80% are benign, no relationship with ovarian cancer
*DX: made by palpable mass with/without tenderness |
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Ovarian Cyst S/S
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may be asymptomatic
fullness cramping dysparenunia irregular bleeding delayed menses |
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Ovarian Cyst TX
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*Observe for 1-2 months or prescribe O.C's or laparascopy is done if they do not go away
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Uterine Leiomyomas (fibroids)
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*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 |
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Uterine Leiomyomas S/S
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may be asymptomatic
lower abdominal pain fullness increased dysmenorrhea with large tumors |
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Uterine Leiomyomas Tx
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removal of the tumor
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Benign Reproductive D/O
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Ovarian Cysts
Uterine Leiomyomas |
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Symptoms of Malignant Reproductive d/o
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*risks increase with age
*no symptoms in ovarian cancer until it is done |
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Malignant Reproductive Disorder Dx
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screening tests
>pap smear >US Serum tests |
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Malignant Reproductive Disorder Tx
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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 |
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Pelvic Floor Dysfunction
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**Cause: muscles, ligaments, fascia that support pelvic organs becomes damaged or weakened; allowing pelvic organs to prolapse into & sometimes out of vagina
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Vaginal Wall Prolapse
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**Anterior or Posterior
*Cystocele *Enterocele *Rectocele |
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Cystocele
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*bladder protrudes downward into vagina
*women are more prone to bladder infections & uterine prolapsed incontinence |
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Enterocele
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prolapse of upper posterior vaginal wall between vagina and rectum
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Rectocele
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*posterior wall of vagina becomes weakened & thin
**probs with constipation, hemmorhoids, infections |
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Uterine Prolapse
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**ligaments that support uterus & vagina are stretched during PG & do not return to normal
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S/S of uterine prolapse
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*pelvic fullness
*dragging sensation *pelvic pressure *fatigue *low bachache |
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uterine prolapse Tx
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*vaginal hysterectomy & tack bladder into place
*anterior or posterior colporrhaphy for cystocele |
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Nursing considerations for uterine prolapse
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1. pelvic exercises
2. urinary incontinence (stress, urge, & mixed) |
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Total Abdominal Hysterectomy (TAH)
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removal of the uterus
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bilateral salpingo oophorectomy (BSO)
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removal of both fallopian tubes & ovaries
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TVH
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total vaginal hysterectomy
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