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_____ & _____ are important in det and detecting health problems and risks.
health history and physical assessment
Health history anbd physical assessment includes what 5 things?
family history, health history, vital signs & weight, auscultation of heart, and social history
What is very important in interviews with women's health?
health Hx so can do teaching
Why is auscultation of the heart important in yearly exam?
may not go to MD enough and not know have prob
birth control, sexual history
____ % of women are overweight in the US.
Obesity is BMI?
30 or greater
How can decreased weight improve health?
decreased risk of DM, heart disease, cancers
How can physical activity improve health?
decreased weight, heart health, decreased osteoporosis with weight bearing activities
thinning of bone
Best way to Tx any probelm?
early prevention, detection and treatment
Prob with women and their health management?
tendency to overlook health probs/issues and their S/S
Any female pt you come into contact with you should ask what 2 questions?
if they do self breast exam and if the say no ask them why not
When encourage a woman to do a self breast exam?
1 week after period starts b/c hormones are back down to normal and noduoles ass with this are gone
Teaching with breast exam?
- 1. in shower is good place to do it
- 2. use opposite hand 3 fingers in tiny circles all over the breast and include the tail of spence and the axillary area
- 3. Never lift hand off the breast once it is on there to move to new areas
- 4. start first by looking in mirror with hands to side to compare 1 breast to other: more veins in one, dimpling or retractions, hand same
- 5. move arms up slowly and examine breasts for even movement: cancer area that is like velcro and skin will dimple
- 6. when arms all the way up press up breast muscles and look for abnormalities
- 7. lay down and put roll under shoulder of breast examining
- 8. nipple discharge
Discharge that is indicative of breast cancer?
Best way to promote learning adherence to SBE?
assessment of learning needs and readiness to learn the guidelines
When should woman have mammograms?
yearly age 40 & up
if high risk of breast cancer will do sooner
When is mammography used?
usually if suspiscious lump is found
if still suspiscious then do MRI then may do biopsy
3 ways to prevent breast cancer by early detection?
SBE, breast exam with pap, and yearly mammogram for 40 & up
Why don't ppl have breast exams/mammograms? (3)
How may insurance be an issue?
- 1. fear: don't want to know, pain, fear of radiation
- 2. expense
- 3. schedule
may not pay for it or not as often as should
Intervention to make sure don't hurt during mammogram?
do after periods
Vulvar self exam should be done when?
monthly in all women 18 and up or when they start having sex
How do a vulvar self-exam?
- 1. Get a mirror and examing from mons pubis, clitoris labia majora, minora, perineum, and anus
- 2. moles can be big prob
Cancerous lesion on labia?
mole with irregular boarders - dark and light brown mixed is precancerous lesion
2 risk factors for vulvar cancers?
HPV and melanoma
Pelvic exam includes?
- 1. external visual exam
- 2. speculum exam - visualization of the cervix and pap smear to test for abnormal cells
- 3. STD screening - all tested for gonorhea and chlamydia
- wet pap also tests for HPV
- 4.bimanual exam
opens up the vagina to view the cervix
2 ways to do a pap test?
1. cytobrush and put scrapings on a slide, spray with a fixative and send to lab
2. wet pap - cytobrush, swish in a solution and send solution to lab
Equipment needed for pap smear? (7)
speculum, gloves, glass slides or liquid pap/thin prep, spray fixative, cytobrush and spatula, cotton swabs, spcimen containers
Pap smear AKA?
2 components of the pap smear?
sample and testing for STD's
palpation of the cervix, uterus, ovaries, and fallopian tubes where MD puts 2 fingers in vagina and uses other hand to press uterus and ovaries b/t the 2 hands so can palpate them
When should pap smears begin?
3 years after sexually active or age 21 if not sexually active
When may pap smear be done every 2 years?
if have liquid pap
If over age 30 with no prior Hx of abnormal pap can go to having the q ____ years.
Who should always go yearly?
q 3 years
person with Hx of HPV
When can woman stop having pap?
over 70 and no abnormal for the last 10 years
What to teach pt about pap?
- 1. do them about 2 weeks after the period
- 2. no sex or douching before the come in
What should be done before the pap?
Screening during pap?
Exams that should be done along with pap exam?
