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128 Cards in this Set

  • Front
  • Back
Dysmenorrhea
painful menstrual flow
pathogenesis of dysmenorrhea
decrease uterine blood flow
increase contractility
peripheral nerve hypersensitivity
Primary dysmenorrhea
cramps without underlying disease
treatment of primary dysmenorrhea
treat symptoms:
narcotics and sedatives
contraceptives
NSAIDS-ibuprofen
heat
exercises and massage help with cramps
diagnosis of primary dysmenorrhea
sx immediately before or at onset of menstrual bleeding
pain not present at other times of the cycle
most severe on first and/or second day of menses
OTC NSAIDS and dysmenorrhea
use preventative dose of NSAIDS
strong loading does
maintanence dose routinely
How oral contraceptives improve primary dysmenorrhea
by inhibiting ovulation, progesterone-stimulating endometrial prostaglandin production is reduced
by reducing menstrual flow, which contains prostaglandins
cause of Secondary dysmenorrhea
associated with underlying disease:
pelvic inflammatory disease
endometriosis
others
characteristics of secondary dysmenorrhea
low anterior-pelvic pain
may begin before onset of menses and last through the end of menstration
may be noncyclic
may be accompanied by pelvic tenderness or a pelvic mass
treatment of secondary dysmenorrhea
find the cause and treat cause
Premenstrual Syndrome (PMS)
collection of symptoms that are cyclic (emotional behavioral and somatic
occur at luteal phase or menstrual cycle
20-40% have severe symptoms
PMS treatment
symptomatic:
limit sodium for bloating
diuretics, eliminate caffeine
support groups
PMS occurs more often in women who:
are between their late 20's and early 40's
have atleast one child
family history of depression
Major life crisis
Life style changes that may help PMS
take a multivitamin that includes 400 micrograms of folic acid
exercise regularly
eat healthy foods
avoid salty, sugary foods, caffeine and alcohol
try to get 8 hrs of sleep each night
find healthy ways to cope with stress
don't smoke
Amenorrhea
absence of menstrual periods
primary and secondary
primary amenorrhea
menstration fails to occur by age 16
Does she have pubic hair?
secondary amenorrhea
menstraton started, but stopped without recurrence for atleast 3 months
must rule out pregnancy
possibly from weight gain/loss, exercise, stress
Post menopausal bleeding
vaginal bleeding occurring after menopause
1st thought- cancer?
treatment of post menopausal bleeding
endometrial biopsy, D and C, hysterectomy, progesterone with estrogen
endometriosis
symptoms of underlying cause
implantation of endometrial tissue outside the uterine cavity: benign
can be planted outside the uterine body
symptoms of endometriosis
pain-starting several days before period
pain during intercourse (dyspareunia)
goes away with period
common sites of endometriosis
uterine sacral ligaments
increase incidence of infertility
Treatment of endometriosis
analgesics, heating pad, oral contraceptives- suppress estrogen, laser treatment, and/or hysterectomy
dysfunctional uterine bleeding (DUB)
bleeding that is excessive or abnormal in amount or frequency
bleeding throughout month
medical treatment of (DUB)
depo-provera, oral contraceptives
surgical treatment of (DUB)
D & C, laser endometrial, ablation, hysterectomy
anovulatory DUB during reproductive years
endocrine disturbances
polycystic ovary disease
stress
obesity or underweight
long term drug use
anatomic abnormalities
ovulatory causes of DUB
Rare
related to dysfunctional corpus luteum
polycystic ovarian syndrome (PCOS)
most common hormonal disorder of woman of reproductive age
ovaries often enlarged, containing small cysts outer edge of ovary
PCOS manifestations
menstrual abnormality
excessive androgen
acne
polycistic ovaries
obesity
infertility
often heavy, facial hair, diabetic possibly
PCOS treatment
life style changes
regular menstrual cycle
reduce glucose levels
reduce excessive hair growth
use meds to induce ovulation
possible surgery
Menopause
normal biologic event for woman
marked by the end of menstrual periods
Marked by 6-12 months of amenorrhea
event really takes months or years
menopause management
hormonal replacement therapy
HRT (Hormonal Replacement Therapy) combination of estrogen and progestin
HRT previously thought to avoid problems with osteoporosis, coronary heart disease, breast and endometrial cancer (wrong)
Menopause problems
osteoporosis esp. in petite women, increase numbers of coronary artery disease, breast cancer, endometrial cancer, vaginal dryness
treatment of menopause
need to weigh risk of HRT with benefits
estrogen available as oral, transdermal, intravaginal, and IM preparations
Herbal therapy
increase soy diet, decrease problems
Simple vaginitis
inflammation of the vagina
very common
yeast infection
causes of vaginitis
changes in normal flora
alkaline ph
insertion of foreign bodies
chemical irritants
medications
bacterial
STDS
preventative measures of simple vaginitis
wipe front to back
cotton
no douching
no tight pants
Bacterial vaginitis
heampohilus vaginitis- most common cause
