NRSE 470: Exam #3

Dysmenorrhea

• Painful menstruation

• Risk Factors 

  • Smoking 

  • High body mass index 

  • Depression / Anxiety 

  • Family history 

Dysmenorrhea: Clinical Manifestations

• Headaches

• Irritability

• Lower abdominal pain

• Lower back pain

• Gastrointestinal manifestations

  • Nausea

  • Bloating

  • Constipation

  • Diarrhea

Dysmenorrhea: Diagnostic & Lab Testing

• Pelvic Exam

• Beta-Human Chorionic Gonadotropin (HCG).

Primary dysmenorrhea

Lower abdominal or pelvic pain that occurs during the menstrual cycle but is not associated with other abnormalities

Secondary Dysmenorrhea

Diagnosed when the manifestations are associated with another medical condition

Amenorrhea

• The absence of menstruation during the reproductive years, after puberty and before menopause

• Higher risk for Osteoporosis

Amenorrhea: Clinical Manifestations

No Menstrual cycles for six months.

Amenorrhea: Diagnostic & Lab Testing

• Beta HCG level.

• Ultrasound to evaluate for Structural Abnormalities.

Primary Amenorrhea

occurs in a female client who has never menstruated

Secondary Amenorrhea

Diagnosed in a female client who did previously menstruate

Premenstrual Syndrome and Quality of Life

• Clinical manifestations:

  • Sadness

  • Extreme mood changes or anger

• These hormonal fluctuations lead to a serotonin deficit that triggers fatigue, insomnia, and depression, which are common manifestations associated with PMS and PMDD.

• Treated with SSRI

Premenstrual Syndrome (PMS) & Premenstrual dysphoric disorder (PMDD): Labs & Diagnostic Testing

• Lab tests hormone levels (estradiol level, FSH level)

• Thyroid stimulating hormone levels may also be evaluated to rule out thyroid.

Premenstrual Syndrome (PMS) & Premenstrual dysphoric disorder (PMDD): Dysfunctional Uterine Bleeding

• Safety considerations for the physical and emotional well-being of clients

• Can cause Hypotension and Shock

• Clinical Manifestations

  • Menstrual flow of greater than 80 mL during a cycle

  • Anemia

• Manifestations of excessive bleeding

  • Confusion

  • Dizziness

  • Hypotensive

  • Tachycardic 

  • Pale skin color

  • SOB 

  • Weakness 

Dysfunctional Uterine Bleeding: Lab & Diagnostic Testing

• Beta HCG to rule out pregnancy

• A Complete Blood Count

  • Red blood cell count, Hemoglobin Hematocrit

  • Evaluate for anemia

• Hormone levels

  • Thyroid stimulating hormone and Prolactin, may also be completed to identify possible causes of the manifestations

• Pelvic Exam

• Transvaginal Ultrasound

• Hysteroscopy to identify masses, polyps, or other abnormalities

• Endometrial biopsy may be collected to rule out cancer

Dysfunctional Uterine Bleeding: Treatment

Patient should seek immediate emergency medical treatment

Endometriosis

• Endometrial tissue that has moved outside the uterus

• Chronic Condition 

• Cause pain and inflammation 

• Higher levels of estrogen: More likely to experience _____________

Endometriosis: Clinical Manifestations

• Varies between patients

• Dysmenorrhea

• Pelvic Pain

• Pain during Intercourse

• Diarrhea

• Constipation

• Infertility

Endometriosis: Labs and Diagnostic Tests

• CA 125 level: Evaluate for cancer

• Transvaginal Ultrasound: Identify endometriosis tissue.

• Laparoscopy: Visualize endometriosis tissue in the pelvis.

Uterine Fibroids: Risk Factors

• Obesity

• Early menstrual period 

• Having never been pregnant 

• Family History 

Uterine Fibroids: Clinical Manifestations

• Dysfunctional Uterine Bleeding

• Pelvic pain

• Painful Intercourse

• Anemia

• Bowel or Bladder dysfunction: Constipation or Urinary Frequency

• Pain and abnormal bleeding are symptoms of fibroids

Uterine Fibroids: Labs and Diagnostic Tests

• beta HCG Level: Verify that the client is not pregnant.

• Complete Blood Count

• Red Blood Cell Level, Hemoglobin, Hematocrit)

• Thyroid stimulating hormone level and prolactin level.

