Exam 1 - ch 52, 52, 54

hormones of menstruation

-day 1-5: releases FSH and egg matures

-day 6-13: estrogen released, causes vascularization of uterine lining

-day 14: released LH, causes rupture of graafian follicle and release of mature ovum

-day 15-28: developing corpus luteum releases estrogen and progesterone

testes (testicles)

maintains temp for sperm production and storage, testosterone

ductal system

transports and stores sperm

-epididymis, ductus deferens, ejaculatory duct and urethra

accessory glands

produce seminal fluid

urethra in males

conveys urine from the bladder and carries sp*erm to the outside

ovaries

release progesterone and estrogen; release egg during menstrual cycle

fallopian tubes

Fertilization occurs here

uterus

consists of endometrium, myometrium, perimetrium

-3 parts: fundus, corpus, cervix

v*gina

-lined with mucous membrane- responsible for lubrication

-passage of infant during birth

s/s of toxic shock syndrome

fever, low BP, headache, desquamation of the palms (skin peeling)

menopause

-occurs in women between ages 42-58 (avg is 51)

-hormone levels decrease

-hot flashes caused by decreased estrogen production

-vagina loses elasticity

-breasts and vulva lose adipose tissue → tissue turgor

-brittle bones → osteoporosis

papanicolaou test (pap smear)

-a sample of cells are collected from the cervix, stained and then examined under the microscope

-most widely known for its use in the early detection of cervical cancer

-recommendation is begin tests within 3 years of sexual activity or no later than 21 years

-test every 2 years

colposcopy

-used to visualize color, the presence of growth and lesions and vascular condition, and obtain specimens

-douching or having intercourse within 24 hours is not recommended

-usually not done during menstruation

culdoscopy

-visualization of the uterus, ovaries, and fallopian tubes

-done under anesthesia

-helps view tumors, cysts, endometriosis, and conization (removal)

-post op: monitor for bleeding, VS, voiding

laparoscopy

-small abdominal incision w/ insufflation (with CO2)

-under general anesthesia

-used for visualization of uterus, fallopian tubes, ectopic pregnancy, PID, biopsies

-post op: pt are going to uncomfortable d/t gas- help pts move around; may have flatulence and burp; monitor for s/s of infection, incision site

biopsy

sample of tissues are taken for evaluation using needle aspiration, forceps or incision

-breast bx: when mass is palpable, suspicious areas on mammogram; can remove all or portion of growth

-endometrial bx: for endometrial cancer and infertility studies; during menstruation; anesthesia given

mammography

radiography of the soft tissue of the breast (around age 45- annually)

-average breast tumor is present for 9 years before palpable

-pts should not use body powders, deodorants, and ointments on breast area

-greater density of breast tissue in younger women can cause to be less sensitive

-with BRCA- also MRI

-US used for further exploration

serum CA-125

cancer marker for ovarian cancer; also endometriosis, PID, pregnancy, etc

testicular biopsy

uses aspiration of incision

-after care: scrotal support, ice pack, pain relief, sitz baths

semen analysis

for evaluation fertility, evaluating effectiveness of vasectomy, ruling out/determining paternity

cystoscopy

done to visualize or Bx prostate and bladder

-consent sign; done under sedation or anesthesia

-may have pink-tinged urine, and greater frequency and burning urination

-HCP may restrict baths, warm cloth

amenorrhea

absence of menstrual flow

-primary: when menarche has not occurred by age 18

-secondary: menarche has occurred but flow has ceased for at least 6 months

dysmenorrhea

painful menstruation

-primary: not associated with pelvic disorders; develops when ovulatory function is established; disappears or declines after pregnancy

-secondary: in women who have normal periods; cause is linked to disorders of the reproductive tract (i.e. fibroid tumors, PID, STIs)

-stress and anxiety can also play a part

menorrhagia

excessive bleeding at the time of the regular menstrual flow; increased duration or amount, or both