cause unknown
associated with preterm labor and birth
Symptoms of bacterial vaginitis
fishy odor
not all have odor-most apparent after sex
discharge- profuse, white, gray, milky
PCOS treatment
life style changes
regular menstrual cycle
reduce glucose levels
reduce excessive hair growth
use meds to induce ovulation
possible surgery
Menopause
normal biologic event for woman
marked by the end of menstrual periods
Marked by 6-12 months of amenorrhea
event really takes months or years
menopause management
hormonal replacement therapy
HRT (Hormonal Replacement Therapy) combination of estrogen and progestin
HRT previously thought to avoid problems with osteoporosis, coronary heart disease, breast and endometrial cancer (wrong)
Menopause problems
osteoporosis esp. in petite women, increase numbers of coronary artery disease, breast cancer, endometrial cancer, vaginal dryness
treatment of menopause
need to weigh risk of HRT with benefits
estrogen available as oral, transdermal, intravaginal, and IM preparations
Herbal therapy
increase soy diet, decrease problems
Simple vaginitis
inflammation of the vagina
very common
yeast infection
causes of vaginitis
changes in normal flora
alkaline ph
insertion of foreign bodies
chemical irritants
medications
bacterial
STDS
preventative measures of simple vaginitis
wipe front to back
cotton
no douching
no tight pants
Bacterial vaginitis
heampohilus vaginitis- most common cause
cause unknown
associated with preterm labor and birth
Symptoms of bacterial vaginitis
fishy odor
not all have odor-most apparent after sex
discharge- profuse, white, gray, milky
bacterial vaginitis
heamphilus vaginitis
most common cause
assoc. with preterm labor and birth
symptoms of bacterial vaginitis
fishy odor
not all have odor
odor must apparent after sex
discharge-profuse, white, gray, milky
candidasis
yeast infection
caused by candida albincans- 80-95% of yeast infections caused by this organism
cheasy spotty looking cervix
risk factors of candidasis
antibiotic therapy
diabetes
obesity
diets in high sugar/artificial sweeteners
steriods
immunosuppressed states
tight fitting clothing
non absorbent underwear
vulvitis
inflammation of the vulva
causes: direct or by extension of irritation from vagina to vulva
symptoms of vulvitis
itching and pruritis, burning during urination
treatment of vulvitis
methods to reduce itching
Toxic Shock Syndrome
systemic infection caused by the toxin of staph aureus
causes of toxic shock syndrome
menstruation and tampon use, nose packing, surgical wound infection, pastpartum conditions, diaphragm, cervical cap and vaginal contraceptive sponge use
Recommend not using tampon during night
Toxic Shock Symptoms
2-3 period of mild symptoms
low grade fever, muscle aches, chills, malaise
body systems affected by toxic shock
skin, lungs, liver, blood, pancreas
Toxic shock manifestations
atleast 102, rash, HA, sore throat, cough, N/V, perfuse diarrhea, abd. pain, fainting/lightheadedness, low bp <90
treatment of toxic shock
fluid replacement, antibiotics, transfusions if low platelets, corticosteroids, prevention should be taught
uterine displacement
abnormal positioning of the uterine body
uterine prolapse
decent of uterus into vagina
Pessary
placed below cervix to hold in place
treatment of uterine prolapse
knee-chest postition, vaginal pessary, hysterectomy
cystocele
protrusion of bladder through the vaginal wall due to weakened pelvic structures
symptoms of cystocele
painful sex, uti, urinary dysfuntion
treatment of cystocele
anterior repair
Rectocele
prolapse of rectum through a weakened vaginal wall
symptoms of rectocele
constipation, uncomfortable sex
treatment of rectocele
posterior repair
leiomyomas (fibroids)
benign
slow-growing tumors of the uterus
most common pelvic tumor
develop from the uterine myometrium, attatched by a pedicle
classified according to a position in layers of uterus
etiology of leiomyomas
cause unknown
may be related to estrogen simulation
often enlarge during pregnancy and diminish after menopause-due to estrogen
Signs and Symptoms of Leiomyomas
pain- not all have it
pelvic pressure
constipation
urinary frequency or retention
abdominal girth increases
painful intercourse
infertility
Incidence of leiomyomas
occur in 20-30% women older than 30
many women are asymptomatic
african american and premenopausal women are at greatest risk
diagnosis of leiomyomas
cbc
pregnancy test
endometrial biopsy
US
laposcopy
non surgical management of leiomyomas
reassess q4-6 mo- may shrink during menopause
Uterine artery embolization (UAE)- occludes blood flow to tumors
Surgical management of leiomyomas
myomectomy
total abdominal hysterectomy
total vaginal hysterectomy
Pre-op nursing care of hysterectomy
lab tests for baselein
prophylactic antibiotics
teach post-op expectations (turn, cough, deep breath)
explore significance of loss of uterus
identify misconceptions so that they can be dealt with
what happens if ovaries are included in hysterectomy
immediate menopause
post op nursing care of hysterectomy
VS
urinary output (Foley)