- 1. rectal exam
- 2. occult stool exam - put on slide and spray with solution to test for blood
Why does the MD squeeze around the outside of the vagina in exam?
checking for the skene's glands and bartholin glands
Lubricant for pap test?
do not use water soluble lubricant until after speculum exam is done and sample collected
Cells on the inside of the cervix and outside?
Where are pap cells collected?
inside is columnar and squamous outside
collected from squamocolumnar junction b/c this is area where cancer most likely to develop
Where are bartholin's glands?
at the bottom of vagina
Where are Skene's glands and their function?
more at the top of vagina for lubrication
What can happen to bartholin's glands?
swell up esp with gonorrhea and chlamydia
put a tube in and drain
What is the Bethesda system?
3 components of the Bethesda system?
reporting system for pap results
- 1. if sample was good enough
- 2. normal/abnormal
- 3. if abnormal what type of abnormality is it
3 different results that may occur with squamous cells in Bethesda results?
- 1. ASCUS - atypical cells of undetermined significance
- 2. SIL - squamous intraepithelial lesion
- 3. squamous cell cancer
2 types of SIL on Bethesda results?
LGSIL low grade SIL - suggestive of precancer
HGSIL - suggestive of cancer - high grade SIL
What are ASCUS cells?
cells that are abnormal but are not quite a cancer
What is the major concern if Bethesda results say squamous cell cancer
2 Bethesda abnormal results in glandular tissues?
AGCUS - atypical glandular cell of uncertain significance
AGCUS on Bethesda?
atypical glandular cell of uncertain significance
indicates cancer but don't know what kind
3 TX for abnormal paps?
colposcopy, cryotherapy, leep procedure
Why is it done?
- 1. speculum exam
- 2. stain cervix with acetic acid/vinegar that will cause cervix to turn white in areas where cells are abnormal
- 3. will take biopsy of white tissue for cytology
- 4. use a video camera to visualize
______ will automatically cause pap to be abnormal even if no weird cells.
When is it used?
used after colposcopy comes back abnormal:
- LGSIL or ASCUS
- use liquid nitrogen in hand held device that freezes the cervix; begins to thaw and all the cells frozen will slough off
Pt teaching with cryotherapy?
will have discharge for a few days
When is it done?
Pt teaching or considerations?
- - used when more concerned about cancer
- - cauterizing/burning with hand held device
- - burn off chunks of cervix and send off for biopsy
- - risk for infection, scarring, cervix may not be able to dilate for labor
Anal pap smear?
When should it be done?
pap done in gay or bisexual men very similar to female pap
recommended q 3 years
intraepithelial neoplasms require treatment
What does the rectal exam consist of?
- send pt home with slides and sticks
- 1. collect 3 consecutive stool samples
- 2. no aspirin or NSAIDS for 7 days before
- 3. no red meats, raw fruits & veggies, vitamin C, or horseradish 72 hours before
- 4. return in special package within 4-6 days
- 5. put solution on it - if turns purple is positive for blood and will need to see a GI MD
Always teach pt what about rectal occult test?
put it in special biohazard envelope and return within 4-6 days
Fibrocystic breast disease?
- what can make it worse?
very common from teens to late 20's
- lumpy spots in breast that are larger before period and smaller after
- caffeine and chocolate can make it worse
Char of lumps in fibrocystic breast disease?
lumpy, moveable, tender, usually in groups, vary in size
teen to 20's age groupd
more firm and rubbery, mobile, may or may not be tender, usually in outer quadrant of the breast, usually more than 1
Which breast disorder usually causes lumps in the outer quadrant of the breast?
Tx for pain ass. with fibrocystic breast disease
NSAIDS, vitamin E will decrease tenderness, apply heat to breast, decrease caffeine, chocolate, and nicotene
Fibroadenoma that has been there a few months what will be done?
biopsy, mammogram, ultrasound to be sure
Who gets ductal ectasia?
premenopausal and menopausal women
S/S of ductal ectasia?
firm irregular borders, tender mass with enlarged axiallary nodes and nipple discharge, nipple retraction, pain
nipple issues because usually occurs behind the nipple
What must be done if ductal ectasia S/S occur?
biopsy to differentiate from cancer
may have to remove milk duct
When does intradermal papilloma occur?
pre-menopausal or at menopause
papillomas develop in epithelium of ducts under areola, causing trauma and erosion of ducts
- may have serosanguineous or serous nipple discharge
Use of ____ & _____ can increase and exacerbate breast cancer.
progesterone and estrogen
If you are diagnosed with breast cancer there is an 80% chance it will be _____
3 gene mutations that have been ID'd to be ass. with breast cancer?