• Transvaginal ultrasound & Hysteroscopy: Visualize the Uterine Fibroids.

• Endometrial biopsy: Rule out cancer

Fibrocystic Breast

• Cause

  • Development of Fibrosis 

• Can occur in one or both breast 

• Alterations in hormone levels, especially estrogen, may cause these changes to the breast tissue.

• Fibrosis may shrink after menopause

  • Estrogen levels decrease.

Fibrocystic Breast: Clinical Manifestations

Breast feel tender, heavy or swollen

Fibrocystic Breast: Treatments

• OTC medications to manage pain or discomfort

• Mammogram or ultrasound may be ordered

Post Menopausal Women’s Health

• A client who has vaginal bleeding or spotting after menopause should notify their provider.

• This may be a sign of…

  • Endometrial cancer

  • Endometrial or vaginal atrophy

  • Endometrial hyperplasia

  • Uterine polyps.

• Caused by

  • hormone replacement therapy.

Diagnostic Procedure: Papanicolaou Test (Pap)

• Completed during pelvic exam

• Collect cells from the cervix .

• Used to detect abnormal cervical cells or human papillomavirus, which causes cervical cancer.

• Colposcopy if test is abnormal

Diagnostic Procedure: Laparoscopy

• Maybe used to diagnose some menstrual disorders

• Allows the provider to see the lesions in the pelvis that may be caused by endometriosis.

• A surgical instrument with a camera, is inserted through the incision to allow the surgeon to visualize the organs.

Diagnostic Procedure: Hysteroscopy

• Procedure that shows the inside of the Cervix and Uterus 

• An instrument that has a camera on it

• Inserted through the vagina, and the images from the camera can be seen on a video display

• Used to Diagnose or treat…

  • Dysfunctional Uterine Bleeding

  • Fibroids

  • Scar Tissue

  • A Blockage at the opening to the Fallopian Tubes.

Menstrual Disorders Medication: NSAID

• Ibuprofen 

• Decreases inflammation and pain 

• Treatment of mild to moderate pain 

Menstrual Disorders Medication: Combined Oral Contraceptive 

• Estrogen and Progesterone

• Medication: Ortho Tri Cyclen

• Treatment for…

  • Pregnancy prevention

  • Menstrual Disorders

  • Premenstrual dysphoric disorder

Menstrual Disorders Medication: Gonadotropin Releasing Hormone Agonist

• Medication: Leuprolide

• Treats

  • Uterine Fibroids

  • Endometriosis 

Menstrual Disorders Medication: SSRI

• Medication: Citalopram

• Treats 

  • Depression 

  • HysterectomyPremenstrual Syndrome 

Hysterectomy

• Removal of female reproductive organs; uterus, and if necessary, ovaries

• Standard perioperative care should be provided.

Hysterectomy: Postoperative Care

• Monitoring complications

• Pain Management 

• Preventing infections 

• Advancing the diet 

• Early mobility 

• Prevention of Atelectasis

Hysterectomy: Signs of Infections

• Elevated Temp

• Pelvic Pain

• Purulent drainage from the vagina can be signs of infection.

Hysterectomy: Patient Education

• At risk for DVT

• Abdominal hysterectomy will require instructions about incisional inspection and care

Acute Prostatitis

• Inflammation that causes frequent urination

• Pain at site

• Causes

  • STI

  • Infection

  • Common in uncircumcised

  • BPH

  • no condom use

• Long-term complications

  • Infertility

  • Chronic Pelvic Pain.

Prostatitis: Clinical Manifestations

• Dysuria

• Hematuria

• Fever

• Lower Back

• Pelvic or Genital pain

• Sexual Dysfunction

Prostatitis: Labs and Diagnostics

• Urinalysis and Culture

• CT Scan of abscess in the prostate gland

• Digital Rectal Exam: Palpate the prostate gland for lumps or tenderness

Prostatitis: Treatment

• Depends bacterial or nonbacterial

• Bacterial: antibiotics

• Non-bacterial: NSAIDS & non-pharm interventions

Erectile Dysfunction: Causes

• Combination of factors

• Cardiovascular disease

  • Hypertension

  • Hyperlipidemia

• Obesity

• Diabetes

• Neurologic diseases

  • Multiple Sclerosis

  • Stroke

• Decreased hormone levels

• hypothyroidism

• Traumatic injuries.

