Exam 3 BMS Repro

what is important to do for people with reproductive disorders

to have respect and dignity for individuals experiencing these disorders, ensuring they receive appropriate care and support while acknowledging their unique experiences.

Important patient history that is needed to know for patients with repro disorders

includes medical history/chronic medical conditions, reproductive screenings, medications, family history, any reproductive disorders and any current problems: pain, discharge or masses.

what is a papanicolaou test (pap smear)

speculum is inserted into vagina and scraping of the cells from the cervix is done to Identify abnormal cells that could lead to cancer.

how often are pap smears completed and when do they start/end

normally every 3 years from ages 21 to 65

what can not be done 24 hours prior to the pap smear

24 hours prior to pap smear no: Intercourse, Douche (cleaning out of vagina with vinegar, common in the 80s), or Vaginal creams/powders.

what is a Cervical cancer screening tool and a very common cause of cancer

HPV (Human Papillomavirus)

what can NOT replace Pap smear under any circumstances

HPV test

what is a Mammogram

X-ray of breast tissue to assesses density (the more dense the more at risk, density normally means an abnormality/cancer chance), screens for breast cancer.

3 things not to bring to a mammogram

1. No lotion

2. no powder

3. no deodorant

When to start doing Mammograms according to American cancer society

Can begin at age 40, 45-54 annually, and 55+ every other year.

what can an US be done on in the reproductive system and what do they test/look for with the results

Can be done with the Breast, Prostate, scrotal, rectal, testicles and tests for Uterine fibroids, cysts, masses in those areas

what is the Benign Breast Disorder (non-cancerous) called

Fibroadenoma

what is a Fibroadenoma

solid rubbery mobile mast, can be moved if touched, not associated with breast cancer.

what confirms breast cancer

breast biopsy is what confirms breast cancer

what are Fibrocystic Breast Changes

Hormonal changes in the lobules of breast before menstrual cycle.

what is Gynecomastia

enlargement of breast tissues in men caused by hormonal changes or medications (spironolactone) and can cause pain.

what do heavy menstrual cycles lead to

Heavy menstrual cycles can lead to a decrease in the quality-of-life causing fatigue, weakness

define Menstruation

bleeding during the menstrual cycle

what are other ways to call a menstrual cycle

Menses, monthly period, cycle or period

what is menarche

age of first period, they can start as easy as age 8 or as late as age 16

what is typically the age of the first menarche

age 12

what are the upper and lower limits of menarche

lower limit is 8 and upper limit is 16 typically

what is perimenopause

10–15-year phase with a decreasing amount of hormones leading to menopause.

typical age for perimenopause to start

as early as late 30s to 50s

biggest symptom of perimenopause and menopause

hot flashes

what is menopause and the average age to end menpause

End of fertility for a woman. 51 years old

what is the telltale sign that menopause occured

12 months consecutive of no period

what could it mean when the period/cycle comes back after 12 months

It could mean uterine cancer

what does having a period/cycle too often lead to

can lead to anemia with all the blood loss

what does having a period/cycle rarely mean

could mean pregnancy or malnutrition

7 Signs/symptoms of Leiomyomas

1. Abdomen distended

2. issues with urination (unable to empty or urinate bladder

3. gradually lowered H/H over time to a 5/6

4. blood clots

5. pressure on rectum (constipation)

6. S/S anemia

7. Report soaking pads/tampons within hours

what are leiomyomas

Fibroids or benign tumors of the uterine muscle

Diagnostic tests for Leiomyomas

decrease in H/H (so a BMP), transvaginal ultrasound, endometrial biopsy

what is the #1 option for detecting Leiomyomas

Transvaginal Ultrasound

what checks if the Leiomyomas are cancerous

endometrial biopsy

what are the two procedures on the uterus that still allow a mother to have children

a Uterine Artery Embolization and Myomectomy

what is it called if a procedure still allows the mother to have children

uterine preserving procedure

what is uterine artery embolization (UAE) and is it uterine preserving

using local sedation an interventional radiologist (IR) inject pellets into tumor to starve the tumor of blood supply. Uterine preserving procedure (2 weeks of cramping as post op symptom)

non-surgical interventions for Leiomyomas

NSAID’s or birth control

what ius a myomectomy

this procedure removes fibroids and the inner lining of the uterus done under general anesthesia.

what is a hysterectomy and is it uterine preserving

removes the uterus completely under general anesthesia. There are different types and it is not uterine preserving

what can removing the ovaries and fallopian tubes with the uterus do

this csn put the person straight into menopause

different ways to perform a hysterectomy

Abdominal: most invasive

Vaginal: mid invasive

Laparoscopic: least invasive type

Hysterectomy pre-op things to do

patient Education, medication and psychological assessment.

Post-op education for Hysterectomy

early ambulation is vital because increased mobility= increased bowel motility. (stool softeners and laxatives are usually given) ensure incision is clean and bleeding should be minimal. major hemorrhage should call Dr.

what will not happen anymore for the patient after a hysterectomy is completed

periods will not longer occur

what should be avoided in hysterectomy post-op patients

No heavy lifting, no stairs, no sitting for long periods of time and no sexual activity for 6 weeks and no driving until cleared by doctor.

how long does sex need to be avoided after hysterectomy

6 weeks

what is pelvic organ prolapse or POP

when pelvic organs tendons drop out of place or lose their strength causing organ to drop (prolapse)

different types of POP

uterine prolapse (most common), cystocele, and rectocele

cystocele defintion

Weakening of the pelvic floor muscles causes the bladder to bulge into the anterior (front) vaginal wall.