-ask woman to keep log- record dates, type of bleeding, also how many tampons and pads used

metrorrhagia

appearance of uterine bleeding between regular menstrual periods or after menopause; may indicate cancer of benign tumors of the uterus and ovaries (in post menopausal women)

-ask woman to log her menstrual and bleeding history

premenstrual syndrome (PMS)

grouping of symptoms (physical and emotional) that affect women coinciding with the woman’s menstrual cycle

-behavioral: anxiety, mood swings, lethargy

-physical: headache, backache, breast tenderness, acne

menopause

phase of the aging process where a woman transitions from a reproductive phase to a nonreproductive stage- normal cessation of menses

-perimenopause: state of transition to menopause; can begin as early as mid 30s and last 4 years

vaginitis

common vaginal infection; can be bacterial or inflammatory

-E. coli is a common cause

-s/s: yellow, white or grayish-white exudate; curd-like; pruritis, burning and edema of surrounding tissue; voiding and defecation generally intensity symptoms

-use medication at bedtime; remain recumbent for more than 30 mins after insertion

senila vaginitis or atrophic vaginitis

-low estrogen levels cause the vulva and vagina to thin and atrophy→ more susceptible to bacterial invasion

-exudate causes pruritis, edema and skin irritation

-seen most commonly after menopause

-estrogen, vaginal suppositories, and ointments may be prescribed

-sustain from vaginal intercourse or instruct partner to wear a condom

cervicitis

inflammation of the cervix; various causes but linked to STIs; bacteria can also be a cause; cervical caps diaphragms

-s/s: dyspareunia (painful intercourse), vaginal pain, pelvic heaviness, abnormal vaginal bleeding, gray, white or yellow discharge

-tx is specific to causative organism- if not tx, can spread to pelvic organs

pelvic inflammatory disease (PID)

most commonly caused by gonorrhoeae, chlamydia, strep, staph, tubercle bacilli

-s/s: fever, chills, severe abdominal pain, malaise, n/v, malodorous purulent vaginal exudates

-gram stain of secretions and control and eradicate infections

PID: 4 points for discharge

-s/s to report to the HCP

-medication therapy

-personal hygiene practices to reduce infection

-can lead to complications and strictures of the fallopian tubes resulting in scarring; increases risk for ectopic pregnancy and infertility

endometriosis

a condition in which the endometrial tissue appears outside the endometrial cavity

-dysmenorrhea is the most common complaint

-US and laparoscopy with biopsy

medical management and nursing interventions -endometriosis

-MM: high dose of anti-ovulatory meds, believed to slow progression of disease; in severe cases laparoscopy or laser removal; most severe- hysterectomy

-NI: pt education regarding meds, report vaginal bleeding, assist with comfort measures (warm compress), eating a balanced diet and regular exercise

vaginal fistula

an abnormal opening between 2 organs- ulcerating process resulting from cancer, radiation, weakening of tissues by pregnancy, and surgical interventions

-can be urethrovaginal, vesicovaginal, or rectovaginal

-s/s: exudate has the distinct odor of urine and feces; bladder infection; constant trickling of urine into the vagina, feces and flatus to enter the vagina

cystocele and rectocele

when the tissue, muscles and ligaments that support the uterus and perineum have been stretched and weakened

-cystocele: bladder into the vagina (incomplete emptying of bladder)

-rectocele: rectum into posterior vaginal wall (causes constipation, rectal pressure, heaviness, hemorrhoids)

-s/s: urinary urgency, frequency and incontinence; fatigue; pelvic pressure

-anteroposterior colporrhaphy (shortening of the muscles that support the bladder) and repair of the rectocele

nursing interventions -cystocele and rectocele

-ensure clean operative area

-enema for empty bowel

-liquid diet for 48 hours before surgery

-post op: check vs, monitor for hemorrhage

-foley cath and stool softener

-early ambulation

-no lifting heavy objects or standing for long periods

-no sexual intercourse for 6 weeks

cancer of the cervix

neoplasm that can be detected in the early curable stage by pap smear

-linked to sexual behavior, STIs, HPV, smoking

-s/s: silent in early stages; leukorrhea (vaginal discharge) and vaginal bleeding or spotting (most often occur after intercourse or menopause); can be watery to dark red and malodorous

