nsg 211 chapter 26

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Anonymous
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nsg 211 chapter 26
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2011-11-16 23:39:50
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nsg 211
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female genitourinary system
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  1. mons pubis
    round firm pad of adipose tissue covering the symphysis pubis.

    after puberty it is covered with hair in the pattern of an inverted triangle
  2. labia majora
    two rounded folds of adipose tissue extending from the mons pubis down around to the perineum.

    hair covers outer surfaces of labia

    inner folds are smooth and moist and contain sebaceous follicles
  3. labia minora
    located inside the labia majora

    two, smaller, darker, folds of skin
  4. frenulum

    aka

    fourchette
    a transverse fold of skin joining the labia minora posteriorly
  5. clitoris
    a small pea shaped erectile body

    homologous to the the male penis and highly sensititive to tactile simulation
  6. urethra meatus
    appears as a dimple 2.5 cm posterior to the clitoris

    surrounding the ureathral meatus are tiny,multiple paraurethral (skene glands)
  7. paraurethral (skene's) glands
    ducts are not visible

    open posterior to urethra at the 5 and 7 o'clock positions
  8. vaginal orifice
    posterior to the urethral meatus

    appears either as a thin slit or as a large opening with irregular edges, depending on the presentation of the membraneous hymen.
  9. hymen
    thin, circular,cresecent shape fold that may over the vaginal orifice or may be absent completely
  10. vestibular (Bartholin's) gland
    located on either side and posterior to the vaginal orifice

    secrete a clear lubricating mucus during intercourse

    ducts not visible but open in the groove between the groove between the labia minora and the hymen.
  11. vagina
    -a flattened tubular canal extending from the orifice up and backward into the pelvis.

    9 cm long

    -sits between the rectum posteriorly and the bladder and urethra anteriorly.

    -walls are in thick transvers walls or rugae, enableing the vagina to dilate widely dyruing childbirth.
  12. cervix
    -located at the end of the vaginal canal projecting into the vagina

    -appears as a smooth shaped doghnut-shaped area with a small circular hole or os
  13. squamocolumnar junction
    -vagina and cervix are covered in smooth pink stratified squamos epithelium

    -the endocervical canal is lined with columnar epithelium that looks red and rough

    the point where these two tissues meet is the squamocolumnar junction.
  14. anterior fornix and posterior fornix
    continuous recess present around cervix in front and back
  15. uterus
    pear shaped

    thick walled

    muscular organ

    flattened anteroposteriorly

    -5.5 to 8 cm long by 3.5 to 4 cm wide and 2 to 2.5 cm thick

    freely moveable, not fixed

    usually tilts fwd and superior to the bladder

    -"a position labeled as anteverted and anteflexed"
  16. fallopian tubes
    two pliable, trumpet shaped, tubes

    10 cm in length

    -extend from uterinefundus laterally to the brim of the pelvis where they curve posteriorly

    their fimbriated ends located near ovaries
  17. ovaries
    one on each side of uterus

    at level of anterior superior iliac spine

    oval shaped

    3 cm long by 2 cm thick

    serves to develop ova (eggs) and female hormones
  18. pediculosis pubis

    aka

    crab lice
    severe perineal itching

    excoriations and erythematous areas

    may see little dark spots

    adherent to pubic hair

    occasionally in eyebrows or eyelashes
  19. herpes simplex virus-type 2

    aka

    type 2 (herpes genitalis)
    episodes of local pain, dysuria, fever

    -clusters of small, shallow vesicles with surrounding erythema

    erupt on genital areas and inner thigh

    inguinal adenopathy edema

    vesicles on labia rupturein 1-3 days

    leaves painful ulcers

    initial infection lasts 7-10 days

    virus remains dormant indefinately

    recurrent infections last 3-10 days with milder symptoms
  20. red rash

    aka

    contact dermatitis
    history of skin contact with allergic substances in environment

    intense pruritus

    primary lesion: red, swollen vesicles

    may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching

    -may result from reaction to feminine hygiene spray or synthetic underclothing
  21. syphilitic chancre
    -begins as small, solitary silvery papule that erodesto a red, round or oval, superficial ulcer with a yellowish serous discharge

    -palpation-nontender indurated base, can be lifted like a buttonbetween thumb and finger

    nontender inguinal lymphadenpathy
  22. genital human papillomavirus

    (HPV, condylomata, genital warts)
    painless warty growths

    pink or flesh colored

    soft

    pointed

    moist

    warty papules
  23. abscess of bartholins gland
    local pain

    can be severe

    overlying red skin

    palpable fluctuant mass and tenderness

    mucosa shows red spot at site of duct opening

    requires incision and drainage

    antibiotic therapy
  24. cystocele
    feeling of preote intoitus widening and the presence of a sft round anterior buldge in vagina

    stress incontinence

    note introitus widening and presence of a soft round anterior bulge

    bladder covered by vaginal mucosa, prolapses into vagina
  25. rectocele
    feeling of pressure in vagina

    possibly constipation

    note intoitus widening and the presence of a soft round bulge from posterior

    part of the rectum covered by vaginal mucosa

    prolapses into vagina
  26. uterine prolapse
    uterus protrudes into vagina

    nontender

    smooth hemisphere

    may cause broad gate

    1st degree: cervix appears at introitus with straining

    -2nd degree: cervix bulges outside introitus with straining

    -3rd degree: whole uterus protrudes even without straining essentially uterus turns inside out
  27. HPV condylomata
    -virus may appear in various forms when effecting cervical epithelium

