Women's Health

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Women's Health
2013-03-25 22:26:17
nursing women health

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  1. _____ & _____ are important in det and detecting health problems and risks.
    health history and physical assessment
  2. Health history anbd physical assessment includes what 5 things?
    family history, health history, vital signs & weight, auscultation of heart, and social history
  3. What is very important in interviews with women's health?
    health Hx so can do teaching
  4. Why is auscultation of the heart important in yearly exam?
    may not go to MD enough and not know have prob
  5. Sexual history?
    birth control, sexual history
  6. ____ % of women are overweight in the US.
  7. Obesity is BMI?
    30 or greater
  8. How can decreased weight improve health?
    decreased risk of DM, heart disease, cancers
  9. How can physical activity improve health?
    decreased weight, heart health, decreased osteoporosis with weight bearing activities
  10. osteoporosis
    thinning of bone
  11. Best way to Tx any probelm?
    early prevention, detection and treatment
  12. Prob with women and their health management?
    tendency to overlook health probs/issues and their S/S
  13. 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
  14. 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
  15. 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
  16. Discharge that is indicative of breast cancer?
  17. Best way to promote learning adherence to SBE?
    assessment of learning needs and readiness to learn the guidelines
  18. When should woman have mammograms?
    yearly age 40 & up

    if high risk of breast cancer will do sooner
  19. When is mammography used? 

    Next test?
    usually if suspiscious lump is found

    if still suspiscious then do MRI then may do biopsy
  20. 3 ways to prevent breast cancer by early detection?
    SBE, breast exam with pap, and yearly mammogram for 40 & up
  21. 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
  22. Intervention to make sure don't hurt during mammogram?
    do after periods
  23. Vulvar self exam should be done when?
    monthly in all women 18 and up or when they start having sex
  24. 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
  25. Cancerous lesion on labia?
    mole with irregular boarders - dark and light brown mixed is precancerous lesion
  26. 2 risk factors for vulvar cancers?
    HPV and melanoma
  27. 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
  28. speculum?
    opens up the vagina to view the cervix
  29. 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
  30. Equipment needed for pap smear? (7)
    speculum, gloves, glass slides or liquid pap/thin prep, spray fixative, cytobrush and spatula, cotton swabs, spcimen containers
  31. Pap smear AKA?

    2 components of the pap smear?
    sample and testing for STD's
  32. Bimanual exam?
    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
  33. When should pap smears begin?
    3 years after sexually active or age 21 if not sexually active
  34. When may pap smear be done every 2 years?
    if have liquid pap
  35. 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
  36. When can woman stop having pap?
    over 70 and no abnormal for the last 10 years
  37. What to teach pt about pap?
    • 1.  do them about 2 weeks after the period
    • 2. no sex or douching before the come in
  38. What should be done before the pap?
    empty bladder
  39. Screening during pap?
  40. 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
  41. Why does the MD squeeze around the outside of the vagina in exam?
    checking for the skene's glands and bartholin glands
  42. Lubricant for pap test?
    do not use water soluble lubricant until after speculum exam is done and sample collected
  43. 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
  44. Where are bartholin's glands?
    at the bottom of vagina
  45. Where are Skene's glands and their function?
    more at the top of vagina for lubrication
  46. What can happen to bartholin's glands?


    swell up esp with gonorrhea and chlamydia

    put a tube in and drain
  47. 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
  48. 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
  49. 2 types of SIL on Bethesda results?
    LGSIL low grade SIL - suggestive of precancer

    HGSIL - suggestive of cancer - high grade SIL
  50. What are ASCUS cells?
    cells that are abnormal but are not quite a cancer
  51. What is the major concern if Bethesda results say squamous cell cancer
    can metastisize
  52. 2 Bethesda abnormal results in glandular tissues?
    AGCUS - atypical glandular cell of uncertain significance

  53. AGCUS on Bethesda?
    atypical glandular cell of uncertain significance

    indicates cancer but don't know what kind
  54. 3 TX for abnormal paps?
    colposcopy, cryotherapy, leep procedure
  55. Colposcopy?

    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
  56. ______ will automatically cause pap to be abnormal even if no weird cells.
  57. Cryotherapy?

    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
  58. Pt teaching with cryotherapy?
    will have discharge for a few days
  59. Leep procedure? 