Erectile Dysfunction: Complications

• Priapism more than 4 hours=  Seek immediate emergency treatment

• Hypotension

Gynecomastia

• Male, Benign condition

• Increased hormonal ratio of estrogen to androgen

• May occur bilateral or unilateral

Gynecomastia: Clinical Manifestations

• Tenderness

• Palpable mass

Gynecomastia: Treatments

• Identify cause

• Medications

  • Selective estrogen receptor modulators

  • Androgens

Benign Prostatic Hyperplasia

• Non-cancerous enlargement of the prostate

• Risk factors

  • Genetic

  • Ethnicity

  • High coffee/caffeine consumption

  • Smoking

  • Age

  • Alcohol Use

  • Obesity

  • Diabetes

  • Heart Disease

Benign Prostatic Hyperplasia: Clinical Manifestations

• Urinary Frequency

• Sensation of Incomplete Bladder Emptying

• Urinary Retention

• Recurrent UTIs

Benign Prostatic Hyperplasia: Labs

• Urinalysis

• Culture

• WBC

• BUN & Creatinine

• PSA

Benign Prostatic Hyperplasia: Medications

• Alpha-Adrenergic Blockers (ZOSIN)

• Relax the smooth muscle of the bladder neck and prostate

  • Alfuzosin

  • Terazosin

  • Doxazosin

  • Tamsulosin

• Side Effects 

  • Dizziness

  • Headache

  • Asthenia/fatigue

  • Orthostatic Hypotension

  • Rhinitis

  • Sexual Dysfunction

Benign Prostatic Hyperplasia: Treatment

• TURP

• Surgical removal of the inner portion of the prostate

Chlamydia

• Bacterial STI

• Transmitted orally, vaginally, or anal

• Cause long-term complications

  • Pelvic inflammatory disease

  • Arthritis

Chlamydia: Labs

• Vaginal, cervical, rectal, or oral swab

• Urine test

• Screening recommended for most sexually active individuals due to lack of symptoms

Chlamydia: Clinical Manifestations

• Most have no symptoms

• If symptomatic, symptoms may appear several weeks after exposure

• Cervix (cervicitis): purulent vaginal drainage and bleeding

• Females and males

  • Infect the conjunctiva of the eye

  • Urethra: Dysuria or urinary frequency

  • Rectum

    • Rectal pain, bleeding, or drainage

Chlamydia: Treatments

• Medication: Azithromycin

• Eliminate manifestations, prevent complication, & decrease transmission

• Abstain from sexual activity for at least 7 days after treatment begins

Gonorrhea

• Bacterial STI

• Causes

  • Pelvic inflammatory disease (females)

  • Anal itching, bleeding, or painful bowel movements

  • Mouth and throat: sore throat

  • Infertility if not treated

Gonorrhea: Clinical Manifestations

• May be no symptoms 

• Females

  • Infects cervix, uterus, fallopian tubes

    • Dysuria 

    • Vaginal drainage/bleeding

• Males 

  • Dysuria; Green, Yellow, or White drainage from urethra

  • Pain in testicles

• Females and males

  • Infects urethra

Gonorrhea: Lab testing

• Culture from cervical, rectal, urethral, or oropharyngeal swab

• Urine specimen

• Annual screening recommended for sexually active individuals who are having sex with males

Gonorrhea: Treatment

• Cefixime with one dose of azithromycin or doxycycline if PID present

• Abstain from sexual activity for at least 1 week after starting treatment

Genital Herpes

• Caused by herpes simplex virus type 2

• No cure

• Long-term complications are rare but include meningitis

Genital Herpes: Clinical Manifestations

• Asymptomatic

• If symptomatic…

  • Vesicles near mouth, genitals, anus

  • Can be painful if vesicles and open and create ulcers

  • Body aches

  • Fever

  • Headaches

  • Localized pain or tingling

  • Recurrent outbreaks

Genital Herpes: Lab Testing

• Swab of vesicles

• Blood test

• Females: annual pap test. Can lead to cervical cancer

Genital Herpes: Treatmetns

• Medication: Acyclovir

• Decrease manifestations and transmission

• Abstain from sexual activity when lesions visible and use condom at other times to decrease risk of transmission

Syphilis

• Bacterial STI

• Untreated can lead to…

• Stroke

• Blindness

• Dementia

• Inflammation of Aorta

• Carotid Artery Stenosis

Syphilis: Lab Testing

• Swab of drainage

• Blood tests

  • Venereal disease research laboratory (VDRL)

