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  1. Menopause
    the end of menstruation and childbearing capacity

    define as 1 yr without menstrual period

    • perimenopausal (is when everything slows down)- menopausal changes are occuring (2-8 years prior to cessation period)
    • - s/s anovulatory (not ovulating) , irregular periods/heavy, hot flashes

    Post menopausal- time of life after menopause
  2. Hormonal influence
    • Increase in Follicle Stimulating hormone FSH- tells eggs to release- and this hormone is going to keep telling ur eggs to release. as it increases the harder it has to work to get the message across
    • if really high- menopause is occuring
    • if low- infertility

    • decrease in estrogen- huge player
    • decrease in progesterone
  3. Physiological Symptoms
    • Brain
    • - hot flashes, disturbed sleep, mood, memory problems

    • Cardiovascular
    • - puts women at risk for cardiovascular dx- b/c when estrogen decreases your HDL- increase CVD bc u build up plaque

    • Skeletal
    • - rapid loss bone density, increase risk of osteoporosis 

    • Breast 
    • - duct from the glands replaced by fat- bc of decrease in estrogen
  4. additional Physiological symptoms
    • GU
    • - vaginal dryness, stress incontinence, cystitis, dyspereuria (painful sex), bladder infection

    • GI
    • - loss calcium levels

    • Intergumentry
    • - skin dry and thin, collagen decrease

    • Body Shape
    • - more abdmoninal fat, waist size swells relative to hips.
  5. Vasomotor disturbances
    • Cause by vasodilation
    • - hot flashes, redness in chest, neck, face
    • - occurs 20-30 times a day
    • - profused sweating, especially at night

    • sleep disturbances (insomonia)
    • occasional chills
    • dizzy spells, palpitations, weakness
  6. Psychological effect
    • Personality changes
    • anxiety and or depression
    • fatigue
    • irritability
    • sleep disorder
    • decrease libido
    • poor self esteem
  7. Causes of Premature Menopause
    • Premature ovarian insuffciency (POI)
    • - 4-6 months without menstruation in women under 40
    • anorexia- skinny girls with the disease
    • chemotherapy
    • oophorectomy- removal of ovaries
    •   - counsel on symptoms of menopause
  8. Management of symptoms HRT (hormone replacement therapy)
    • Proceed with caution: short term only 
    • pt can go on estrogen unless if they have risk factors:
    • hx of breast cancer, hx of blood clots, heart attack, stroke

    it is mostly only used for woman who have a vasomotor or osteoporosis risk

    • estrogen therapy 
    • - a young woman who have undergone a hysterectomy

    • combined estrogen with progestrone- ept
    • androgen/estrogen androgen to increase libido

    short term 3 years
  9. Management of symptoms (HRT)
    • Vaginal Atrophy
    • - causes increase PH, incre susceptobility to infection, decrease circulatory results

    • Treatment
    • estrogen vaginal tabs, premarin cream, estring, testorone, otc creams
  10. Management of symptoms Lifestyle changes
    • Lower room temp- use fan
    • wear clothing layers- to remove
    • limit caffeine and alcolhol intake
    • drink 8-10 glasses of water/day
    • stop smoking/cut back
    • avoid hot drinks/spicy food
    • take calcium, vit d (green leafy veg, milk, dairy, soy, yogurt, fatty fish- salmon, sardines, breads enriched in vit d.)
    • try relaxation technique, deep breathing and meditation
    • excerise daily (not before bed time)
    • maintain a healthy weight
    • identify stressors and try to manage them.
  11. Menopausal Women at risk for
    • Osteoporosis
    • CVD- weight gain contributes
    • DM due to weight gain
  12. Osteoporosis
    condition in which bone mass declines to such such extent that fractures occurs with minimal trauma 

    bone matrix is tight. Calcium leaves and osteoblast stops developing u get poris bones. 

    Elderly woman- fracture hip joint, fracture back, forearms (wrist). 

