repro

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copperkid2
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172334
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repro
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2012-09-23 18:24:11
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repro
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  1. menopause
    • absence of  menses for 12 months
    • occurs between 45 and 55
    • estrogen secretion decreases and ovulation and menstrual cycles  become irregular and finally cease
    • increased risk of heart disease
    • osteoporosis
  2. breast examination
    • palaption is the most important technique
    • monthly BSE recommended
    • perform BSE 1 week aftger menses
  3. breast exam recommendations
    • yearly mammograms at age 40
    • clinical breast esam every 3 years during the 20s and 30s, yearly at 40
    • optional BSE starting in the 20s
    • MRI and mammogram for women at high risk
  4. reproductive health in aging women
    • increased bone loss due to lower estrogen levels
    • dietary calcium and vitamin D required unless on hormone replacement
    • elevated choloesterol levels
    • dry vagina
    • women over age 65 should have bone density tests
    • women over 50 should be assessed for bone loss
  5. is the bladder full or empty for a pelvic examination
    empty
  6. insufflation
    pain in neck, shoulders and upper back after CO2 pumped into body during endoscopy of abdomen or pelvis
  7. gynecomastia
    • presence of breast tissue in men
    • indicates excess femal hormones
  8. varicocele
    • vericose veins in the spermatic cord
    • feels like a bag of worms
  9. position of patient during a DRE (digital rectal exam)
    knee-chest position
  10. DRE (digital rectal exam)
    • recommended for all men over 40
    • prostate palpated by inserting a gloved, lubricated finger into the rectum
  11. TSE (testicular self exam)
    • done monthly
    • best done after a warm shower or bath
    • examine testicles for lumps or hard spots
  12. cystourethroscopy
    foley catheter inserted and a dye is injected into the bladder
  13. cyclic breast discomfort
    • swelling, tenderness and sometimes pain associated with hormonal changes
    • oral contraceptives and NSAIDs helps alleviate symptoms
  14. fibrocystic breast disease
    • common in women between 30 and 50
    • overresponsiveness to in breast cells to hormonal stimulation
    • normal tissue replaced with fibrous tissue and cysts may form
    • breasts feel hard and lumpy
    • subside with menopause
    • non-cancerous
  15. diagnosis and treatment of fibrocystic breast disease
    • identified by palpation
    • no treatment needed
    • limit dietary fat and caffein
    • addition of oral contraceptives may help control hormonal changes that result in discomfort
  16. mastitis
    • breast infection with inflammation
    • abscess may form
    • breast feels...
    • swollen
    • hot
    • red
    • painful
  17. treatment and care of pt with mastitis
    • NSAIDs
    • warm packs
    • ice packs
    • antibiotic
    • breast supports
    • breast feedingis ok; infant usually already colonized
  18. factors that increase risk of breast cancer
    • family history of breast, ovarian or prostate cancer
    • didn't breast feed
    • smoking
    • high-fat diet
    • high alcohol diet
    • treament with estrogens
    • earl menarche
    • late menopause
    • first pregnancy after 25
  19. s/sx of breast cancer
    • lump or thickening of breast tissue
    • change in contour of breast
    • clear or bloody nipple discharge
    • swelling, discoloration or tenderness of breast
  20. prevention of breast cancer
    • moderation in fat and alcohol consumption
    • methods for nonhormonal birth control and menopause symptoms
    • breastfeeding
  21. lumpectomy
    removal of tumor from breast
  22. mastectomy
    • partial: remove tumor and margin
    • simple: remove breast tissue from one or both breasts
    • radical: remove entire breast tissue, underlying muscle and lymph nodes
  23. therapeutic measures for breast cancer
    • targeted therapy
    • hormone therapy
    • chemotherapy
    • radiation therapy
    • surgery
  24. hormone therapy as a breast cancer treatment
    • drugs reduce amount of circulating estrogen in the body
    • drugs block use of estrogen by cancer cells
  25. amenorrhea
    menses absent for more than 6 months or 3 of previous cycles
  26. the aging reproductive system in men
    • less testosterone
    • less spermatogenesis
    • enlarged prostate (BPH)
  27. menorrhagia
    passing more than 80 ml of blood per menses
  28. whatcan cause menstrual disorders
    • stress
    • pregnancy
    • hormonal imbalances
    • metabolic imbalances 
    • tumors
    • infection
    • organ disease
    • foreign bodies in the uterus (ex. iud)
  29. Best way to estimate menstrual flow of a pt
    weigh the pads
  30. treatment of menstrual disorders
    • hormone therapy 