Prob with this?
BRCA1, BRCA2, and CHEK - 2
insurance will not cover tissue removal even if they are positive
The ____ the pt the greater the risk that a lump will be breast cancer.
older - age 60 and up greatly increases risk
3 most common places breast cancer metastisizes to?
brain, lungs, and bones
Who finds most breast cancers?
the pt through self exam
Least common breast cancer?
inflammatory - most malignant and worst kind to get
Factors that increase risk for breast cancer?
1. family Hx of mom, sister, and grandmother
2. positive BRCA 1 or 2 or CHEK 2
3. early menarche less than 12
4. late menopause >55
5. never had a child or first pregnancy after age of 30
6. 85% of ppl who get it have no family Hx
5 factors that affect cancer prognosis?
- 1. size when found
- 2. axillary node involvement - bad sign
- 3. tumor differentiation
- 4. human epidermal growth factor receptor (HER-2) status
- 5. estrogen and progesterone receptor status
Estrogen and progesterone receptor status?
does the cancer have estrogen receptors
3 things tumor staging is based on?
tumor, node, and metastasis (TNM)
Tumor staging range and prognosis?
4 is the worst prognosis
Use of tumore staging?
oncologist can use it to determine Tx
have lymph node and metastasis
persitant lesion of the nipple and areola with or without a palpable mass
S/S of Paget's disease?
itching, burning, bloody nipple discharge with superficial erosion
ulceration may become present b/c skin is irritated and will B/D
Dx of Paget's disease?
Teaching for pt about itchy dry nipples?
put lotion on it. if it is relieved it isn't cancer
Most malignant type of breast cancer?
inflammatory breast cancer
S/S of inflammatory breast cancer?
- 1. palpable lump- hard, irregular shaped, poorly delineated, nonmobile, and nontender
- 2. lump seen on mammogram
- 3. clear or bloody nipple discharge
- 4. Peau d'orange skin appearance
- 5. nipple retraction
- 6. dimpling of skin
- 7. may have hive appearance
- 8. progresses - not acute
orange peel appearance
What should breast cancer feel like?
Does it cause pain?
will have an irregular shape b/c grows in tendrils
usually has no pain
What will be done if breast cancer is suspected?
- MRI to find out if it is solid or fluid - filled mass
Therapeutic surgeries of breast cancer?
breast conservation surgery, quadrantectomy, simple mastectomy, modified radical mastectomy, sentinel lymph node biopsy, adjuvant therapy will be used
Breast conservation surgery?
only area that has the cancer is removed
more extensive than breast conservation involving removal of quadrant of tissue to clear margins and sample lymph nodes
take out the tissue and send to pathology- wait until pathology says margins are clear - will cont to remove tissue until they are
removes entire breast but not all lymph nodes
Modified radical mastectomy?
removes breast, axillary nodes and some chest muscles
Sentinel lymph node biopsy?
small number of key sentinel lymph nodes removed and biopsied after dye is injected to identify correct nodes that need tested/removed
allows pt to keep lymph nodes that are not affected
In inflammatory breast cancer what type of surgery will be done?
modified radical mastectomy
3 adjuvant therapies to surgery with breast cancer pt?
radiation, chemo, hormonal therapy
IMRT - intensity modulated radiation therapy
may have skin marked to show areas where radiation should be done - do not ever remove these
- combo of drugs that kill rapidly changing cells
- mouth cells will be affected b/c rapidly changeing cells here: mouth ulcers and thrush
may cause hair loss, NV depending on what is used
Breast reconstruction methods?
tissue expansion, tissue flap proceudres, nipple/areola reconstructions, tattoo
Tissue expansion method of breast reconstruction?
small incision, insert plastic implant with a port to inject 100-200 mL of NS, causes skin to stretch so that it will match other breast
once stretched will put in implant
Tissue flap procedure for breast reconstruction?
remove portion of skin and create flap of skin to cover breast implant with
Nipple and areola reconstruction?
create a nipple with tissue from vaginal area
Nursing considerations for pt with breast cancer or suspected breast cancer?
psychosocial, sleep disturbances, diet, sexual issues, pain, warning S/S, education
Major concern with psychosocial of pt with suspected breast cancer?
she will have to wait a long time to know the final Dx: up to a month then will have to have surgical Tx and she will have to wait again to know if it has spread to nodes
ANXIETY is a major nursing considerations
Leading cause of death in men and women?
