Reproductive Test 6

What problem is this for Pelvic support?

Downward displacement of the uterus into the vaginal canal

Uterine prolapse

What problem is this for Pelvic support?

Weakening between the vagina and bladder are weakened. Bulging of anterior vaginal wall when the client bears down.

Bludging of bladder into vagina

Causes: Urinary stasis

Pelvic exam: Xray for degree of this

Cystocele

What problem is this for Pelvic support?

Weakening between the vagina and rectum. Bulging of posterior vaginal wall when the client bears downs

buldging of bladder into rectum

Causes: Constipation

Rectal exam

Rectocele

What is the treatment for prolapse?

Kegel exercises, Pessary for support. Teach patient how to insert, remove, and clean

Notify for pain, discomfort, or discharge

What is the prolapse teaching for Colporrhaphy?

Report signs of infection, avoid straining with defecation, tighten and support pelvic muscles when sneezing/ coughing, avoid heavy lifting, no intercourse for 6 weeks

What type of cancer is this?

Second most cause of cancer related deaths in women

Early diagnosis for best outcome

Breast cancer

What are the teachings for breast cancer?

Teach monthly BSE 1 week after menses, and yearly mammograms after 40

What is the greatest risk factor for breat cancer?

Age

What stage of breast cancer is this?

Tumor 2 cm or less with no lymph node spread and no distant metastasis

Stage 1

What stage of breast cancer is this?

Tumor may increase in size with possible spread to nearby lymph nodes; no distant metastasis

Stage 2

What stage of breast cancer is this?

Tumor may increase in size with possible spread to lymph nodes, chest wallm or skin; no distant metastasis

Stage 3

What stage of breast cancer is this?

Tumor of any size with direct extension to chest wall or skin and with distant metastasis

Stage 4

What are the long term complications for breast cancer surgery?

Shoulder immobility, pain, lymphedema

What is this disorder related to reproductive?

Less common first few years after menarche ( average age of first menses in 12,4 years)

More common as regular ovulatory cycles are establish; cycles typically 28 days long ovulation occurs around day 14

Symptoms:Abdominal cramping, headache, N/V

Dysmenorrhea (difficult monthly menses)

What is the difference between DCVIS and LCIV?

Ductal lesion occur in and are limited to the lining of the milk ducts

Lobular lesions occur in the lobules where milk is produced

What are the radiation side effects for breast cancer?

Bleeding, Infection, tiredness, emesis, skin changes (BITES)

What are the risk factors of Dysmenorrhea?

Smoking and 10% related to pelvic patho like endometriosis

What is the medical management for Dysmenorrhea?

NSAIDS (begin 1-2 days prior to onset of menses

Combined oral contraceptives

Non-pharm therapies: TENS, herbal preparations, heat, physical therapy, diet

What is this female reproductive disorder?

Symptoms: Dysmenorrhea, excessive bleeding during menses, dyspareunia, infertility

Most common cause of secondary dysmenorrhea

Endomentrial tissue found on outside of uterus implanted on other body structures: Ovaries, fallopian tubes, bowel)

Hereditary link

Endometriosis

What is the medical diagnosis for endometriosis?

Laparoscopy and biopsy of suspected lesions

What are the treatments for endometriosis?

Oral contraceptives FIRST

GnRH agonists- cause ovaries to STOP making strogen and progesterone (administer with calcium and vitamin D supplement)

What are the complications for Endometriosis?

Scarring - chronic pain, infertility

Catamenial pneumothorax - endometrial implants on the lungs result in cyclic pneumothorax associated with the menstrual cycles

What female reproductive disorder is the?

Symptoms: Hot flashes, Atrophy of the vagina, Vaginal dryness, Osteoporosis risk, Cardiovascular risk, Sleep disturbances. HAVOCS

12 months of NO vaginal bleeding (Amenorrhea)

Occurs on average at age 50-51

Ovaries fail and estrogen production declines

Menopause

What is this type of menopause?

Time that precedes menopause approx 4 years

Irregular bleeding occurs (metrorrhagia)

Decreased fertility

Perimenopause

What is the good and bad of Estrogen treatment for menopause?

