Reproductive Health Chapters 4

common menstrual disorders

-Amenorrhea

-Dysmenorrhea

-Dysfunctional uterine bleeding (DUB)

-Premenstrual syndrome (PMS)

-Premenstrual dysphoric disorder (PMDD)

-Endometriosis

MENO=

menstrual rleated

meto=

time

oligo=

few

a=

without/none/lack of

rhagia=

excess or abnormal

dys=

not or pain

rhea=

flow

common womens reproductive disorders

-Menstrual disorders

-Infertility

-Contraception

-abortion

-Menopause

any miscarrage before 16 weeks is considered an

abortion even though you do not actually take out the baby

menstrual cycle lasts

21 days

count for menstrual cycle starts

the first day of your period

menstrual cycle

follicle falls, you shed, you bleed

-fluctuation of hormones

amenorrhea is the

absence of menstruation

2 types of ammenhorea

primary and secondary

2 types of primary amenorrhea

1. absence of menstruation age 14 without development of secondary sex characteristics

2. absence of menstruation by age 16 with normal development of secondary sexual characteristics

-Primary amenorrhea is defined as the failure to reach menarche in females of reproductive age

secondary characteristics

-protruding breasts

-hair on body

what is the difference between the two primary amenorrhea

-at 14 with no development of secondary characteristics

-at 16 with normal development of secondary characteristics

by 16 if a women hasn't had a menses what happens

-endocrinologist and womens health dr

-not normal

secondary amenorrhea

the absence of regular menses for three cycles or irregular menses for 6 months in women who have previously menstruated regularly

a women has had periods but missed them 3 months in a row, or irregular for 6 months

-secondary amenorrhea

ammenorrhea therapeutic management

-primary and secondary

Primary therapeutic management

-involves the correction of any underlying disorders

-estrogen replacement therapy

secondary therapeutic management

-cyclic progesterone

-treatment of hyperprolactinemia

-eating disorder

-obesity

-hypothalamic failure

-hypothyroidism

amenorrhea nursing assessment

-Tanner stages of breast development

-Laboratory testing

tanner stages

by 9: breast buds

by 11: menses

dysmenorrhea is

painful menstruation

DYSMENORRHEA risk factors

younger age, smoking, and stress

types of dysmenorrhea

primary and secondary

primary is what type of pain

spasmotic

primary dysmenorrhea is

-spasmodic

-caused by increased prostaglandin production

primary dysmenorrhea meds

-midol or ibuprophen

-stops prostaglandin production

secondary dysmenorrhea pain is

all over, parts begin to hurt

secondary dysmenorrhea

-congestive

-pelvic or uterine pathology

-endometriosis most common cause of secondary dysmenorrhea

most common cause of secondary dysmenorrhea

endometriosis

nursing assessment for dysmenorrhea includes

-Past medical history

-sexual history

-menstrual history: when was your last period

-bimanualpelvic examination

client with dysmenorrhea will have these mabifestation

-nausea/vomiting/diarrhea

-fatigue

-fever

-headache

-dizziness

-bloating

-water retention

-weight gain

-muscle aches

-food cravings

-breast tenderness

First-line treatment measures for dysmenorrhea usually include

-nonsteroidal anti-inflammatory drugs (NSAIDs)

-hormonal contraceptives

dysmenorrhea client education includes

-Comfort measures

-heat

-lifestyle changes

-pain relief

-ask dr for meds for patient

tips for managing dysmenorrhea

-excercise to decrease prostaglandin release

-decrease salty food

-cut alcohol and smoking

-fiber

ABNORMAL UTERINE BLEEDING (AUB) is

-Painless endometrial bleeding that is prolonged, excessive, and irregular and not attributed to any underlying structural or systemic disease

-Similar to and may overlap with other uterine bleeding disorders

AUB patient will be

going through several pads and bleeding for more than 5 days

AUB occurs most often when?

at beginning and end of reproductive years

-when hormones are put of wack

etiology of AUB

hormone disturbance

tx for AUB includes

treating the underlying cause

nursing management for AUB includes

-client education

-explain what is going on

goal for treatment of AUB

-Goal is to normalize the bleeding

-correct the anemia

-prevent or diagnose early cancer

-restore quality of life

PERSON WITH AUB bleeds alot so we need to watch for

Anemia

pharmacotherapy for AUB

meds or insertion of a hormone-secreting intrauterine system

surgical intervention for AUB

-dilation and curettage (D&C)

-endometrial ablation

-uterine artery embolization

-hysterectomy

dilation and curettage (D&C)

-dilate the os and go in to scrape and clean out stuff like old blood cells

-we wake up with cramps and bleeding (scant and spotty due to procedure)

endometrial ablation

-cut the bleeding sources

-arteries connected to uterus get cut and stop the sources where blood can come through

uterine artery embolization

-cut, tie, snip uterine artery

hysterectomy

uterus removed surgically

nursing assessment for AUB

-pain

-anemia

-full assessment

-labs to rule out any pathology

why is it important to stop AUB

-we want to avoid anemia, which can lead to arrhythmia due to blood loss

-heavy bleeding can also lead to clots

-we need to stop this

premenstrual syndrome (PMS)

