medsurg lecture 5 exam 5

Premenstrual Syndrome (PMS)

Symptoms occurring during the luteal phase that resolve with menstruation

Very common: 75% of all women experience this

Sudden drop in estrogen and progesterone

causes of pms

breast tenderness, pain, bloating, headaches, fatigue

physical symptoms of PMS

mood swings, irritability, anxiety, sleep changes

emotional sympotms of PMS

exercise, reduced sodium/caffeine/alcohol

lifestyle changes to help reduce PMS

NSAIDs, SSRIs, oral contraceptives

meds for PMS

excess prostaglandins

Dysmenorrhea cause

first 24-48 hours

when does pain peak with Dysmenorrhea

24 hours before bleeding

when to start NSAIDs if having dysmennorhea

Primary Dysmenorrhea

painful menstruation that begins at puberty and has no clear cause

Secondary Dysmenorrhea

painful menstruation that begins during adult life, usually as a consequence of a pelvic disorder

dyspareunia, abnormal uterine bleeding, rogressively worsens month to month

Secondary Dysmenorrhea symptoms

Abnormal Uterine bleeding

Irregularities in menstrual frequency, regularity, duration, or volume

Acute AUB

heavy bleeding requiring immediate treatment

chronic AUB

abnormal bleeding for ≥ 6 months

Structural (PALM) and Non-Structural (COEIN)

causes of AUB

Tranexamic acid

med for heavy bleeding

uterine cancer

Post-menopausal women- must consider ______ ______ with AUB

Dilation & Curettage

Dilates cervix and scrapes endometrium

Used for acute bleeding control or diagnostic evaluation

Uterine artery embolization

cuts off blood flow to the fibroid- shrinking the fibroid

Fertility may be preserved depending on the cause

Myomectomy

surgical removal of uterine fibroids

Fertility-sparing procedure

Endometrial ablation

destroying the lining of the uterus (laser, radiofrequency, heat)

Not for patients who desire future pregnancy

Reduces or eliminates bleeding

Hysterectomy

Definitive treatment for structural causes or refractory bleeding

Surgical removal of the uterus, may include cervix, ovaries, fallopian tubes

fibroids, malignancy

Indications for Surgical Intervention

Failure of medical management

Severe or recurrent acute bleeding

Symptomatic _____

Structural abnormalities

Concern for ________

c

A 45-year-old client reports irregular, heavy periods for the past 4 months. Which finding would be most concerning and warrant immediate follow-up?

A. Presence of small clots during menstruation

B. Spotting between periods

C. Hemoglobin level of 7.8 g/dL

D. Mild lower abdominal cramping with bleeding

Polycystic Ovarian Syndrome

Common endocrine disorder affecting menstrual, metabolic, and reproductive function

insulin resistance and high LH: FSH ratio

causes of Polycystic Ovarian Syndrome

androgen, follicle development

insulin resistance and high LH: FSH ratio drive excess ______ production & impaired ______ ______-> anovulation, irregular periods, and multiple immature follicles

ovulation, infertility

POS: Infrequent or absent _______ -> infrequent or absent periods -> _______

acne

POS: High androgen levels: _____, excessive facial/body hair (hirsutism), thinning hair, weight gain

Polycystic ovaries

enlarged with multiple small, fluid-filled cysts seen on ultrasound

irregularities, androgen, Polycystic

POS Diagnosed based on the presence of 2 of the 3 criteria:

Menstrual ______

Signs of hyperandrogenism or elevated serum ______ levels

_____ ovaries on ultrasound

insulin, Metformin, Fertility, Anti-androgens

POS Treatment:

Lifestyle changes (diet, exercise) to improve ______ sensitivity

Combined oral contraceptives- regulate periods and reduce androgen symptoms

______ - for insulin resistance & regulate cycles

_______ treatment - if pregnancy desired

________- spironolactone for hirsutism and acne

DM, CVD, endometrial cancer

Untreated PCOS can lead to :

Menopause

Permanent cessation of menses for 12 consecutive months (age 45-55)

4-5 years

menopause Symptoms can last _________

Vasomotor, vaginal dryness, osteoporosis

menopause symptoms:

_____ instability (hot flashes, night sweats)

GU: ______ _____, pain with sex, urinary changes

Systemic: fatigue, insomnia, mood change, wt. Gain

MSK: bone loss -> _______ risk 

topical estrogen, clonidine, calcium and Vit D

Menopause Treatment - Symptom management

Hormone replacement therapy (short-term 4-5 years), ______ _______(for GU symptoms)

SSRIs, gabapentin, ______ (reduce vasomotor symptoms)

Self-care - ______ _____ supplements, exercise, yoga, sleep hygiene

Bacterial vaginosis

An overgrowth of bacteria in the vagina; characterized by itching, burning, or pain, and possibly a "fishy" smelling discharge.

vulvovaginal candidiasis

A yeast infection of the vagina and tissues at the opening of the vagina (vulva).

trichomoniasis

an STD caused by a microscopic protozoan that results in infections of the vagina, urethra, and bladder

Endometriosis

Endometrial tissue grows outside the uterus

Common chronic painful condition, age 30-40

Retrograde flow

cause of endometriosis

____ _____->endometrial tissue implants in pelvis. Leads to adhesions, scarring, chronic pain, bleeding + inflammation

pain, dysmenorrhea

sympotms of endometriosis

Severe cyclic pelvic pain, dysuria, _____ with bowel movements & sex, AUB, worsening _____

Infertility, risk of ovarian cancer

complications of endometriosis

Pelvic Inflammatory Disease (PID)

Infection of the upper reproductive organs

Gonorrhea, chlamydia, trichomoniasis infections, BV, gynecologic procedures, PPI

causes of PID

pelvic pain, fever, chills, purulent discharge, pain with sex & urination, N/V, AUB

symptoms of PID

b

A sexually active female presents with fever, lower abdominal pain, and purulent vaginal discharge. The nurse suspects pelvic inflammatory disease. Which statement by the client indicates a need for further teaching?