    -warty growths here appear as abnormal thickened white epithelium

    -visibilty of lesion is enhanced by acetic acid which dissolves mucus and temporarily causes intracellular dehydration and coagulation of protein
  28. polyp
    may have mucoid discharge or bleeding

    bright, red, soft, peduculated growth emerges from os

    benign lesion (must be determined from byopsy)

    may be lined with squamos or columnar epithelium
  29. carcinoma
    bleeding between menstrual periods or after menopause

    unusual vaginal discharge

    -chronic ulcer and induration are early signs of carcinoma although the lesion may or may not show on the exocervix (here the lesion is mostly around theexternal os)

    diagnosed by pap smear and biopsy

    risk factors:

    first in intercourse

    multiple sex partners

    cigarette smoking

    certain sexually transmitted infections
  30. atrophic vaginitis
    post menopausal vaginal itching

    dryness

    burning sensation

    dyspareunia

    mucoid discharge (may be flecked with blood)

    pale mucosa with abraded areas that bleed easily

    may have bloody discharge

    opportunist infection related to chronic estrogen deficiency
  31. candidiasis (moniliasis)
    intense prurititis

    thick whitish discharge

    vulva and vagina are erythematous

    discharge usually thick, white, curdy "cottage cheese"

    -diagnose by microscope examination with microscope of discharge on hydroxide wet mount

    caused by;

    oral contrceptives or antibiotics

    -more alkaline vaginal ph (as with menstrual periods,postpartum,menopause)

    pregnancy from increased glycogen and diabetes
  32. trichomoniasis
    pruritis

    watery and often malodorous vaginal discharge

    urinary frequency

    terminal dysuria

    itching

    -symptoms worse during menstration when PH becomes optimal for organisms growth

    vulva may be erythematous

    vagina may be diffusely red

    granular

    -occasionally with red raised papules and petechiae (stawberry apperance)

    frothy yellow green foul smelling discharge

    -microscopic examination of saline wet mount specimen shows characteristic flagellated cells
  33. bacterial vaginosis
    profuse discharge

    constant wetness

    foul fishy smell or rotten odor

    thin creamy gray white malodorous discharge

    no inflammation because its a surface parasite

    vaginal PH >4.5

    microscopic view of saline wet mount specimen shows typical "clue cells", (epithelial cells with stippled borders)

    sniff for fishy odor after adding KOH to slide "whiff test"
  34. chlamydia
    minimal or no symptoms

    may have urinary infrequency

    dysuria

    vaginal discharge

    postcoital bleeding

    may have greenish/yellow mucopurulent discharge

    friable cervix

    cervical motion tenderness

    -signs are subtle and easily mistaken for gonorrhea (important to distinguish between the two because different antibiotics used for each)

    -chlamydia can ascend to cause pelvic inflammatory disease (PID) and result in infertility

    most common STD

    highest prevalence in sexually active adolescent girls

    -urine chlamydia testing using nucleic acid amplification tests (NAAT), noninvasive method to screen

    single urine specimen to detect both pregnancy and chlamydia
  35. gonorrhea
    -variable discharge, dysuria, abnormal uterine bleeding, abscess in Bartholin's or Skene's glands

    majority of cases asymptomatic

    may have purulent vaginal discharge

    diagnose by positive culture of organism

    may progress to acute salpingitis (PID)
  36. pregnancy
    -amenorrhea, fatigue, breast engorgement,nausea, change in food tolerance, weight gain

    -early signs: cyanosis of vaginal mucosa and cervix (chadwick sign)

    palpation:

    soft consistency of cervix

    -enlarging uterus with compressible fundus and isthmus (hegar sign at 10-12 weeks)
  37. myomas

    (leiomyomas, uterine fibroids)
    varies depending on size and location

    often no symptoms

    syptoms consist of:

    vague discomfort

    bloating

    heaviness

    pelvic pressure

    dyspareunia

    urinary frequency

    backache

    hypermenorrhea if myoma disturbs endometrium

    -uterus irregulary enlarged, firm, mobile, and nodule in the uterine wall

    heavy bleeding produces anemia

    usually benign

    -highest incidence occurs between ages 30-45 in blacks

    estrogen dependent

    after menopause usually regress but do not disappear

    surgery may be indicated
  38. carcinomas of endometrium
    -abnormal and intermenstrual bleeding before menopause

    -postmenopausal bleeding or mucosanguineous discharge

    pain and weight loss occur late in disease

    uterus may be enlarged

    -pap smear rarely effective in detecting endometrial cancer

    -abnormal vaginal bleeding or at high risk women should have endometrial tissue sample taken

    risk factors include are early menarche, late menopause, history of infertility, failure to ovulate, tamoxifen, uopposed estrogen therapy (which continually stimulatest the endometrium, causing hyperplasia), obesity (causes excess endogenous estrogen)
  39. endometriosis
    -cyclic or chronic pelvic pain, occurring as dysmenorrhea. or dyspareunia, low back ache

    may have irregular uterine bleeding or hypermenorrhea

    may be asymptomatic

    uterus fixed, tender to movement

    -small firm nodular masses tender to palpation on posterior aspect of fundus, uterosacral ligaments, ovaries, sigmoid colon.


    ovaries often enlarged

    -masses are aberrant growths of endometrial tissue scattered throughout pelvis, probably as a result of transplantation of tissue by retrograde menstruation.

    -ectopic tissue responds to hormone stimulation, builds up during menstruation

    -ectopic tissue responds to hormone stimulation, builds up between periods, sloughs during menstration

    may cause infertilityfrom pelivic adhesions from pelvic adhesions , tubal obstruction, decreased ovarian function

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