Health Assessment

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Health Assessment
2012-06-04 13:45:54
Female Genitourinary System FT

Chapter 26
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  1. What is Bartholin's Gland, where is it, and why do we care?
    • Glands posterior to the vaginal opening which produce lubricating mucous.
    • They can sometimes get infected or develope cysts. Both can be painful.
  2. Why is a torn hymen not a great indicator of virginity?
    Because heavy menses or use of tampons can also tear it.
  3. What is Infibulation?
    • Sewing the vaginal canal shut to prevent intercourse or pleasure during intercourse.
    • It's a cultural thing.
  4. Cultural Competence: Aging Woman
    • Female’s hormonal milieu decreases rapidly in contrast with slow decline in aging male
    • Uterus shrinks in size because of decreased myometrium
    • Ovaries atrophy to 1 to 2 cm and are not palpable after menopause
    • Uterus droops as sacral ligaments relax and pelvic musculature weakens
    • Vagina becomes shorter, narrower, and less elastic because of increased connective tissue
    • Externally, mons pubis looks smaller because fat pad atrophies
    • Labia and clitoris gradually decrease in size
    • Pubic hair becomes thin and sparse
  5. Subject Health Hx questions concerning reproductive system
    • Menstrual history: When was your first? When was your last normal? Can help if determining the possibility of pregnancy.
    • Obstetric history: remember all the uncomfortable questions we four weeks ago? Review those.
    • Menopause: Technically, is not menopause until 1 year after last normal period.
    • Self-care behaviors: Shower? IUD? Partners? Pap smears? DES?
    • Urinary symptoms
    • Vaginal discharge
  6. What is menorrhagia?
    Unusually heavy bleeding.
  7. What is Dyspareunia?
    • Pain during intercourse. Can be caused by:
    • Lack of estrogen--> dry, unelastic vaginal canal.
    • Fear/reluctance to engage. Great time to ask about childhood/current abuse, peer pressure, educate about date rape, etc...
  8. What is an STI?
    • Sexually Transmitted Infection
    • Changed from STD to avoid negative connotation with the word, "disease."
  9. What are some additional questions for the aging woman?
    • Postmenopausal bleeding? Always cancer until proven otherwise.
    • Atrophic vaginitis: Lack of estrogen
    • Uterine prolapse. Normal, may need to be meshed.
    • Sexual satisfaction
  10. Preping for a pelvic exam
    • Lithotomy position (feet in stirrups) and draping
    • Measures to enhance comfort during exam
    • Mirror pelvic examination. Pt need need a mirror to follow along and to identify structures and/or areas of concern.
  11. What do you need to condut a pelvic exam?
    • Gloves
    • Protective clothing for examiner
    • Goose-necked lamp with a strong light
    • Vaginal speculum of appropriate size/shape
    • Large cotton-tipped applicatorsn (aka Proctoswabs)
    • Materials for cytologic study (microscope slides)
    • Water soluble lubricant (e.g., K-Y)
  12. Do's and don'ts of the pelvic exam
    • External genitalia—Palpation
    • Skene’s glands
    • Bartholin’s glands
    • Support of pelvic musculature: less intrinsic support in children and aged.
    • Have pt empty bladder before exam.
    • Don't have the table facing the door.
  13. What might you see when inspecting the cervix using a speculum?
    • Nullparous, parous, and Nabothian cycsts are normal findings.
    • Cervical eversion: Can be normal in children/teens women through their 20s. Important because HPV (which can cause cancer) can attach to exposed mucosa. After it involutes it becomes less likely.
  14. Things to think about when obtaining a cervical smear/culture.
    • Vaginal pool
    • Cervical scrape
    • Endocervical specimen
    • Data to include for the
    • laboratory: When was last menestral cycle? Any IUD, DC, BC, etc.
    • Inspect vaginal wall
  15. Abnormal findings of the external female genitalia.
    • Pediculosis pubis (crab lice)
    • Syphilitic chancre: Sore or blister. Can be open and painless. Is syphilitic so can travel to brain.
    • Herpes simplex virus—type 2 (herpes genitalis): 1st outbreak always most painful.
    • Red rash—contact dermatitis: Can be contracted via bubble bath, condoms, intercourse, etc.
    • Human papillomavirus (HPV) warts: Four types are known to cause cancer, worst are 16-18. Cannot be seen with naked eye. Can also show up in throat mouth due to oral sex.
  16. What is cystocele?
    • Downward migration of the urinary bladder.
    • Usually due to age and decreased musculature.
  17. What is a uterine prolapse?
    Downward migration of the uterus.
  18. What is rectocele?
    Downward migration of the rectum.
  19. Abnormal findings of the cervix...
    • Bluish cervix—cyanosis. Also called Chadwick's sign. Indicates pregnancy.
    • Human papillomavirus (HPV, condylomata)
    • Diethylstilbestrol (DES) syndrome
    • Erosion
    • Polyp: Protrusion from cervix, always benign. Must be biopsied (painless) to rule out carcinoma.
    • Carcinoma
  20. Abnormal findings of the Vulvovaginal orifice.
    • Atrophic vaginitis: Lack of estrogen.
    • Candidiasis (moniliasis): Yeast nfxn
    • Trichomoniasis: sexually transmitted bacterial nfxn.
    • Chlamydia
    • Bacterial vaginosis: Fishy smell.
    • Gonorrhea
    • Vulvodynia: Pain during sex @ vulva. Red-haired, fair skinned women most at risk.
    • Vulvar Vestibulitis: Pain during sex @ vulva. Red-haired, fair skinned women most at risk.
  21. Considerations for the older woman during a pelvic exam.
    • To avoid painful examination, take care to lubricate instruments and examining hand adequately
    • Use Pedersen speculum, rather than Graves, because its narrower, flatter blades are more comfortable in women with vaginal stenosis or dryness
    • Menopause and resulting decrease in estrogen production cause numerous physical changes
    • Older women may have special needs and will appreciate following plans of care