9 Risk factors for cardiovascular disease?
hypertension, sedentary lifestyle, overweight/obesity, poor nutrition, DM II, hyperlipidemia, cigs, post menopause, family Hx
Most traumatic part of breast removal?
don't feel like a woman and feeling like husband won't want them anymore
If pt doesn't want dressing removed from breast surgery removed what should nurse do?
encourage her to do it on her own time and to have a support person nearby when they do
Dietary concern with breast cancer?
may have decreased appetite due to depression
elastic sleeves for compression and decreased swelling and keeping arm up can prevent this, exercise to increase circulation, no sticks or BP's in this arm
tell pt not to put ACE bandage on it
Education for breast surgery pt?
exercise very painful but need to move
S/S of CAD / MI in women?
- 1. pain in upper body, but other than the chest- arm, neck, back, jaw, throat, teeth
- 2. not typical crushing chest pain
- 3. dyspnea
- 4. dizziness
- 5. upper abd pain, heartburn, or loss of appetite
- 6. fatigue or weakness
- 7. diaphoresis
may be mistaken for toothache or GI s/s
6 ways to prevent CAD?
- 1. lowering hypertension to levels lower than 140/90 reduces risk of MI and CVA
- 2. smoking cessation
- 3. fat should not be more than 30% of daily calories and no more than 10% sat fat
- 4. one alcoholic drink per day helps reduce BP
- 5. 30 minutes of moderate activity per day
- 6. 81mg low dose aspirin qd or 4 po if chest pain with MI suspected
S/S of ischemic stroke?
- 1. arm/leg weakness with or without loss of sensation
- 2. speech disturbances
- 3. facial weaknesses
- 4. HA
- 5. non-orthostatic dizziness
- 6. mental status changes
- 7. there are few gender differences
dizzy due to position
If you suspect a person is having a stoke what should you do?
have them smile for you and ask them some questions
3 things to give person who may be having a stroke?
What should you ask them first?
4 baby aspirin, 1 325 mg aspirin, or plavix
ask them if they are allergic to aspirin
Normal, prehypertensive, and hypertensive?
- normal = < 120/80
- prehypertensive - 120/80
- hypertensive - 140/90
failure to start menses by expected age
When is primary amenorrhea suspected?
if girl 1 year later starting than mother and sisters
When is Turner's syndrome suspected as the cause of primary amenorrhea
if secondary sex characteristics are also absent: no body hair, breast dev
Causes of primary amenorrhea other than Turner's syndrome?
incomplete development of uterus, ovaries, or fallopian tubes
cessation of menses for 6 months after est menses pattern
4 possible causes of secondary amenorrhea?
exercise, eating habits, systemic diseases, and stress, hormone problems like hypothyroidism
If person has not had a period for 2 months what does nurse do:
need to know if they have been regular before that; need to est a regular pattern before secondary amenorrhea can be diagnosed
endometrial tissue found outside the uterus with unknown cause
can be anywhere outside uterus
S/S of endometriosis?
cyclic excrutiating pain, dyspareunia, rectal pain, diarrhea/constipation, leads to infertility, endometriosis
rectal pain - when they sit down it hurts
Tx options for endometriosis?
surgical - laproscopic lysis of adhesions, hysterectomy
hormonal - oral contraceptives, testosterone derivatives
The one thing that will help endometriosis?
getting pregnant but can't get pregnant b/c of infertility
Laproscopic lysis of adhesions?
remove the lesions
Why do many women get hysterectomy with endometriosis?
Testoserone therapy for endometriosis is what 3 drugs?
danocrine and/or lupron
Side effects of testosterone derivative therapy for endometriosis?