    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
  60. 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
  61. 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
  62. Always teach pt what about rectal occult test?
    put it in special biohazard envelope and return within 4-6 days
  63. 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

  64. Char of lumps in fibrocystic breast disease?
    lumpy, moveable, tender, usually in groups, vary in size
  65. Fibroadenoma?
    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
  66. Which breast disorder usually causes lumps in the outer quadrant of the breast?
  67. Tx for pain ass. with fibrocystic breast disease
    NSAIDS, vitamin E will decrease tenderness, apply heat to breast, decrease caffeine, chocolate, and nicotene
  68. Fibroadenoma that has been there a few months what will be done?
    biopsy, mammogram, ultrasound to be sure
  69. Who gets ductal ectasia?
    premenopausal and menopausal women
  70. 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
  71. What must be done if ductal ectasia S/S occur?
    biopsy to differentiate from cancer

    may have to remove milk duct
  72. When does intradermal papilloma occur?
    pre-menopausal or at menopause
  73. Intraductal papilloma?
    papillomas develop in epithelium of ducts under areola, causing trauma and erosion of ducts

    - may have serosanguineous or serous nipple discharge
  74. Use of ____ & _____ can increase and exacerbate breast cancer.
    progesterone and estrogen
  75. If you are diagnosed with breast cancer there is an 80% chance it will be _____
  76. 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
  77. The ____ the pt the greater the risk that a lump will be breast cancer.
    older - age 60 and up greatly increases risk
  78. 3 most common places breast cancer metastisizes to?
    brain, lungs, and bones
  79. Who finds most breast cancers?
    the pt through self exam
  80. Least common breast cancer?
    inflammatory - most malignant and worst kind to get
  81. 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
  82. 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
  83. Estrogen and progesterone receptor status?
    does the cancer have estrogen receptors
  84. 3 things tumor staging is based on?
    tumor, node, and metastasis (TNM)
  85. Tumor staging range and prognosis?

    4 is the worst prognosis
  86. Use of tumore staging?
    oncologist can use it to determine Tx
  87. Stage 4?
    have lymph node and metastasis
  88. Paget's disease?
    persitant lesion of the nipple and areola with or without a palpable mass

  89. 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
  90. Dx of Paget's disease?
  91. Teaching for pt about itchy dry nipples?
    put lotion on it.  if it is relieved it isn't cancer
  92. Most malignant type of breast cancer?
    inflammatory breast cancer
  93. 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
  94. Peau d'orange?
    orange peel appearance
  95. What should breast cancer feel like?

    Does it cause pain?
    will have an irregular shape b/c grows in tendrils

    usually has no pain
  96. What will be done if breast cancer is suspected?
    • mammogram
    • MRI to find out if it is solid or fluid - filled mass
  97. Therapeutic surgeries of breast cancer?
    breast conservation surgery, quadrantectomy, simple mastectomy, modified radical mastectomy, sentinel lymph node biopsy, adjuvant therapy will be used
  98. Breast conservation surgery?

    AKA lumpectomy

    only area that has the cancer is removed
  99. Quadrantectomy?
    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
  100. Simple mastectomy?
    removes entire breast but not all lymph nodes
  101. Modified radical mastectomy?
    removes breast, axillary nodes and some chest muscles
  102. 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
  103. In inflammatory breast cancer what type of surgery will be done?
    modified radical mastectomy
  104. 3 adjuvant therapies to surgery with breast cancer pt?
    radiation, chemo, hormonal therapy
  105. Radiation therapy?

    Nursing consideration?
    IMRT - intensity modulated radiation therapy

    may have skin marked to show areas where radiation should be done - do not ever remove these
  106. Chemotherapy?