    Dywers hump- decrease bone mass in vertebrae
  13. Risk Factors osteoporosis
    • Increasing age
    • post meno status w/out hormone replacement
    • small frame- thin woman
    • caucasain/asain
    • RA
    • low calcium and vit d intake
    • anorexia/bullumia
    • hx of osteoporosis
    • sendentary life
    • hx treatment w/anacid, heparin, thyroid replacement drugs
    • smoking or consuming alcohol
    • excessive amt of caffeine
    • impaired eye sight- fall 
  14. Treatment Prevention!!!
    • Education- primary
    • - weight bearing excerises- jogging, walking, running, tennis, dancing- (not weight bearing swimming, biking etc)
    • smoking cessation
    • fall prevention strag.
    • adequate intake of calcium and vit d.

    • Screening- secondary
    • Bone density screening 
    • dual energy x-ray (DEXA)
  15. Pharmacological treatment
    • calcium supplements (1500mg) oscal, tums
    • HRT (premarin)
    • Evista/fosamax- 
    • parathyroid hormone- controls ur vit d production
    • calcitonin (miacalcin)
  16. CVD
    • Role of estrogen for cardiovascular system
    • - protects
    • - smoothens, relaxes and dilates blood vessels
    • - boost HDL cholesterol and lowers LDL
    • - keeps arteries from plaque accumulation

    when u take estrogen away ur HDL lowers and ur LDL is higher
  17. CVD risk factors
    • post menopausal
    • smoking
    • obesity
    • high fat diet (dyslipdemia
    • sedentary lifestyle 
    • family hx of cardiovascular disease
    • HTN
    • apple shaped body
    • DM
  18. Prevention CVD
    • Education
    • - good nutrition
    • - increased activity
    • - excerise
    • - smoking cessation
    • - decreased alcohol intake
    • - weight reduction
    • - familarize women with signs of myocardial infarction (present with MI differently- epigastric pain, tired and fatigue)
    • - low salt
  19. Education for all menopausal women
    • weight bearing excerise
    • kegal exerise- pelvic loosen bc estrogen decre
    • risk/benefits HRT- short term
    • relaxation techniques-
    •  - yoga medication, deep breathing techniques
    • avoid foods that are triggers- like hot coffee
    • dietary restriciton- esp cv people
  20. Nursing Assessment and management of menopause
    • Education on the need of screening
    • - screening for osteoporosis
    • - assesst of BP to identify HTN
    • - check cholesterol- hyperlipidemia
    • - mammogram screening (breast cancer)
    • - pap smears (rectal/colon cancer)
    • - bone density
    • - assessment of lifestyle and how to prevent chronic conditions
    • - education regarding alternative method and side effects (soy has estrogen in it)
  21. Hysterectomy
    • Surigical removal of the uterus
    •  Types
    • radical- removal of the uterus, cervix, ovaries- everything and the vagina is left
    • total- THA- uterus and cervix is removed
    • subtotal/partial- the upper portion of the uterus is removed leaving the ovaries and cervix intact

    • sometimes they leave the cervix intact to help with dryness
    • sometimes they leave one ovary in or two (but they don't like two because it can bring them into menopause)

    • Methods
    • laproscopic assisted hysterectomy-
    • vaginal hysterec- an incision in the vagina
    • abdominal hysterectomy- incision in the abd (horon/bikini

    • Indication
    • endometrosis
    • disfunctional bleeding 

    • when you take the ovaries out- ophrectomy
    • salpingo- tube removal

    • Methods
    • Lapa
  22. reasons why u would have hysterectomy 
    disfunctional bleed, tumor, fibriods- partial
  23. Types Advantage/disadvantage 
    • Vaginal advantage
    • - early ambulation
    • - decrease pain
    • - decrease blood loss
    • - no scar
    • - shorter hospital stay
    • - can be used for removal of ovaries
    • used for pelvic floor disorders and prolapse

    • disadvantage 
    • - limited surgical view- u can develop a hematoma
    • laparoscopic assisted vaginal hysterectomy 

    anethesia- spinal, light sedation
  24. Types advantages/disadvantages
    • Surgical "bikini"- incision lower abdomen
    • advantage: increase surgical view
    • used for TAH/ BSO
    •  disadvantage 
    • - need GA
    • - longer stay in the hosp
    • - more pain
    • - visible scar
    • - higher cost

    laparosopically assisted abdominal hyster..
  25. Risk for all types
    • post op infections
    • hemorrhage
    • UTI
  26. Care for women with a hyster
    Pre op

    Post op


    review p242 

    review very well
Card Set:
2014-09-13 03:02:46

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