women's health and alterations

how to reduce risks of causes of death?

• healthy diet

• exercise

• avoiding dangerous exposures

• vaccines

• avoid alcohol/smoking

hpv key fx

•most common sexually transmitted virus in the US

- Main cause of cervical cancer and genital warts

-can cause cancers of the cervix, vulva, vagina, penis, anus, or oropharynx

hpv vaccine dose

- route and dose: IM, two doses rec if initiating vaccine < age 15 years. second dose is given 6 to 12 months after first dose.

• Three doses rec if >=15. The second dose is given 1 to 2 months after the first dose; third dose is given 6 months after the first dose.

breast cancer screening

- mammograms - based on risk factors

- no deodorant, powder, or lotions (can cause shadows and will need repeat scan)

s/s breast cancer

- lumps

- skin dimpling

- change in color or texture of skin

- change in nipple appearance, pulling in of nipple

- clear or bloody discharge from nipple

key fx cervical cancer screening

- starting at 19

- q3 yrs if never had abnormal results

- q 5yrs if > 30 with no abnormals

intimate partner violence

- occurs in 1 in 4 women

- use valid screening tools

- when to screen: In private during annual exams, initial prenatal visit, each trimester, postpartum check-up, ER visits.

mandatory reporting and offering resources for ipv

- KY not a mandatory reporting state, unless it is a vulnerable population (children, elderly, disabled)

- woman must agree to being reported

when does puberty occur

- onset usually occurs between ages 8 and 13. Puberty is complete with regular menses and cycle.

- period dev 2-2.5 yrs after secondary sex characteristics dev (breast dev, pubic and axillary hair)

what is perimenopause

- irregular periods, but period occurs before 12 full months

- starts around 30-40s

what is menopause

- have to go 1 year with no period

- avg age 51, occurs from 40-58

tx menopause

•Lifestyle changes

•Alternative medicine - hypnosis, herbals, acupuncture

•Hormone replacement therapy

• s/s: Hot flashes, night sweats, sleep disturbances, weight gain, hair thinning

lifestyle changes for menopause s/s

- increase sleep and exercise

- smoking, alcohol, caffeine cessation

hrt for menopause

- if still have ovaries but not uterus-> only need estrogen (increases risk of breast cancer)

- if still have uterus and ovaries->need estrogen and progesterone (lowers risk of endometrial cancer)

how is uterine bleeding assessed

- by frequency (24 to 38 days)

- duration (8 days or less)

- regularity (shortest to longest cycle variation is 7 to 9 days)

- flow (normal vs. light or heavy)

menstrual d/o

•Amenorrhea (Primary or Secondary)

•AUB

•Dysmenorrhea (Primary or Secondary)

•Premenstrual syndrome (PMS)

what is primary amenorrhea, s/s

No menses by age 16 and no secondary sex characteristics or no menses by age 13 with secondary sex characteristics

what is secondary amenorrhea

• No menses in 3 months in a woman who has had normal menstrual cycles

what is abnormal uterine bleeding

• Uterine bleeding that is abnormal in duration, frequency, volume, or regularity for 6 months

what is primary dysmenorrhea

• Painful menstruation: Cramping usually begins 12-24 hours before onset of flow and lasts 12-24 hours.

what is secondary dysmenorrhea

• Painful menstruation associated with known anatomic factors or pelvic pathology.

• Pain can be present at any point of the menstrual cycle.

what is pms

- A combination of emotional and physical symptoms that begin during the luteal phase and diminish after menstruation begins.

what is chronic pelvic pain, s/s

• Pelvic region pain lasting longer than 6 months

•S&S: uterine or abdominal cramping, sharp pain, steady pain, intermittent pain, pressure or heaviness deep in the pelvis, pain during intercourse, pain while having a bowel movement

nursing actions chronic pelvic pain

- assess and teach, management depends on cause

chronic pelvic pain - PID complications

• infertility

• scarred fallopian tubes

• chronic pain

• ectopic pregnancy

• abscess

dx pcos

must have have two of the following three features: clinical or biochemical androgen excess, oligo-ovulation or anovulation, polycystic ovarian morphology ultrasound

what is pcos

- polycystic ovarian syndrome

- hyperadrogenic disorder

s/s pcos

•infertility (usually related to anovulation)

- menstrual disorders (AUB)

- hirsutism

- ovarian cysts

- obesity

- oily skin and acne

- pelvic pain

- alopecia

comp pcos

•higher risk for type II DM (insulin resistance), CV disease, HTN, endometrial ovarian or breast cancer, infertility, pregnancy and birth complications, sleep apnea, metabolic syndrome, depression, anxiety, eating disorders

managing pcos

- exercise and weight loss (decreases diabetes risk, androgens, and cv disease)

- hormone therapy

- anti-androgens

- fertility therapy

- diabetic meds

- laser hair removal for hirtuism

what is endometriosis

- Estrogen-dependent, build up and break down with cycle - bleeding into surrounding tissues causes pain and inflammation