-if tumor invasive, pt may report back and leg pain, weight loss, malaise

medical management -cancer of the cervix

gardasil vaccine (reduce incidence of HPV); cervix vaccine

-carcinoma in situ is tx by removal of affected area

-early cancer is tx with hysterectomy and/or intracavity radiation

-for more extensive, radical hysterectomy with pelvic lymph node dissection

cancer of the endometrium

usually affects post menopausal women; usually adenocarcinoma

-can be localized or spread to cervix, bladder, rectum, lymph nodes

-s/s: abnormal bleeding (post menopausal women or spotting between cycles), may report abdominal pressure or pain, pelvic fullness

medical management and diagnostics -cancer of the endometrium

-diagnostics: pelvic and rectal manual examination, US, endometrial biopsy

-MM: depends on stage of tumors; surgery, radiation or chemotherapy; for early TAH-BSO is done followed by intracavity radiation

-is slow growing and metastasis occurs late

cancer of the ovary

fifth most common cause of cancer death in women

-early stage is asymptomatic; by time of discovery, metastasis

-risks: nulliparous, delay childbearing until 35, hormone therapies after menopause, high-fat diet, exposure to industrial chemicals

-s/s: vague abdominal discomfort, flatulence, mild gastric disturbances, pressure, bloating, change in bowel habits, menstrual irregularities

*observe for increase in abdominal girth

medical management and diagnostics -cancer of the ovary

-diagnostics: annual bimanual pelvic exam, to assess ovaries- rectovaginal exam, CT scan, tumor biopsy for staging, aspiration of ascitic fluid to detect cancer cells in the fluid, blood test to determine high CA-125, vaginal US

-MM: surgery alone or in conjunction with radiation or chemotherapy (depends on staging)

hysterectomy

removal of the uterus, cervix, fallopian tubes, ovaries, and sometimes other structures

-can be subtotal (only uterus), total (uterus and cervix), TAH-BSO (uterus, cervix, fallopain tubes, ovaries), laparoscopic, or radical (includes pelvic lymph nodes)

-vaginal: for prolapsed uterus (uterus removed through the vagina)

-abdominal: used for visualization

hysterectomy pre and post op nursing interventions

-pre: instruct pt how to cough, turn and deep breath, empty colon, low residue diet (limit fiber foods), catheter day of surgery, antiseptic vaginal douche, NPO after midnight

-post: assessment Q4H first day after surgery, assess lung fields, splint abdomen with pillow, incentive spirometer, urine output, early ambulation

breast self exam- pt teaching

-for premenopausal, 7-8 days after conclusion of menstruation, and postmenopausal, same day each month

-visual inspection and palpation should be done

-always examine the axillae

-specific examination of the nipple, compression for discharge

lumpectomy

breast conservation surgery; circumscribed area is removed along with the tumor; breast contour, muscle support, and nipple preservation

-followed by 6 weeks of radiation

simple mastectomy

removal of the entire breast; skin flap retained; pectoralis major and minor left intact

-option for breast reconstruction

modified radical mastectomy

if the tumor is 4 cm or larger or invasive; all breast tissue, overlying skin, nipple, and pectoralis minor muscle removed along with axillary lymph nodes and fascia under breast- option for breast reconstruction

adjuvant therapies (radiation, chemo, hormonal, monoclonal antibody)

-radiation therapy: can be primary tx, used to shrink a large tumor, palliative tx

-chemotherapy: used for lymph node involvement or metastasis

-hormonal therapy: removes or blocks source of estrogen → tumor regression

-monoclonal antibody therapy: drug herceptin; used to treat metastatic breast cancer in women who have excess amount of breast cancer cell antigen HER2