  • Rapid plasma regain (RPR)

Syphilis: Treatments

• Varies by stage

• 1 dose penicillin G genzathine IM for primary, secondary, or early latent stage

• 3 doses penicillin G genzathine IM for late latent or tertiary stage

• Other treatment based on symptoms

Primary Syphilis: Stage 1

• Chancres appear;

• Usually painless;

• Go away with treatment

Secondary Syphilis: Stage 2

• Lesions appear on mouth, vagina, or anus

• Brown or red rash on body, palms and feet

• Fever, sore throat, muscle aches, headache, weight loss, and fatigue

• Go away with treatment;

  • If not treated, progress to latent Syphilis

Latent Syphilis: Stage 3

• No symptoms 

• Can last for many years 

Tertiary Syphilis: Stage 4

• Occurs when individuals are not treated

• Can take up to 30 years to develop this stage

• Symptoms depend on organs and tissues infected

Human Papilloma Virus (HPV)

• More than 180 subtypes of HPV

• Effects both men and females

• Vaccine recommended age of 11

• Can cause cancer in throat, tongue, penis, anus, vagina, and vulva

Human Papilloma Virus (HPV): Clinical Manifestations

• Asymptomatic

• If symptomatic

  • Genital warts can appear many years after exposure

Human Papilloma Virus (HPV): Lab Testing

• Visible genital warts should be removed and analyzed

• Pap test & possible colposcopy (females)

Human Papilloma Virus (HPV): Treatments

• Vaccine

  • `Ages 9-26, both males and females

• No treatment/ symptom management

• Genital warts: removed by

  • Cryotherapy

  • Pharmacologic therapy

  • Laser therapy

• Abnormal cervical cells: LEEP or cone biopsy

Bacterial Vaginosis

• Bacterial infection of vagina

• Unknown cause due to disruption of normal vagina flora

• More common in

  • Sexually active females

  • Having multiple sex partners

  • Douching

  • Not using condoms during intercourse

Bacterial Vaginosis: Clinical Manifestations

• White or gray vaginal drainage with fishy odor

• Burning/itching around vagina

• Dysuria

Bacterial Vaginosis: Lab Testing

Swab of vagina drainage

Bacterial Vaginosis: Treatments

• Vaginal clindamycin or metronidazole

• Antibiotics

Pelvic Inflammatory Disease (PID)

• Inflammation of upper gynecologic reproductive tract caused by infection

• Involve uterus, fallopian tubes, and ovaries

• Common Cause

  • Gonorrhea

  • Chlamydia

• Complications

  • Infertility

  • Ectopic Pregnancy

Pelvic Inflammatory Disease (PID): Clinical Manifestations

• Pain in lower abdomen or pelvis

• Vaginal drainage or bleeding

• Painful intercourse

Pelvic Inflammatory Disease (PID): Diagnosis

• Pelvic exam

• Pregnancy test to rule out pregnancy

• Ultrasound

STI reported to the Local Health Department

• Syphilis (including congenital syphilis)

• Gonorrhea

• Chlamydia

• Chancroid

• HIV

Skin

• Skin Layers

  • Epidermis

  • Dermis

  • Hypodermis

• Protection against infection and IV light

• Infection

• Temperature Regulation

Wound Healing

• Hemostasis and Inflammation

  • Form a fibrin clot, bring immune cells to clean the wound, and cause redness and swelling.