- 1. stop having period
- 2. menopausal S/S - pseudomenapause
- 3. may grow more facial hair
- 4. osteoporosis
Education for women who are taking testosterone derivatives for endometriosis?
need to be taking Ca and vit D supplements to combat bone loss
oral contraceptives used for endometriosus?
depo-provera q 3 months and/or mincronor
Prob with oral contraceptives for endometriosis?
causes weight gain
Nursing considerations for women with endometriosis?
- 1. acknowledge the pain
- 2. suggest OTC pain relief
- 3. encourage frequent rest periods
- 4. heat therapy
- 5. educate regarding expected SE of meds
- 6. encourage moderate exercise and well balanced diet
How is PMS/PMDD diagnosed?
must eliminate other underlying conditions
based on S/S
keep S/S diary for 2 to 3 months
must be s/s free before ovulation and must have 7 days without s/s
must be severe enough to effect life
premenstrual dysphoric disorder
Common S/S of PMS?
breast tenderness, peripheral edema, abd bloating, sensation of weight gain, episodes of binge eating, HA, heart palpitations/dizziness, irritability/mood swings/anxiety/depression
Best way to diagnose PMS?
Management for PMS?
1. 50-100mg/day vitamin B6 (mood enhancer), 1200mg/day Ca supplements, Mg 200-400mg/day(can help with HA), vitamin E 400 IU/day (reduces breast tenderness)
2. food beverages rich in complex carbs - helps modd
3. reducing caffeine - decreases anxiety
5. danazol helps with mastalgia
7. prostaglandin inhibitors (NSAIDS)
8. buspar - antianxiety
9. oral contraceptives
vitamins/interventions that may taken during PMS to improve mood?
B6, Ca, Mg, increased complex carbs,
Vitamin that can help relieve breast tenderness?
2 ways anxiety may be treated during PMS?
buspar and decreasing caffeine intake
Nursing considerations for pt with PMS?
- 1. acknowledge pain
- 2. suggest OTC pain meds
- 3. allow time for pt to discuss concerns
- 4. teach expected effects for drugs
- 5. may recommend evening primrose herbal supplement
- 6. remember the family unit
- 7. observe for s/s of self harm of abuse of children
- 8. help her ID times when s/s start and how to get control of them
Menopause AKA? AKA?
What is it?
climacteric period, change of life
end of menses
prior to cessation of menses but irregular menses
includes premenopause, menopause, and at least 1 year after menopause
periods have ceased all together usually after 1 year without menses
What should evaluated if a postmenopausal woman has vaginal bleeding?
17 S/S of menopause?
hot flashes, night sweats, atrophic vagninitis (thinning of labia and decreased pubic hair), absent menses for 1 year, vaginal dryness, elevated LDL & decreased HDL, mood swings, changes in hair distribution and amount, irritabiltiy, increased agitatiuon, depression, osteoporosis, elevated FSH and LH hormones, muscle and joint pain, redistribution of fat/weight gain (boobs go away and fat in abd), changes in skin elasticity, stress and urge incontinence,
CV risk ass. with menopause?
increased LDL and decreased HDL
Cons of using estrogen and progestorone during menopause?
cancer, stroke, heart disease, DVT, pulmonary emboli
2 vitamins that should be taken during/after menopause?
1200 of Ca and 600Iu of vit D
to decrease risk of osteoporosis due to decreased estrogen
Pros of estrogen and progesterone during menopause?
fewer hip fractures, lower colorectal cancer, lower uterine cancer
Risk factors for osteoporosis?
1. white, fair-complected, and thin
2. family Hx
4. smokers, drinkers, caffeine
5. corticosteroid and anticonvulsant
6. inadequate intake of Ca and vit D
7. late menarch and early menopause
Most common place fractured with osteoporosis falls?
2 cons of taking estrogen alone for tx of menopause?
DVT but less risk than with progesterone and estrogen use
Dual energy x-ray absorptiometry for osteoporosis
When should ppl get dexascan xray done?
screening should begin at age 65 or 60 if at increased risk
2 diff classifications of bone b/d?
- osteoporosis - low bone mass
- osteopenia - bone loss but not as bad as osteoporosis/ beginning of osteoporosis
Pros of estrogen therapy alone with menopause?
less hip fractures/osteoporosis
no change in risk ass. with heart disease, colorectal cancer, or breast cancer
Ca intake for premenopausal and postmenopausal women?
- pre - 1000 mg/day
- post - 1500 mg/day
7 prevention/tx of osteoporosis?