-bone marrow and stem cell transplant

instructions for radical mastectomy

-sleep on opposite side

-wear a well-fitting prosthetic

-explain the importance of breast self exam and annual mammogram

-avoid injections, vaccinations, venipuncture in involved arm

*think of lymph nodes (immune) being diminished

prostatitis

most commonly caused by bacteria; acute or chronic

-s/s: chills, fever, prostate pain and tenderness, arthralgias, dysuria, frequency, weak stream, acute urinary retention, edematous and firm upon palpation

-diagnostics: C&S of urethra, prostatic fluid and urine → proper antibiotic therpay

-antibiotics for 4 weeks with acute; 4-16 weeks for chronic; heat/sitz baths

epididymitis

an infection of the cordlike excretory duct of the testicle, usually secondary to an infectious process- travels from urethra

-symptoms can occur after trauma, physical exertion or prolonged sexual activity, or after instrumentation of the urethra and cystoscopy

-s/s: severe pain suddenly appears in the scrotum and radiates along the spermatic tube, pain in groin, lower abdomen; pain can worsen with bowel movements; testicular edema causes waddling gait; pus or blood is semen or urine

diagnostics and medical management -epididymitis

-diagnostic: urinalysis and CBC; test for gonorrhea and chlamydia

-MM: bed rest and support of the scrotum; antibiotics for patient and sexual partner; I&D of scrotum if abscess occurs; anti-inflammatory meds

hydrocele vs varicocele

-hydrocele: accumulation of fluid between the two layers of the tunica vaginalis (a membrane covering the testicle)

-varicocele: veins within the scrotum become dilated, usually after internal spermatic vein reflux; prevents adequate drainage of blood from the testis

testicular self-exam

-as early as 15 y/o

-perform after bath or shower

-testis should feel smooth and egg shaped and firm to tube

-epididymis, found behind the testis, should feel like a soft tube

genital herpes, HPV

viral infection

-at times, no lesions but can infect their sexual partners

gonorrhea

bacterial infection

-women show a greenish-yellow, malodorous discharge; men present with purulent discharge and painful urination

-cure is verified by 3 consecutive negative smears

candidiasis

fungal infection

-may occur when sugar levels are elevated for a diabetic or in pt with compromised immune systems

-scaly skin, erythematous rash, exudate that appears under breast, between fingers or in axillae, groin or umbilicus area

chlamydia

bacterial infection

-pruritus, burning with urination, pelvic pain, low grade fever

syphilis

spirochete bacterial infection

-chancre (painless skin lesion), enlarged lymph nodes, fever, fatigue

-late phase: dementia, pain or loss of sensation in the legs, destruction of the aorta

cranial nerves for eye movement

-ocular nerve (CN III)

-trochlear nerve (CN IV)

-abducens nerve (CN VI)

lacrimal apparatus

manufactures and drains tears; keeps eye moist and sweeps away debris

outer layer of the eye

fibrous tunic

-composed of sclera and cornea

middle layer of the eye

vascular tunic

-composed of the choroid, ciliary body and iris

inner layer of the eye

retina- composed of nervous tissue

chambers of the eye

-anterior: filled with aqueous humor

-posterior: filled with vitreous humor

four processes to form an image

-refraction: bend light rays

-accommodation: distance

-constriction: pupil size

-convergence: both eyes allows light rays to hit the same point in both retinas

how light travels from eye to the brain

-light enters the eye and travels through the cornea

-aqueous humor

-pupil

-crystalline lens

-vitreous humor

-rods and cones in retina

-image transported via the optic nerve to the visual center of the cerebral cortex in the brain

snellen test

most common, assesses visual acuity

-20/20: normal vision, can read at 20 ft

-20/40: at 20 ft, the pt can read what a normal eye can see at 40 ft

refraction test

tests for the inability of the eye to accommodate the images and may diagnose hyperopia, myopia, astigmatism, and presbyopia