-WIDE RANGE OF RECURRENT SX

-more severe varient is premenstrual dysphoric disorder

etiolofy for PMDD is

unknown

therapeutic management for PMDD

-Multidimensional approach

-Vitamin supplements

-diet changes

-exercise

-Lifestyle

-medications

when do you treat PMDD

-treated before and during

-before menses load up on ibuprophen

NURSING ASSESSMENT FOT PMS will reveal

-irritability

-tension

-dysphoria (most prominent and consistent symptoms)•

A: anxiety• C: craving• D: depression• H: hydration• O: other

ACOG criteria goes with ACDHO

A: anxiety• C: craving• D: depression• H: hydration• O: other

main sx of PMDD

mood disorders

endometriosis etiology

risk factors; exact cause unknown

-Tall height

-Lower BMI

-Family history of endometriosis in a first-degree relative -Short menstrual cycle (<27 days apart)

-Heavy menstrual flow

-Late menopause

-Obstruction of menstrual flow

-young age of menarche (younger than 11 to 13 years of age)

-No pregnancies (nulliparity)

therapeutic management fot endometriosis

-Medication therapy

-pain relief

-hormonal suppression

-surgery

endometriosis is caused when

-it is caused when tissue similar to that of the endometrium implants outside of the uterus, most commonly throughout the abdominal cavity including the bowel, bladder, ovary, uterosacral ligaments, diaphragm, and pleural cavity.

-Although it is a benign process, it can cause dysmenorrhea, dyspareunia, infertility, and chronic pelvic pain

endometriosis Nursing assessment:

-infertility and pain

-nonspecific pelvic tenderness

-tender nodular masses on uterosacral ligaments, posterior uterus, or posterior cul-de-sac

grade 1

grade 2

grade 3

grade 4

Can you still bleed with endometriosis

yes because those black things are big and can cause bleeding

-At the beginning of the menstrual cycle, when the lining of the uterus is shed and menstrual bleeding begins, endometriosis implants swell and bleed as well.

-In short, the person with endometriosis experiences several "mini-periods" throughout their abdomen, wherever this endometriosis tissue exists.

process of becoming pregnant begins where

fallopian tube, endometriosis can ruin tube causing infertilitry

egg becomes embryo

when its fertilized

endometriosis nursing management

-Education: make sure they understand issues

-Healthy lifestyle habits

-Support groups

infertility can be 2 types

primary or secondary

how does culture go with infertillity

-Cultural expectations for reproduction

-Impact of culture, ethnicity, and religion on perceptions and management of infertility

risk factors for infertility

-Multiple known and unknown factors affecting fertility

-Male and female risk factors

male risk factors

-mumps can cause them to become sterile

-injury

-testicular cancer

therapeutic managagement of infertility

drugs or surgery

how do we assess infertility

-male factor assessment

-female factor assessment

-lab/diagnostic tests

-drugs and alcohol

male factor assessment

-semen analysis

-sexual characteristics

-external and internal reproductive organ examination

-digital prostate examination

female factor assessment

-ovarian function

-pelvic organs

Laboratory and diagnostic testing

-home ovulation predictor kits

-clomiphene citrate challenge test

-hysterosalpingogram

-laparoscopy

hysterosalpingogram

-checks uterus and fallopian tube

-shoot dye that contrasts female organs

-laying in lithotomy position and the table moves

-they want to make sure dye flows through both tubes and uterus

-done by a maternal fetal specialist OBGYN

-done when your ovulating or about to ovulate

NURSING MANAGEMENT OF INFERTILITY

-Respect for couple

-Education

-anticipatory guidance

-stress management

-counseling

-Assistance in decision-making; advocacy

-Assistance with financial strategies

selected treatment options for infertility

-table 4.3

-donor eggs

-donor sperm

contraception behavioral methods

-Abstinence

-Fertility awareness

-Withdrawal (coitus interruptus)

-Lactational amenorrhea method

Fertility Awareness Methods

• Cervical mucus ovulation method

• Basal body temperature

• Symptothermal method

• Standard days method: im busy

withdrawal

pull out

-Lactational amenorrhea method

your mind thinks there is a baby you dont ovulate as you should, some do ovulate when they breast feed and get pregnant right after having a baby

-dont get period while breast feeding but still ovulate

basal body temp is spiked higher during

ovulation

contraception barrier methods

-Condoms

-Diaphragm

-Cervical cap

-Contraceptive sponge

condoms are ______

99.9 percent effective

-can break, or tear

internal condom

-flexible ring

-female

internal condom is ____

95% effective

diaphragm

-reusable dome made of silicone that covers cervix

-does not stop from STI

-similar to cap

after missing one day of birth control what do you do

double up

after missing 2 days of birth control what do you do

-back up methods

-you missed the hormones and your body thinks its free

CONTRACEPTION: HORMONAL METHODS

-Oral contraceptives

-Injectable contraceptives

-transdermal patches

-Vaginal rings

-Implantable contraceptives

-Intrauterine contraceptives• Emergency contraception