• Proliferation

  • Creates granulation tissue, new blood vessels, and epithelialization

• Tissue Remodeling

  • Strengthens collagen and contracts the wound for final closure

Inflammation: Conditions

• Eczema

• Psoriasis

  • Red White Silvery White Patches in Elbows, Knees, Scalp, Trunk

  • No cure

• Dermatitis 

  • Variety of shape and sizes and reasons

  • Itchy, rash

  • internal: Food allergies, what they eat

  • External: Poison Ivy, Soaps, Chemicals, Jewelry

  • Genetic

  • Stress

• Itchy redness

• Flaking

Inflammation: Causes

• Smoking

• Alcohol

• Poor Sleep

• Obesity

• Gluten

• Older Adults: Thin and fragile skin

• Decreased dietary fiber & omega fatty acids = worsening 

Inflammation: Comorbidities

• Celiac Disease/Gluten: Inflammatory skin conditions

• Diabetes – sugar dec wound healing

• Heart disease – poor perfusion/BF

Dermatitis and Psoriasis: Treatments

• COOL compress and baths

• Antihistamines (itching): Diphenhydramine

  • Make you drowsy

  • No driving

• Steroid anti-inflammatory

  • Prednisone, Cortisone, Hydrocortisone

    • Don’t stop abruptly

    • Can cause immunosuppression

    • Can increase Blood sugar

• OTC pain medications

• Tylenol or NSAIDS

• Oat meal bath

Infection

• Bacteria, Virus, fungi, or parasites

  • MRSA

  • Streptococcus

Infection: Risk Factors

• Any break in the skin

  • Thin Skin

• Age 65 and older 

  • Have an impaired ability to recover from ________

• Smoking

• Obesity

• Malnutrition

• Use of steroids

Infection: Treatments

• Determine the cause and treat the pathogen

• WARM

• Topical

• Stronger antibiotics may be needed

• Antifungal (–azole)

  • Ointment, cream, powder,

  • Patient Education: Avoid sharing personal items

• Antiviral: Acyclovir

  • Varicella

  • Shingles

  • Herpes zoster

  • Contact precautions (avoid close contact, hand hygiene)

• Medication for lice or scabies

• report changed findings

  • Progression fever

  • Chills

  • Not feeling good

Inflammation & Infection: Lab Testing and Diagnostic Studies

• Patch test for allergens

  • Apply patches w/ specific allergen THEN 2-4 days later if allergic it will show

• Blood test

  • Normally not for skin

  • Markers like C-reactive Protein, Presepsin, and Procalcitonin can indicate _________.

• Biopsy

  • Can provide specific diagnosis for ________ skin conditions

  • Preformed under local anesthesia

  • Rule in/out malignancy

  • Sterile dressing over biopsy site

  • Topical medication (if ordered) to prevent infection

  • Report excessive bleeding or evidence of infection

Inflammation & Infection: Role of the Nurse

• Safety considerations

• Hand hygiene 

• Patient Education

  • Preventing the spread: Contact precautions

    • Scabies, Lice and Impetigo

  • Don’t pick or scratch the healing wound or wound

Burns: Pathophysiology

Burns trigger the release of inflammatory cytokines, histamine, and prostaglandins, leading to vasodilation and increased capillary permeability. This improves blood flow but also causes edema. Burns are described in three zones: the coagulation zone (closest to the injury, with tissue loss), a middle zone (potentially reversible damage with resuscitation), and an outer hyperemic zone (least likely to have permanent damage).

Parkland Formula 

• Use of high volume fluid – Large bore IV for fluids

• See how much fluid a patient needs

• Moderate – severe burns covering 5% of TSA

• Fluids

  • Lactated ringers

  • Urine: 30-50ml/hr

  • Systolic Blood Pressure: Over 100

• 4 ml/kg/TSA

  • Whatever half is give that within the first 8 hrs and then a quarter and a quarter

Burns: Total Surface Area

RULE of 9 is main one to measure _____

Approximate the extent of ______

Other ways to measure Burns

• Lund & Browder

  • More exact method to estimate burns

• Palmar method:

  • Quick method, for scattered burns, using the palm (including fingers) = 1% of TBSA

Burns: Treatments

• Medications: IV Narcotics

  • Constipation

• Fluid Replacements

  • Severe dehydration

• Nutrition

  • Patient can easily become malnourished 

  • High nutrition demand 3-4x caloric intake for wound healing

  • At risk for Hyper Metabolic State

  • May need 5000 cal/day

  • Diet high Protein and Carbs

• Electrolyte imbalance

  • Severe cases = releases myoglobin =rhabdomyolysis & kidney damaged

• Wound Debridement

  • Pain meds prior to starting 

  • Get rid of  necrotic tissue

  • Done in first 48 hours to promote wound healing

Burns: Grafts 

• Autograph: Own site to cover full thickness

• Allo graph is from donor or cadaver

• Escharotomy

• Surgical procedure may be needed to relieve the tension of eschar tissue

Burn Classification: Superficial & Frist Degree

Damage to the epidemies only

Example: Sunburn

Burn Classification: Superficial partial thickness & Second Degree

• Damage to epidermis and superficial portion of dermis

• Pink/red or red and blistering, wet