Good: Most effective for treatment of menopause

Bad: Increases risks for breast cancer, increases risks for embolism causing stroke

What are the complications for menopause?

Osteoporosis and bone loss, Increased risk for cardiovascular disease

What is this female reproductive disorder?

Found in 70%-80% of women; more common in african american women older than 30 who have never been pregnant

Most common solid benign tumors of female pelvis

AKA uterine leiomyomas associated with vaginal bleeding

Symptoms: Excessive vaginal bleeding (menorrhagia), anemia, pelvic pressure resulting in dyspareunia, dysuria

Fibroids

What are the complications of large fibroids?

Impaired renal function (monitor BUN and Creatinine), Anemia (monitor hemoglobin and if less than 7 consider transfusion), Leiomyosarcoma

What is this female reproductive disorder?

Fifth most common cancer found in women

70-75% not discovered until late stages; causes most gynecological deaths

The CA 125 can be useful in diagnosis:ascites

Symptoms: Bloating, Pelvic or abdominal pain, Early satiety or problems eating, urinary urgency or frequency, and Ascites (LATE STAGES)

Ovarian Cancer

What are the risk factors to Ovarian Cancer?

Hormonal replacement therapy, advanced age, use of infertility meds, Family Hx

What is the protective effect for ovarian cancer?

Breast feeding, pregnancy, oral contraceptives

What is this female reproductive disorder?

Most common gynecological cancer in the US

Primarily occurs in post menopausal women

AKA endometrial cancer; associated with vaginal bleeding after menopause

Symptoms: Vaginal bleeding especially postmenopausal women with it

Uterine cancer

What are the risk factors for uterine cancer?

Unopposed etrogen exposure; with out progesterone, Obesity, nulliparity, late menopause

What is this female reproductive disorder?

13th most common cancer in women in US

It is in the top 10 cancers among black women, American Indian, or Alaska Native, and Hispanic Women

Most often related to HPV virus

Risk factors: Human papillomavirus, Herpies simplex 2, smoking, douching, poor nutrition, oral contraceptive use

Vaginal bleeding

Cervical cancer

What are the preventions for cervical cancer?

Delay sexual intercourse, avoid smoking, practice safe sex, gardasil vaccine

What diagnostic test is this for the male reproductive?

measures amount of protein produced by the prostate gland in the blood

Normal value is < 2.5 but increases with age; greater than 4 needs follow up

Check before DRE to avoid false positive

Prostate specific antigen (PSA)

What diagnostic test is this for the male reproductive?

Yearly screening for men over the age of 50-70

Normal size is similar to a walnut

The patient will lean over the table or lay on one side in a lithotomy position

The provider palapates the posterior portion of the prostate gland through the rectal wall using lubricated gloved finger

Digital Rectal Exam (DRE)

What male reproductive disorder is this?

Enlargement of the prostate

Symptoms: Difficutly starting flow of urine, weak urine stream, multiple interruptions during urination, dribbling once urination is complete, urgency, nocturia, may lead to bladder outlet obstruction

LUTS and BOO symptoms

Risk factors: Increased age, smoking, alcohol, sedentary lifestyle, obesity, western diet, diabetes, heart disease

50% of men aged 51-60

90% of men over age 80

Benign Prostatic Hyperplasia

What surgical management is this for Benign Prostatic Hyperplasia?

Most common surgical procedure

Endoscopic instrument inserted through the urethra meatus into urethra. Part of prostate is removed in small pieces. The small pieces are continuously irrigated away through the scope

Advantage: Erectile dysfunction unlikely

Disadvantage: Bleeding, Retrograde ejaculation semen enters the bladder instead of out the penis

NEED TO MONITOR FOR BLEEDING

Transurethral Resection of the Prostate (TURP)

What male reproductive disorder is this?