- chronic inflammatory disease

s/s endometriosis

- low back pain

- sharp pelvic pain

- pelvic pressure

- painful intercourse

- infertility

- dysmenorrhea

- AUB

- diarrhea

- pain with BM, constipation

- bloody urine and dysuria

managing endometriosis

- nsaids

- hormonal suppression

- surgery: endoscopic removal of lesions, hysterectomy

- assisted reproduction

- heat therapy

what is candida

•yeast infection: overgrowth of yeast in the vagina

risk fx candida

•suppressed immune system, antibiotic therapy, steroid therapy, diabetes, pregnancy, menopause

s/s candida

•itching and irritation in the vulva and vaginal areas

- white cheesy vaginal discharge

-pain with intercourse

- burning on urination

-vaginal pH below 4.5

managing candida

•OTC medications, prescription antifungal when OTCs are not effective

nursing actions candida

•teach proper use of OTC meds, instruct patient to notify HCP if symptoms continue or are recurrent, instruct to wear cotton underwear to decrease risk of recurrent infections

what is bacterial vaginosis

•most common vaginal infection

- disruption of normal vaginal flora

- symptoms are similar to some STIs

- pregnant women at increased risk for preterm labor and endometritis

s/s bv

vaginal odor, often described as fishy, vaginal discharge that is often thin and white or gray

managing bv

• microscopic exam to rule out STIs, pharmacological therapy, male partner does not need to be treated, female partner may need to be treated

what are leiomyomas

- benign fibrous tumors of the uterine wall.

- They vary in size, number, and location and are estrogen and progesterone sensitive

risk leiomyoma

• Early menarche

• Heredity: Increased risk when mother or sister has myomas

• Race: Black women more likely to have myomas

• Obesity

s/s leiomyoma

• Pelvic pressure from the enlarging mass

• Dysmenorrhea

• AUB

• Pelvic pain, backaches, or leg pain

• Urinary frequency and urgency when myomas are pressing on the bladder

• Palpation of tumor during bimanual pelvic examination

Interventions leiomyomas

• pelvic U/S

- blood transfusions may be needed for severe anemia related to excessive blood loss

- treatment is based on size, location, and the degree in which they interfere with the woman's quality of life:

- most tumors will shrink after menopause

what are fibrocystic breasts

•Benign breast disease

-it is common for breasts to develop fibrous tissue and benign cysts

- the cause is unknown but believed to be related to an imbalance of estrogen and progesterone

s/s fibrocystic breasts

•cyclic bilateral breast pain (usually in upper, outer quadrants of the breast

- increased engorgement and density of the breast

- increased nodularity of the breasts

- fluctuation in size of the cystic areas

managing fibrocystic breasts

• mammogram to rule out malignancy

- aspiration of the cyst fluid

-oral contraceptives

- NSAIDs and acetaminophen

- wearing supportive bra

-avoid caffeine, smoking and alcohol

- apply heat to the breast

risk fx breast cancer

increasing age

- defects in BRCA 1 or 2 genes

- family Hx

-dense breasts

- use of hormonal birth control

-women who did not breastfeed

- personal Hx of cancer in at least one breast

- exposure to head or chest radiation

- excess weight

- exposure to estrogen through early onset menarche

- late menopause

- hormone therapy

-excessive use of alcohol

dx/screening breast cancer

•BSE, Mammograms (gold standard, every year between the ages of 45 to 54, every 2 years 50-74, over 85 no longer need screened)

- breast U/S, MRI, biopsy

managing breast cancer

surgical interventions (lumpectomy, mastectomy), radiation, chemotherapy, hormone therapy, targeted therapy

surgery for breast cancer

• Lumpectomy: The lump and an area of surrounding normal tissue are removed. This procedure is usually followed by radiation therapy.

• Partial or segmental mastectomy: The tumor and small margin of surrounding healthy breast tissue

• Simple mastectomy: Entire breast, including nipple and areola. NOT chest wall

• Radical mastectomy: Everything INCLUDING the chest wall

what is cervical cancer

•Typically slow-growing and begins with dysplasia, a precancerous condition that is 100% treatable. Untreated dysplasia can develop into cervical cancer and can spread to the bladder, intestines, lungs and liver

risk cervical cancer

•HPV infection

- early onset of sexual activity (before 16)

- smoking

- weakened immune system

- multiple sex partners

- use of oral contraception for 5 or more years

- given birth to 3 or more children

s/s cervical cancer

early stages of cervical cancer usually do not produce symptoms

- vaginal discharge that may be watery, pink, brown, or foul smelling,

- leaking of urine or feces from the vagina,

- abnormal vaginal bleeding, AUB, painful intercourse

- loss of appetite or weight

- fatigue

- pelvic, back or leg pain

managing cervical cancer

cervical cone biopsy, CT scans, treatment is based on stage of cancer

pre-op care hysterectomy

• physical assessment and health Hx

- lab tests (CBC, type and cross-match, urinalysis)

- ECG

- NPO 8 hours before surgery

- informed consent obtained

-antibiotics when indicated

nursing actions pre-op hysterectomy

- complete the admission assessments and required pre-op forms,

- ensure that all required documents, such as H&P, current labs, and consent forms are in the chart,

- verify that the woman has been NPO,

- complete the surgical checklist, which includes removal of jewelry, eyeglasses or contact lenses, and dentures, explain what to expect before and after surgery, start an IV, administer antibiotics per orders, provide emotional support, address the woman's or family's concerns

medical management post-op hysterectomy

•IV therapy,

- medications for pain management,

- antibiotic therapy for risk of infection

- hormone replacement therapy if ovaries removed (but not if smoker or hx of breast cancer)

- progression of diet within 12 to 24 hours

- foley catheter for 12 to 24 hour

- ambulation once recovered from anesthesia

nursing actions post op hysterectomy

•monitor vital signs, blood loss, LOC, level of sensation for side effects of anesthesia

-assess lung sounds

- assist with deep breathing and coughing (teach to splint her abdomen with a pillow when coughing)

- assess for pain

-assist with position changes,

- assist with ambulation,

- monitor I&O, DC IV and foley per orders

- assess bowel sounds

- provide emotional support