    • dilation and curretage
    • laser ablation of endometrial tissue
    • hysterectomy
  31. dysmenorrhea
    • painful menstration
    • caused by prostaglandins
    • treated with aspirin and NSAIDS; prostaglandin synthesis is supressed
  32. PMS
    • symptoms: water retention, headaches, discomfort of joints muscles and breasts, changes in affect and concentration, sensory changes
    • treatment: nsaids, aspirin, antidepressants, diuretics, calcium, magnesium, vitamin e, vithamin b12
    • restrict alcohol, caffeine, nicotine, salt and simple sugars
  33. endometriosis
    • fuctioning endometrial tissue is located outside the uterus
    • causes bleeding into abdominal structures
    • treated by reducing estrogen and preventing ovulation
  34. s/sx of endometriosis
    • pain 
    • swelling
    • damage to abdominal organs
    • scar tissue development
    • infertility
  35. perimenopause
    • period of gradual decline in hormone production
    • lasts from months to years
    • erratic menses
    • less lubrication
    • more alkaline PH
    • hot flashes
    • night sweats
  36. menopause treatment
    • hormone replacement therapy
    • phytoestrogens: soy, tofu, flax seeds, black cohosh and dong quai
  37. administering meds for a pt with vaginal inflammation or infection
    • pt should wear absorbent pad to prevent staining
    • best to apply meds when pt is lying down and ready to sleep
    • administer medicated douches to hospitalized pt sitting in a bed pan in semi fowlers
    • pt may self admin while on toilet
  38. toxic shock syndrome
    • associated with use of super absorbent tampons or nasa packings
    • s/sx:
    • redness of palms and soles of feet
    • sudden high fever with sore throat
    • headache
    • dizziness
    • rash
    • blisters
    • petechiae
    • peeling of the skin
    • confusion
  39. perevention of toxic shock syndrome
    • use sanitary napkins instead of tampons at night
    • change tampons every 4 hours
    • wash hands before inserting anything into vagina
    • don't leave female barrier contraceptives in longer than needed
    • not using female barrier contraceptives in teh first 12 weeks after birth
  40. what causes displacement disorders in women
    • pregnancies that produce large babies or are rapid/traumatic
    • scarring from STDs
    • aging and lower estrogen levels
    • chronic constipation
    • obesity
    • lack of exercise
  41. therapeutic measures for female displacem disorders
    • pessary
    • kegels
  42. pessary
    • supportive device to support pelvic organs
    • placed at proximal end of vagina
    • expect increased clear vaginal discharge
  43. cystocele
    • bladder sags into vaginal space
    • kegels or pessary help
  44. rectocele
    • rectum sags into vagina
    • kegels and high fiber diet may help
    • s/sx:
    • pelvic pressure
    • fecal incontinence
    • constipation
    • hemorrhoids
  45. uterine prolapse
    • uterus sags into vagina
    • causes:
    • gravity
    • poor pelvic support
    • excessive lifting or straining
  46. s/sx of uterine prolapse
    • painful intercourse
    • pelvic pain
    • back pain
    • urinary incontinence
    • constipation
    • hemorrhoids
  47. vasovagal reflex
    • stimulation of vagal nerve
    • caused when cervix, larynx or trachea manipulated
    • hypotension
    • decreased cardiac output and rate
  48. advantage of oral contraceptives
    • improved dysmenorrhea
    • increased regularity of menses
    • decrease in menstrual flow
    • improvement of endometriosis
  49. disadavantage of oral contraceptives
    • higher rates of blood clot formation
    • strokes
    • high b/p
    • heart attacks
    • worsening of diabetes
  50. use of hormonal contraceptives increases the risk of which vitamin deficiency
    vitamin b
  51. most effective form of birth control if a pt had a medical reason for not wanting to get pregnant
    depo provera; intramuscular shot lasts 3 months
  52.  implanted birth control
    • implanon and uniplant
    • not effective for first 2 weeks
    • fertility may not return for several months to a year
    • gain 5 to 10 pounds
  53. contraceptive ring
    • left in place for 3 weeks
    • removed for 1 week
    • use estorgen-progesterone
  54. transdermal contraceptive patch
    • ortho evra
    • on for 3 weeks
    • off for 1 week
    • place on abdomen, buttock or upper arm
  55. IUD
    • made of copper or plastic
    • paragard (copper wire) lasts for 10 years
    • mirena (plastic with progestin) lasts for 5 years
    • may cause pelvic inflammatory disease
    • inserted during first 7 days of menstrual cycle
    • insertion has risk of vasovagal reflex
  56. abortion methods for early pregnancy
    • menstrual extraction: suction away endometrial lining within 7 weeks
    • vacuum aspiration: suction of uterus within 13 weeks
    • DandC: cervix dilated and uterine contents scooped out wthin 13 weeks
  57. fibroid tumors
    • benign tumors implanted in walls of the uterus