The inability to maintain an erection sufficient for sexual intercourse

30 million suffer from this

Risk Factors: Prostatectomy, Pelvic fracture, vascular disease hypertension, chronic neurology conditions, endocrine disorders, diabetes/thyroid, smoking and alcohol, medications-hypertensives, poor overall health

Erectile Dysfunction

What is the the teaching for a patient geting a Penile Doppler ultrasound?

Teach no ED meds 2 days prior to test

What are these medications used for ED?

Phosphodiesterase type 5 inhibitors

Taking these may cause sudden hypotension

Silendafil, vadrenafil, tadalafil

What are these medications used for ED?

Medicated urethral system for erection

Urinate before application to improve action

Alprostadil

What are these medications used for ED?

Results in immediate erection

Rare chance of priapism

Intracavernosal injection

What are these medications used for ED?

A cylinder is placed around the penis while a vacuum is created to draw blood into the penis

A rubber ring is applied to maintain the erection

Vacuum constriction device (VCD)

What medication is this for BPH?

5-alpha-reductase inhibitor

Limits the production of DHT

Can take up to 6 months for full effects

SE: Impotence and decreased libido

POTENTIAL risk to fetus if pregnant women in contact with this med

Finasteride

What medication is this for BPH?

Alpha-adrenergic blockers

relax the smooth muscle of the prostate

SE: postural hypotension; change positions slowly

Tamsulosin

What is this surgical management for ED?

An inflatable tube is placed in the penis with the inflation bulb in the scrotum

The male compresses the bulb to inflate the tube, creating an erection

There is a 90% success rate with the implant

Penile Prosthesis

Can be caused by bacteria, viruses, or parasites

Infectious diseases spread through sexual contact with the penis, vagina, anus, mouth, or sexual fluids of an infected person

Risk Factors: Alcohol, drugs, new or Hx of it, More than one sexual partner, sexual partners who have had multiple partners, inconsistent condom use

Can be spread by: Skin to skin, blood or blood products, autoinoculation

Sexual transmitted infections

What are the bacterial STI’s?

Chlamydia (Genital Herpes), Gonorrhea (Genital warts), Syphilis (HIV)

What is a parasitic/protozoan STI?

Trichomonasis (HEP B and C)

What are the reportable STI’s?

Gonorrhea, Syphilis, HIV, Chlamydia (Good, Sex, Has, Consequences)

What are the HIGH risk populations for STI’s?

Adolescents with early onset of sexual intercourse, Some ethnic groups, Men who have sex with men, incarcerated individuals, transgender women, victims of sexual assault, person of low socioeconomic status

What is this STI?

Very common and precursor to cervical cancer

Virus that is transmitted through genital and oral sex; congenitally from mother to fetus

Can become systemic entering blood and lymp system

Symptoms: Asymptomatic (Routine screening for females 21-65 PAP) or genital warts

Need Pap test or colposcopy for diagnosis

Human Papillomavirus

What is this STI?

Can cause serious long term complications if not treated; 12 million affected

Most affected people are men who have sex with other men

It is bacterial and transmitted through genita and oral sex; mother to fetus

Has 4 stages

Diagnosed through blood work

Syphilis

What stage of syphilis is this?

Painless, hard lesions develops (chancre)

Primary Stage

What stage of syphilis is this?

Maculopapular rash develops on palms of hands and soles of feet

Secondary stage

What stage of syphilis is this?

No S/S what so ever but can damage the heart silently

Late stage

What stage of syphilis is this?

Gummas cause damage to internal organs; may result in vavular problems, seizures, issue in mobility, and eventually paralysis

Tertiary Stage

What should do teach about HPV cream medications?

Do not use if pregnant

What is this vaccine?

Given 2 to 3 IM doses over a 6 month period

Initiate as early as age 11 up to 26

HPV prevention

Gardasil

What medications are used for Syphilis?

Penicillin IM single dose and Doxycycline orally if allergic to PCN: do not give if pregnant

What is this STI?

Highly Contagious through open skin

More common in Women

Symptoms: Episodic outbreaks; one or more clear vesicles and vesicles ruptures forming painful ulcers on genitals

Diagnosed through visual inspection, cell culture, and blood work

Genital Herpes

What medications are used to treat Genital Herpes?