- 1. app. Ca supplementation for age and menopause status
- 2. Ca in diet
- 3. vit D supplement
- 4. weight bearing exercise
- 5. smoking cessation
- 6. decrease alcohol intake
- 7. fosamax, actonel, boniva, & evista help preent further bone loss
ppl 55 and over need _____ mg Ca per day
Nursing considerations for osteoporosis?
- 1. suggest ways to increase safety concerns
- 2. encourage lifestyles beneficial
- 3. educate regarding following med regimens
Adults up to 70 years old need _____ IU vit D per day and over 70 need _____ IU per day.
anterior weakened wall of vagina no longer able to support bladder and bladder protrudes down into the vagina
Ways to increase safety in pt with osteoporosis?
nonskid footwear, no rugs,
S/S of cystocele?
stress incontinenece and cystitis
bladdeer protrudes down into the vagina
sneeze and pee
Complication ass. with cystocele?
increased UTI r/t urine staying in bladder too long
herniated protrusion of the rectum into the posterior vaginal wall in which defecation of stool can be pused into the vagina
What to do if woman has stool coming into vagina?
can use digital manipulation to push the stool out
Most common non-malignant tumor?
Causes of uterine leiomyomas?
usually atrophy with menopause unless estrogen is used
Most common complaint with uterine leiomyomas?
intermittent bleeding with clots
S/S of uterine leiomyomas?
heavy menstrual bleeding with clots, pain, increase in uterine size
Tx of uterine leiomyomas?
hysterectomy, myomectomy, uterine artery embolization
Uterine artery embolization?
insert polyvinyl particles into the uterine artery, blood supply carries it to the fibroid and causes it to clot off, not get anymore blood and die off
PID - pelvic inflammatory disease?
infection of the upper genital tract
PID is ass. with ______ including _____, ____, _____, & _____.
2 types of ovarian cysts?
follicular and luteal
Follicular ovarian cyst?
Ovarian follicle fails to rupture
corpus luteum becomes cystic and fails to regress
pain and late menses
3 dx / tx for ovarian cysts?
- 1. transvaginal ultrasounds - view it
- 2. laproscopy - surgical incision and look with scope and may do some drainage
- 3. laparotomy (removal)
2 complications of PID?
increased risk for infertility and ectopic pregnancy
Most common S/S of PID?
positive chandelier sign/cervical motion tenderness
looks like they are trying to grab chandalier due to extreme pain
Why does PID cause infertility?
Other risk this causes?
can scar fallopian tubes
also at risk for tubal pregnancies
Tx for PID?
IV antibiotics first 48 h then po X 14 full days
may need surgery if abscess occurs
4 reasons for elective abortion?
- 1. social or economic
- 2. rape or incest
- 3. poor health of client
- 4. birth defects
3 methods of abortion?
1. within 7 weeks of LMP - mifepritone and cytotect meds
2. more than 7 weeks up to 12 weeks - surgical abortion - vaccum aspiration with curettage
3. second trimester abortions
Post-abortion nursing considerations?
- 1. teach no tampons/douching for 1 week
- 2. birth control methods
- 3. infection s/s and check temp bid
- call MD if temp goes above 100
- 4. may resume light activity for few days - no strenuous activity
- 5. light bleeding for 1 to 2 weeks but should not get heavier
cervix dilated, plastic cannula, suction contents of pregnancy, currette the uterus to make sure all removed
Common complication of curretage?
What to teach pt about pain and discharge post abortion?
will have cramps for 30 min, bleeding, but should not be odor or weird discharge
Abortion during second trimester?
laminara tents (seaweed) inserted into cervix and expands the cervix, allows vacuuming of fetal contents
Toxic shock syndrome?
rare but fatal condition caused by staph aureus where a toxin alters capillary permeability
9 S/S of TSS?
hypovolemia, hypotension, shock, and defects in coagulation, fever 102/38.9, flulike s/s, generalized rash, peeling skin, watery diarrhea
6 nursing considerations/pt teachings for TSS?
- 1.educate women to avoid changing tampons or inserting diaphragm without washing the hands first
- 2. do not use super absorbent tampons
- 3. do not use tampons hs
- 4. do not use diaphragm during menses
- 5. remove diaphragm within recommended time