assess dressing and drains
assess vag bleeding
monitor po intake and bowel sounds
assess for thrombophlebitis
pain meds
sitz baths, heat or cold
hysterectomy postop complications
paralytic ilius
wound infection
embolism, hemorrhage
atelectasis, pneumonia
UTI, urinary retention
atelectasis
the collapse of part or (much less commonly) all of a lung
Bartholin's cyst
occlusion of the bartholin gland of the vulva
patho of bartholin's cyst
obstruction of the duct of the bartholin gland and fills with fluid
what causes a bartholins cyst
infection, thickened mucus near ductal opening
trauma such as an episiotomy or laceration
Barholin cyst treatment
only if symptomatic
simple incision and drainage may produce temp. relief
infection usually causes rupture spontaneously within 72 hours
moist heat, antibiotics
Endometrial cancer
one of the most commonly occuring reproductive cancers
good prognosis 80-90% of the time
Risks for endometrial cancer
obesity
DM
Hypertension
infertility
nulliparity
polycystic ovary disease
late menopause
history of uterine cancer
symptoms of endometrial cancer
post menopausal bleeding
low back or abdominal pain
low pelvic pain
diagnosis of endometrial cancer
D & C
endometrial biopsy
managment of endometrial cancer
progestational therapy- Tomoxifen
TAH and BSO
or radical hysterectomy
TAH
Total abdominal Hysterectomy
Cervical cancer
abnormal cells develop in lining of cervix
Risk factors of cervical cancer
AA and Native american women
Multiparity- <18 at 1st intercourse
multiple sex parnters
infections- HIV, HPV, CMV, HSV
Prevention of cervical cancer
gardasil vaccine-recomeneded for all femails up to age 26
not recommended for pregnant women
Gardasil vaccine
3 injections usually in deltoid
Dose 1- at choosen date
Dose 2- 2 months later
Dose 3- 6 months after dose 1
symptoms of cervical cancer
Early- no symptoms
Late- vaginal discharge and bleeding
post menopausal bleeding
fistualas
Diagnostics of cervical cancer
PAP smear
cytologic
pelvic exams
PAP smear
recommended at 20 years old or when sexually active
Medical management of cervical cancer
laser therapy
cryosurgery
radiation therapy
chemotherapy
Surgical management of cervical cancer
conization- biopsy of cervix
hysterectomy
pelvic exoneration
pelvic exoneration
very radical procedure
anterior and posterior
total- both
anterior pelvic exoneration
removal of cervix, ovaries, fallopian tube, vagina, bladder, urethra, and pelvic lymph nodes
posterior pelvic exoneration
cervix, ovaries, fallopian tube, vagina, descending colon, rectum and anal canal
ovarian cancer
leading cause of death from female reproductive malignancies
1 out of 70 women will develop
risks of ovarian cancer
family history
nulliparity
increased incidence with menopause
diets high in fats
symptoms of ovarian cancer
asymptomatic in early phase
abdominal distention
urinary urgency and frequency
urinary and bowel obstruction
feeling of being full very quickly
Hint to ovarian cancer
women who have vague abdominal or GI symptoms lasting several weeks
Ovarian cancer diagnosis
palpation of ovary in postmenopausal women
IV urography
transvaginal US
Lab values
definitive diagnosis based on surgical exploration
Lab values that may indicate ovarian cancer, also used for breast cancer
BRCA 1
BRCA 2
CA 125
management of ovarian cancer
chemo and radiation
surgical mangament of ovarian cancer
TAH & BSO
BSO
bilateral salpingo-oophorectomy
the surgical removal of one or both ovaries
post surgical standard of care for TAH and BSO of ovarian cancer
periodic CA125
vaginal US
chest x-ray
non surgical management of ovarian cancer
chemo
monoclonal antibiotics- hormones and agents that target cell growth
external radiation therapy
prevention of Ovarian cancer
maintain normal weight
well balanced diet low in fat, high in fiber
decreased risks- have had children, used contraception for atleast 5 years, and breast fed
Vulvar cancer
primarily disease of older women
slow growing
stays localized for long time
relationship with herpes simplex 2, HPV, and other STD's
Vulvar cancer symptoms
itching and irritation of perineal area
a sore taht won't heal
bleeding-late symptom
management of vulvar cancer
Premalignant- laser therapy (healing for several weeks)
Invasive cancer- surgery, reconstructive surgery
surgical managment of vulvar cancer
skinning vulvectomy- remove superficial skin
simple vulvectomy- removal of vulva
radical vulvectomy- clit, subcu, and lymph nodes
vulvectomy post-op care
multiple drains for 7-10 days
pressure reducing mattress
bed cradle to keep linens off
SCD's
catheter for 7-10 days
Major concern-wound healing and pain management
vaginal cancer
rare
90% menopausal
risks factors for vaginal cancer
repeated vaginal injury (multipara)
STD's
prior radiation
vaginal cancer symptoms
asymptomatic
abnormal PAP
Late symptoms- foul smelling discharge, painless vaginal bleeding
management of vaginal cancer
laser therapy
close follow-up (PAP, colposcopic exam q 4 months for 1 year)
partial or total vaginectomy
radical or pelvic exeneration
topicla chemo
radiation therapy