-pt sits with chin resting on support and asked to evaluate clarity of images

automated perimetry test

patient in front of computer-like device, stares at a screen and presses a button when flashes of light enter the field of vision; 6 fields of vision, determines loss of any fields

myopia

-abnormal shaped eye and/or cornea can lead to refractive errors

-inability to see distant objects clearly; nearsightedness

-MM: refractory surgery, most commonly corrected by laser

-post op: pt wear eyepatch until next morning, may have photosensitivity and blurred vision, no contacts for 1-2 weeks

hyperopia

inability to see close objects clearly; farsightedness

-MM: corrective eyewear; most purchase OTC eyewear

-NI: emphasize importance of care of the contact lenses, eyeglasses should fit properly, clean glasses daily, pt should see optometrist yearly

hordeolum, chalazion, blepharitis

-MM: anti-infective agents, localized I&D of cyst or stye, warm NS compress, lid scrubs with no tear baby shampoo, topical therapies

-NI: prevent spread of infection; possible gentle massage of the eye; avoid irritating scents, rubbing eyes and eye makeup

blepharitis

inflammation of eyelid margins usually involving portion of the eyelid where the lashes grow

-ulcerative: from bacterial infection

-nonulcerative: caused by psoriasis, allergic response

-s/s: pruritus, excessive tearing, matting during sleep

chalazion

inflammatory cyst on the meibomian gland at the eyelid margiin

-blockage of oil glands or complication of stye

-s/s: discomfort, mass on eye, pressure as eyelid closes

hordeolum

acute infection of eyelid margin; also called a stye

-caused by staphylococcal

-s/s: abscess localized to base of lashes with edema of lid, tearing of eye, blurred vision, scratching sensation in eye

conjunctivitis “pink eye”

caused by bacterial of viral infections, allergies or environmental factors

-s/s: erythema of conjunctiva, edema of eyelid, mucopurulent crusting on the lids and cornea - must be treated

-NI: hand hygiene!, NS to cleanse exudate, warm compress 2-4x/day, cold saline for edema, eye irrigations, possible antibiotics or corticosteroids

keratitis

inflammation of the cornea that results from injury, allergies, fungal infections

-s/s: severe eye pain

-diagnostics: C&S, corneal stain to check for ulcers

-MM: topical antibiotics, analgesics, pressure dressings, warm and dry compress, epithelial debridement of loose tissue, corneal transplant; corticosteroids are contraindicated

dry eye disorders

caused by a variety of ocular disorders; characterized by decreased tear secretion or increased tear film evaporation; caused by lacrimal gland dysfunction- result of autoimmune reaction

-s/s: red eyes, stringy mucous, photosensitivity, sandy/gritty sensation in the eye

-diagnostics: schirmer’s test- placement of filter paper in the lower eyelid; normal results are 10-15mm of wet paper in 5 mins; fluorescein drops- dye should disappear in 1 min

-MM: artificial tear replacement (should be used sparingly); immunosuppressant (cyclosporine)- may take 3-6 months for effect

sjögren syndrome

immunologic disorder characterized by deficient fluid production by lacrimal, salivary, and other glands resulting in abnormal dryness of mouth, eyes and mucous membranes

ectropion and entropion

-ectropion: outward turning of the eyelid margin

-entropion: inward turning of the eyelid margin

-MM: topical meds to reduce inflammation of drying; surgery is preferred tx

cataracts

a crystalline opacity or clouding of the lens; in aging pt opacification occurs gradually- lens becomes foggy which decreases visual acuity; eventually light cannot reach retina

-s/s: blurred vision, difficulty reading fine print, diplopia, glare

-MM: changing eyewear is first step, surgery can be intracapsular (removes lens and entire capsule) or extracapsular (anterior capsule opened, lens nucleus and cortex removed)

diabetic retinopathy

disorder of the retinal blood vessels characterized by capillary microaneurysms, hemorrhage, exudates, and the formation of new vessels and connective tissue

-s/s: microaneurysms, progressive vision loss, presence of “floaters”; often early stages no symptoms present

-MM: photocoagulation (laser beam to destroy new blood vessels, seal leaking vessels and prevent retinal edema), cryotherapy (probe is placed on eye and creates frozen area that extends through external tissues)

who has a higher incidence of hearing impairment?