    Nursing considerations?
    • 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
  107. Breast reconstruction methods?
    tissue expansion, tissue flap proceudres, nipple/areola reconstructions, tattoo
  108. 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
  109. Tissue flap procedure for breast reconstruction?
    remove portion of skin and create flap of skin to cover breast implant with
  110. Nipple and areola reconstruction?
    create a nipple with tissue from vaginal area
  111. Nursing considerations for pt with breast cancer or suspected breast cancer?
    psychosocial, sleep disturbances, diet, sexual issues, pain, warning S/S, education
  112. 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
  113. Leading cause of death in men and women?
  114. 9 Risk factors for cardiovascular disease?
    hypertension, sedentary lifestyle, overweight/obesity, poor nutrition, DM II, hyperlipidemia, cigs, post menopause, family Hx
  115. Most traumatic part of breast removal?
    don't feel like a woman and feeling like husband won't want them anymore
  116. 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
  117. Dietary concern with breast cancer?
    may have decreased appetite due to depression
  118. Lymph adenopathy?
    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
  119. Education for breast surgery pt?
    exercise very painful but need to move
  120. 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
  121. 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
  122. 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
  123. Orthostatic dizziness?
    dizzy due to position
  124. If you suspect a person is having a stoke what should you do?
    have them smile for you and ask them some questions
  125. 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
  126. Normal, prehypertensive, and hypertensive?
    • normal = < 120/80
    • prehypertensive - 120/80
    • hypertensive - 140/90
  127. Primary amenorrhea?
    failure to start menses by expected age

  128. When is primary amenorrhea suspected?
    if girl 1 year later starting than mother and sisters
  129. When is Turner's syndrome suspected as the cause of primary amenorrhea
    if secondary sex characteristics are also absent:  no body hair, breast dev
  130. Causes of primary amenorrhea other than Turner's syndrome?
    incomplete development of uterus, ovaries, or fallopian tubes
  131. Secondary amenorrhea?
    cessation of menses for 6 months after est menses pattern
  132. 4 possible causes of secondary amenorrhea?
    exercise, eating habits, systemic diseases, and stress, hormone problems like hypothyroidism
  133. 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
  134. Endometriosis?
    endometrial tissue found outside the uterus with unknown cause

    can be anywhere outside uterus
  135. S/S of endometriosis?
    cyclic excrutiating pain, dyspareunia, rectal pain, diarrhea/constipation, leads to infertility, endometriosis

    rectal pain - when they sit down it hurts
  136. Tx options for endometriosis?
    surgical - laproscopic lysis of adhesions, hysterectomy

    hormonal - oral contraceptives, testosterone derivatives
  137. The one thing that will help endometriosis?
    getting pregnant but can't get pregnant b/c of infertility
  138. Laproscopic lysis of adhesions?
    remove the lesions
  139. Why do many women get hysterectomy with endometriosis?
    so painful
  140. Testoserone therapy for endometriosis is what 3 drugs?
    danocrine and/or lupron

    OR synarel
  141. 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
  142. Education for women who are taking testosterone derivatives for endometriosis?
    need to be taking Ca and vit D supplements to combat bone loss
  143. oral contraceptives used for endometriosus?
    depo-provera q 3 months and/or mincronor
  144. Prob with oral contraceptives for endometriosis?
    causes weight gain
  145. 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
  146. 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
  147. PMS?
    premenstrual syndrome
  148. PMDD?
    premenstrual dysphoric disorder
  149. 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
  150. Best way to diagnose PMS?
    symptom diary
  151. 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

    4. antidepressants

    5. danazol helps with mastalgia

    6. diuretics

    7. prostaglandin inhibitors (NSAIDS)

    8. buspar - antianxiety

    9. oral contraceptives
  152. vitamins/interventions that may taken during PMS to improve mood?
    B6, Ca, Mg, increased complex carbs,
  153. Vitamin that can help relieve breast tenderness?

    Other med?
    vitamin E

  154. 2 ways anxiety may be treated during PMS?
    buspar and decreasing caffeine intake
  155. 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
  156. Menopause AKA?  AKA?

    What is it?
    climacteric period, change of life

    end of menses
  157. Premenopause?
    prior to cessation of menses but irregular menses
  158. Perimenopause?
    includes premenopause, menopause, and at least 1 year after menopause
  159. postmenopause?
    periods have ceased all together usually after 1 year without menses
  160. What should evaluated if a postmenopausal woman has vaginal bleeding?
    endometrial cancer
  161. 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,
  162. CV risk ass. with menopause?
    increased LDL and decreased HDL
  163. Cons of using estrogen and progestorone during menopause?
    cancer, stroke, heart disease, DVT, pulmonary emboli
  164. 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
  165. Pros of estrogen and progesterone during menopause?
    fewer hip fractures, lower colorectal cancer, lower uterine cancer
  166. Risk factors for osteoporosis?
    1. white, fair-complected, and thin

    2. family Hx

    3. sedentary

    4. smokers, drinkers, caffeine

    5. corticosteroid and anticonvulsant

    6. inadequate intake of Ca and vit D

    7. late menarch and early menopause
  167. Most common place fractured with osteoporosis falls?
  168. 2 cons of taking estrogen alone for tx of menopause?