    • cause pain or menstural disorders
    • exert pressure on bladder or bowel
    • affect fertility
    • cause necrosis by cutting off blood supply
  58. treatment of fibroid tumors
    • hormone suppression
    • hysterectomy; removal of uterus
    • myomectomy; removal of fibroid tumor only
  59. polyps
    • benign growths that grow inside uterus or on cervix
    • may bleed after intercourse or between menstrual cycle
    • usually develop after 42 
    • removed vaginally or transcervically
  60. polycystic ovary syndrome
    • endocrine imbalance
    • excessive insulin stimulates androgen secretion 
    • linked to family history of too much or too little hair, severe acne, infertility and irregular menses
  61. s/sx of polycystic ovary syndrome
    • infertility
    • obesity
    • menstrual disturbances
    • masculanization
    • elevated b/p
    • coronary artery disease
    • endometrial cancer
  62. tx for polycystic ovary syndrome
    • bp meds
    • lipid control meds
    • oral hypoglycemics
    • diet
    • oral contraceptives
    • antiandrogen meds (aldactone)
  63. dermoid cysts
    • cells in ovary become foreign tissue (ex. skin, teeth, etc)
    • surgically removed
    • biopsy done to confirm non-malignancy
    • hormone therapy if needed
  64. vulvar cancer
    • persistent itching of vulva
    • appearance of white or red patches, rough areas, skin ulcers or wartlike growths
    • risk factors:
    • stds
    • precancerous or cancerous changes of anus or genitalia
    • immune system depression
    • smoking
  65. cervical cancer
    • associated with hsv 2 and hpv
    • may experience slight spottingor serosanguineous discharge
    • usually asymptomatic
  66. diagnostic tests for cervical cancer
    • pap smear
    • schillers test done after abnormal pap smear
  67. gardasil
    • hpv vaccination
    • for women 9 to 26
    • given regardless of sexual activity or hpv exposure
  68. endometrial cancer
    • most common uterine cancer
    • develop from estrogen excess
  69. ovarian cancer
    • usually asymptomatic until cancer is adavanced
    • treatment involves surgery and radiation therapy
    • risk factors:
    • low fertility
    • low number of children
    • late menopause
    • family history of colon cancer
    • diet rich in animal fats
  70. prostatitis
    • inflammation of prostate
    • prostate swells resulting in pain when standing
    • prostate is warm, irregular and swollen during DRE
  71. s/sx of prostatitis
    • urgency
    • frequency
    • hesitancy
    • dysuria
    • low back pain
    • perineal pain
    • postejaculation pain
  72. tx of prostatitis
    • bactrim for 30 days
    • anti-inflammatory agents
    • warm sitz baths
    • sit on a pillow
    • prostatic massage
    • stool softeners
    • decrease spicy foods and alcohol
  73. bph
    • enlargement of prostate
    • doesn't increase risk of cancer
    • narrows urethra 
    • increases PSA, serum creatinine, BUN levels
  74. s/sx of bph
    • obstruction or problems related to riirtation
    • difficulty in startin a stream
    • dribbling after urination is complete
    • urinarty retention
    • feeling that the bladder is not empty
    • overflow incontinence
    • nocturia
    • dysuria
    • urgency
  75. complications of bph
    • hydronephrosis
    • renal insufficiency
    • urosepsis
    • damage to bladder walls
    • recurrent uti
    • calculi
    • inability to urinate
  76. tx of bph
    • catheterization
    • fluids and antibiotics for uti
    • proscar and avodart to reduce prostate size
    • flomax relaxes smooth muscles; monitor for hypotension
  77. transurethral resection of the prostate (turp)
    • rectoscope inserted into urethra and prostate is "chipped"
    • away
    • foley catheter filled with 30 - 60 cc of water to stop the bleeding
    • continuous bladder irrigation for 24 - 48 hrs to maintain patency
  78. post surgical care of turp pt
    • monitor amount and color of urinary output for first 24 - 48 hrs
    • bloody urine is normal
    • sent home with light pink to clear urine
    • encourage pt to drink up to 2500 ml of fluids
    • avoid constipation and heavy lifting
    • avoid aspirin and nsaids
    • belladonna and opium suppositories for bladder spasms
    • no driving
    • no sex for 6 weeks
    • stool softeners for 6 - 8 weeks
  79. retrograde ejacualation
    • common side effect of prostate surgery
    • semen falls back itno bladder
    • semen is urniated out
  80. prostate cancer
    • most common cancer in men
    • grow slowly, not a major threat
    • spreads to bladder, seminal vesicles, peritoneum or lymph
    • often in men over 65
    • during DRE hard lump or hardened lobe found
    • elevated PSA or PAP
  81. s/sx of prostate cancer
    • urinary obstruction
    • hematuria
    • urinary retention
    • hip or back pain during metastic stage
    • complications: difficulty urinating, bladder or kidney infection, erectile dysfunction

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