Caucasians more than African Americans or Asian Americans

who has a higher incidence and severity of glaucoma

African Americans are greater than among Caucasians

age-related macular degeneration (ARMD)

affects retina; characterized by slow, progressive loss of central and near vision; most common cause of vision loss in 60+

-wet type (neurovascular MD); and dry type (non-exudative or non-neovascular MD)

-s/s: appearance of drusen (yellow exudates) in the fundus; bilateral loss of vision- one eye may be worse than the other, scotomas (blind spots in visual field), distorted vision

medical management and diagnostics -MD

-diagnostic: ophthalmic exam, amsler grid test

-MM: meds to stop the growth of new blood vessels (avastin and macugen); antibiotics drops to prevent infection; photodynamic therapy for wet;

-*no tx for dry

retinal detachment

a separation of the retina from the choroid in the posterior of the eye; results in a hole in the retina that allows vitreous humor to leak between the choroid and the retina; can be caused by trauma or result from internal changes r/t aging or inflammation

-s/s: sudden or gradual development of flashes of light, followed by floating spots, a “cobweb” or “hairnet” and a specific field of vision; as detachment progresses, patients will have enlarging dark spot in visual field like a curtain being drawn over their eye

medical management- retinal detachment

corrective intervention- laser or cryotherapy can be used to burn or freeze localized tear with the hopes of sealing it; surgery (i.e. scleral buckling)

glaucoma

characterized by increased IOP because of obstruction of outflow of aqueous humor, optic nerve atrophy, and progressive loss of vision

-no s/s in early stages, loss of peripheral vision, eye pain, difficulty adjusting to darkness, increased IOP, as progresses- optic disc cupping occurs (disc becomes wider, deeper, paler)

corneal injuries

-cornea has 5 layers and is nonvascular

-wound to cornea can decrease level of transparency though scar formation

-can include: foreign bodies, burns, abrasions/lacerations, penetrating wounds

-flushed with NS, topical antibiotics for abrasions

*morgan lens used to flush in emergency

enucleation

surgical removal of the eyeball; implant is inserted into the eye socket; usually after severe eye trauma or malignant tumors

-need pressure dressing over socket to control hemorrhage

-avoid coughing and turning

-healing takes 6 weeks, then prosthetic can be placed

keratoplasty (corneal transplant)

removal of the full thickness of the patients cornea followed by surgical implantation of a cornea from a human donor

-immunosuppressants and corticosteroids to prevent graft rejection

-post op: coughing is discouraged; avoid use of irritants, no rubbing eyes

photocoagulation

nonsurgical procedure that small, intense beam of light is directed into small spot on retina; light converts to heat energy, and coagulation of tissue protein occurs- this seals leaks and destruction of offending tissue occurs

-often used for ARMD and diabetic retinopathy

-pt may have headache postop

-procedure is NOT curative

vitrectomy

removal of excess vitreous humor fluid caused by hemorrhage and replacement with NS- used to manage conditions: retinal detachment, macular holes, vitreous hemorrhage

-topical eye meds for 4-6 weeks

-patient must lay on his or her abdomen or sit forward, resting non-operative side of head on table (4-5 days), dark glasses, eye patch, cold packs

otoscopy

initial exam of the ear, visualized the external auditory canal and the tympanic membrane

-normal tympanic membrane is disk shaped and pearl pale pink

whispered voice test

examiner stands 12-24 inches away and speaks simple words and pt repeats them; 50% is considered normal for accuracy

weber test

-sensorineural loss: the unaffected ear perceives the sound as louder

-conductive hearing loss: the sound is louder in the affected ear because the patient does not hear ordinary background noise conducted through the air and receives only vibrations by bone conduction