    DVT but less risk than with progesterone and estrogen use
  169. Dexascan?
    Dual energy x-ray absorptiometry for osteoporosis
  170. When should ppl get dexascan xray done?
    screening should begin at age 65 or 60 if at increased risk
  171. 2 diff classifications of bone b/d?
    • osteoporosis - low bone mass
    • osteopenia - bone loss but not as bad as osteoporosis/ beginning of osteoporosis
  172. Pros of estrogen therapy alone with menopause?
    less hip fractures/osteoporosis

    no change in risk ass. with heart disease, colorectal cancer, or breast cancer
  173. Ca intake for premenopausal and postmenopausal women?
    • pre - 1000 mg/day
    • post - 1500 mg/day
  174. 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
  175. ppl 55 and over need _____ mg Ca per day
    1200 mg
  176. Nursing considerations for osteoporosis?
    • 1. suggest ways to increase safety concerns
    • 2. encourage lifestyles beneficial
    • 3. educate regarding following med regimens
  177. Adults up to 70 years old need _____ IU vit D per day and over 70 need _____ IU per day.

  178. Cystocele?
    anterior weakened wall of vagina no longer able to support bladder and bladder protrudes down into the vagina
  179. Ways to increase safety in pt with osteoporosis?
    nonskid footwear, no rugs,
  180. S/S of cystocele?
    stress incontinenece and cystitis

    bladdeer protrudes down into the vagina
  181. Stress incontinence?
    sneeze and pee
  182. Complication ass. with cystocele?
    increased UTI r/t urine staying in bladder too long
  183. Rectocele?
    herniated protrusion of the rectum into the posterior vaginal wall in which defecation of stool can be pused into the vagina
  184. What to do if woman has stool coming into vagina?
    can use digital manipulation to push the stool out
  185. Most common non-malignant tumor?
    uterine leiomyomas/fibroids
  186. Causes of uterine leiomyomas?
    usually atrophy with menopause unless estrogen is used
  187. Most common complaint with uterine leiomyomas?
    intermittent bleeding with clots
  188. S/S of uterine leiomyomas?
    heavy menstrual bleeding with clots, pain, increase in uterine size
  189. Tx of uterine leiomyomas?
    hysterectomy, myomectomy, uterine artery embolization
  190. 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
  191. PID - pelvic inflammatory disease?
    infection of the upper genital tract
  192. PID is ass. with ______ including _____, ____, _____, & _____.
  193. 2 types of ovarian cysts?
    follicular and luteal
  194. Follicular ovarian cyst?

    Ovarian follicle fails to rupture

    usually asymptomatic
  195. Luteal cyst?

    corpus luteum becomes cystic and fails to regress

    pain and late menses
  196. 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)
  197. 2 complications of PID?
    increased risk for infertility and ectopic pregnancy
  198. Most common S/S of PID?
    positive chandelier sign/cervical motion tenderness

    looks like they are trying to grab chandalier due to extreme pain
  199. Why does PID cause infertility?

    Other risk this causes?
    can scar fallopian tubes

    also at risk for tubal pregnancies
  200. Tx for PID?
    IV antibiotics first 48 h then po X 14 full days

    may need surgery if abscess occurs
  201. 4 reasons for elective abortion?
    • 1. social or economic
    • 2. rape or incest
    • 3. poor health of client
    • 4. birth defects
  202. 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
  203. 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
  204. Surgical abortion?
    cervix dilated, plastic cannula, suction contents of pregnancy, currette the uterus to make sure all removed
  205. Common complication of curretage?
    post hemorrhage
  206. 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
  207. Abortion during second trimester?
    laminara tents (seaweed) inserted into cervix and expands the cervix, allows vacuuming of fetal contents
  208. Toxic shock syndrome?
    rare but fatal condition caused by staph aureus where a toxin alters capillary permeability
  209. 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
  210. 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