A. "I will take all of my antibiotics even if I feel better."

B. "It's okay to have sex again as soon as I feel well."

C. "I should return if my fever or pain gets worse."

D. "My partner should be treated as well."

Uterine Fibroids

Benign smooth muscle tumors of the uterus

Very common, 70-80% of women develop by the age of 50, and shrink after menopause

genetic mutation in uterine smooth muscle

causes of uterine fibroids

Heavy, Frequent, enlargement

uterine fibroid symptoms

_____ menstrual bleeding or prolonged

Pelvic pain and pressure

_____ urination or difficulty emptying

Painful intercourse

Abdominal _______, feel full or bloated

Infertility or pregnancy complications

wait and watch, contraceptives, uterine artery embolization, surgical removal, hysterectomy

uterine fibroids treatment

Ovarian Cyst

Fluid-filled sacs that develop on or within the ovary

Very Common in women of reproductive age

Follicular cyst

follicle fails to rupture → fluid accumulates

Luteal cyst

follicle releases egg but sac does not dissolve → seals & fills with fluid

Rupture, Ovarian torsion

complications of ovarian cysts

ultrasound

how are ovarian cysts diagnosed

NSAID, oral contraceptives, Surgery

ovarian cysts treatment

Pelvic Organ Prolapse

Descent of one or more pelvic organs into the vaginal canal due to weakened support structures

Cystocele

bladder proplase into anterior vaginal wall (most common)

rectocele

rectum buldges into posterior vaginal wall

Uterine Prolapse

descent of uterus into the vagina

feeling of "something coming down," dyspareunia, heaviness, urinary incontinence, constipation

symptoms of pelvic organ prolpse

child birth, advancing age, increased intraabdominal pressure

pelvic organ prolapse risk factors

Quit smoking, lose weight, Kegels

Non-surgical treatment of pelvic organ prolapse

connective, excess, sling

surgical treatment of pelvic organ prolapse

secures the involved organ with _____ tissue, may reduce ______ tissue, may need ______ to support the organs

Ovarian Cancer

Rare deadly cancer that begins in the ovaries

no symptoms until advanced

ovarian cancer symptoms

Endometrial (Uterine) Cancer

Most common gynecologic cancer, often detected early due to AUB

Endometrial biopsy, US

Diagnosis of endometrial cancer-

c

The nurse is caring for a postmenopausal client who reports vaginal bleeding. Which nursing action is most appropriate?

A. Reassure the client that postmenopausal spotting is normal B. Document the finding and schedule a routine gynecologic exam C. Refer the client for an endometrial biopsy

D. Encourage the client to monitor for heavy bleeding

Cervical Cancer

Cancer of the cervix - strongly linked to HPV infection

HPV

cause of cervical cancer

HPV vaccine

prevention of cervical cancer

b

A 33-year-old client is diagnosed with early-stage cervical cancer. Which finding in her history most likely contributed to the diagnosis?

A. Nulliparity

B. HPV infection

C. Early menopause

D. History of endometriosis

Vaginal and Vulvar Cancers

Rare gynecological cancers linked to HPV and chronic irritation

Risk factors: HPV infections (esp. vulvar), age, cervical cancer, smoking, lichen sclerosus

AUB or discharge, Pain with sex, pelvic pain

Vaginal Cancer symptoms

Persistent vulvar itching, Visible changes in skin color or thickness, Pain or bleeding

vulvar cancer symptoms

Partial Hysterectomy

only the uterus is removed

total Hysterectomy

removal of the uterus and the cervix

total with bso

Uterus + cervix + ovaries + fallopian tubes

radical hysterectomy

excision of the uterus, ovaries, uterine tubes; lymph nodes, upper portion of the vagina, and the surrounding tissues (abdominal)

sutured

After a total hysterectomy, the cervix is removed, and the top of the vaginal canal must be ______ closed to create a vaginal cuff

partial hysterectomy

In contrast, during a _____ ____, the cervix remains in place, so the top of the vagina stays naturally closed and vaginal cuff is needed

1 week

Spotting for ______ expected after hysterectomy

Sensation

_______ will not return for several months after vaginal hysterectomy

ovaries

If _____ removed -> hot flashes and mood change may occur

d

A nurse is caring for a patient on the first postoperative day following a vaginal hysterectomy. Which intervention is the highest priority?

A. Encourage the patient to cough and deep breathe every 2 hours.

B. Assist the patient with early ambulation to prevent venous thromboembolism.

C. Monitor the abdominal incision for signs of infection.

D. Assess vaginal bleeding and observe the perineal pad for excessive drainage

Sexual Assault 

forcible perpetration of a sexual act on a person without their consent through physical force, coercion, intimidation, threats or fear

shock

with SA, Treat _____ or other urgent medical problems first

STI, Emergency contraception

with SA, Prophylactic _____ treatment, _____ _____ if desired

d

A patient arrives to the emergency department stating she was sexually assaulted a few hours ago. What is the first action the nurse should take?

A. Encourage the client to take a shower

B. Notify law enforcement immediately

C. Perform a physical assessment and collect evidence

D. Ensure the client is in a private, safe environment