Antiviral Meds (Vir meds) and Suppressive therapy if 6 or more outbreaks in a year occur

What STI is this?

Primarily infects the urethra and cervix; may lead to conditions such as conjuctivitis, pharyngitis, and pneumonia

Often occurs with gonorrhea but incidence of chlamydia

Bacterial infection; 1 to 3 week incubation period and most have no early signs; result in dysuria with discharge

Unusual vaginal bleeding or discharge, Painful urination and painful intercourse

Diagnosis is through swab specimen and nucleic acid amplification test

Chlamydia Trachomatis

What is the medical managment for Chlamydia Trachomatis

Doxycycline twice a day for 7 days

Azuthryomycin in one dose best for noncompliance

What is this complication that affect men and women with Chlamydia?

Rare, autoimmune arthritic condition that causes urethritis, or inflammation in the urinary genital tract, and conjuctivitis, an inflamation of the mucous membranes lining the eyes

Reiter’s syndrome

What is this STI?

Second most common bacterial STI

the CLAP

May lead to systemic complications such as arthirits, tenosynovitis, and skin lesions

Bacterial transmitted by skin/mucous membranes; incubation period is 1-14 days

Diagnosis is NAAT assay and Gram staining

Neisseria Gonorrhoeae

What medications are used for Neisseria Gonorrhoeae?

Dual therapy with cephalosporin and macrolide

IM ceftriaxone and oral azithromycin

What should we not use for Neisseria Gonorrhoeae?

Do not use fluoquinolones due to resistance

What is this STI?

More commin in women especially with HIV

Incubation is 1 week to 1 month can lead to PID

Diagnosis is NAAT testing and Pap smear with wet mount to detect the presence

Men: Burning with urination or ejaculation or uethral discharge

Women: Painful urination, vaginal itching, painful intercourse, bleeding after sex, or yellow green discharge with foul odor; strawberry appearence in exam

Trichomoniasis

What medications are used for trichomoniasis?

Metronidazole (avoid alcohol)

What is this complication in STI?

acute infection from vagina or cervix ascends to upper genital tract, infecting uterus, fallopian tubes, and ovaries

Symptoms: Lower abdominal pain, uterine tenderness, purulent discharge, adnexal tenderness, cervical motion tenderness

Complications: chronic pelvic pain, infertility, ectopic pregnancy

Diagnosis is a clinical picture

Treatment is Ceftriaxone and oral antibiotics, metronidazole or doxycycline

Pelvic Inflammatory Disease

What is this opportunistic infection?

Aka PCP

This is the most common illness associated with AIDS

Prevention with TMP-SMX as prophylaxis

S/S: Fever, fatigue, dyspnea, non-productive cough

Pneumocystis Jurovecii

What is this opportunistic infection?

Herpes virus common in patients with HIV

Causes vision impairment and possible blindness and can spread to other organs like GI and lungs

Cytomegalovirus (CMV)

What is this opportunistic infection?

Primarily affects the brain, Pt c/o headache

Monitor for seizures

Prevention: avoid raw meat; cat feces and treated with TMP/SMX

Toxoplasmosis

What is this opportunistic infection?

Most common cancer r/t AIDS

Painless small purple like lesions appear anywhere on the skin surface or on internal organs; treated with chemo

Karposi’s Sarcoma

What does the ELISA test do for AIDS?

Screens for antibodies

What does the Western blot test do for AIDS?

Screens for antigens

What are the Postexposure Prophylaxis Guidelines for blood exposure or needle stick injury?

Wash immediately with soap and water

Treatment within hours of exposure for 4 weeks with antiretrovirals

Go to department and get immediate help

What is this drug used for HIV?

Nucleoside Reverse Transcriptase Inhibitors

Blocks Reverse Transcriptase preventing synthesis of viral DNA

Used in combination with other HAART

Zidovudine (AZT)

What is the medical treatment if pregnant and taking antiretrovirals?

Can take if pregnant and the baby will take the meds for first 6 months after birth

C section is required at 38 weeks