Rectocele

Weakening of the pelvic floor causes the rectum to bulge into the posterior (back) vaginal wall.

causes of POP

childbirth, heavy lifting or chronic constipation

diagnostic testing for POP

rectovaginal examination, pelvic floor muscle testing and ultrasound

non-surgical interventions for POP

pelvic floor exercises (Kegel’s, used for early stages), and Pessary (object that pushes uterus back in in a non surgical way)

what is a Pessary and it is surgical

an object that pushes the uterus back in place (non-surgical)

Surgical management for POP

Transabdominal repair with mesh, and Reconstructive surgery with or without hysterectomy 

4 post-op teaching after pelvic organ prolapse( POP) surgery

1. Avoid strenuous exercise, heavy lifting,

2. straining with BM (constipation)

3. sexual intercourse (6 weeks)

4. patient will have Increased abdominal pressure.

what is Benign Prostatic Hyperplasia BPH and is it in men or women

Non-malignant enlargement of the prostate, that can obstruct the urethra, only men

when is BPH typically seen

Rarely before age 40, but 50% of men by age 60 have BPH and 90% of men have BPH by age 85

6 complications with BPH

obstructive nephropathy, recurrent UTI’s, urinary retention, weak stream, frequent urination and nocturia

5 Diagnostics to detect BPH

Digital Rectal Exam (DRE is most common), Prostate specific antigen (PSA, International prostate symptom score (I-PSS), Transrectal ultrasound, Cystoscopy biopsy

if PSA is elevated for a man what could this mean

this indicates inflammation in prostate but does not confirm prostate cancer

what test diagnoses BPH 100%

transrectal US

what is a cystoscopy

scope that goes into penis to look at the inside of urethra and bladder

what test confirms cancer in bladder/prostate

BIOPSY

6 clinical manifestations of BPH

Urinary retention, hematuria, straining to void, fatigue, nocturia, and frequent urination

BPH compassionate nursing care tips

Provide privacy, Run water (this sound helps pee come out), Provide enough time for urination (can take awhile), Position, Monitor I&O, Bladder scan, and Catheterization as prescribed. (Coude catheter may be used for patients with BPH, it is stiffer and more curbed at the end to get around enlarged prostate)

why does a Coude catheter need to be used sometimes for BPH patients

Coude catheter is stiff and can get around enlarged prostate easier to get into the bladder

ALL Medications for BPH

Tamsulosin (Flomax), Terazosin (Hytrin), Doxazosin (Cardura), Finasteride (Proscar), Dutasteride (Avodart)

what do Alpha-adrenegic antagonists do for BPH

relaxes the smooth muscles

what is the difference between selective and non-selective Aplha-adrengic antagonists

selective only targets smooth muscles in bladder and non-selective targets all muscles

what is the only selective Aphla-adrengic antagonist selective medication

Tamsulosin (flomax)

what are the non-selective Aphla-adrengic antagonists

Terazosin (Hytrin), Doxazosin (Cardura)

what is another use for non-selective Aphla-adrengic antagonists

HTN control due to relaxation of all smooth muscles

adverse effects of on-selective Aphla-adrengic antagonists

hypotension, dizziness, and syncope

what are the 5-alpha-reductase inhibitors

Finasteride (Proscar), Dutasteride (Avodart)

what do 5-alpha-reductase inhibitors do

they shrink the prostate

how long do 5-apha reductase inhibitors take to work

6-12 months

what is TURP

Transurethral resection of the prostate

what is the surgery for TURP and is it invasive?

This is the most minimally invasive surgery for BPH, but they are under general anesthesia, there is no incision, the urologist goes in with a cystoscope and removes inner core of prostate to allow urine to flow

is TURP a permanent fix for BPH

no

what is the permanent fix of BPH

complete removal of prostate

what is an expected symptom of TURP and how long does it last

hematuria is expected after BPH and it can last 24 hours

what is CBI

continous bladder irrigation that continuously flushes the bladder with sterile normal saline through a 3-way urinary catheter

what is continuous bladder irrigation (CBI) used for

to remove blood clots, prevent catheter blockage and to maintain urine drainage

7 Post-op patient care tips/teaching points for TURP

1. keep a close eye on drainage system (bladder distention can cause pain/bleeding).

2. maintain catheter patency,

3. watch for bladder spasms,

4. give analgesics

5. lower activity for the next 24 hours to control pain

6. avoid straining with BM’s

7. increase fiber in diet and give laxatives to prevent strain.

5 TURP complications

1. Hemorrhage

2. hematuria (expected for 24 hours)

3. urinary incontinence (last up to a year)

4. infections

5. DVT (due to bedrest)

what does giving fluids prevent in TURP

dehydration and infection

5 TURP discharge teachings

encourage fluids, pelvic floor exercises (Kegels), no heavy lifting, temporary incontinence is normal, if incontinence persists contact HCP

how are STI’s transmitted

sexual contact

5 Risk factors for STI’s

more than one sexual partner, history of STI’s, IV drug use, unprotected sex, and having sex using drugs/alcohol

types of STI’s

genital herpes, syphilis and HPV

what is the most common STI

HPV

what is Syphilis and how is it spread

Syphilis is a complex bacterial STI and is spread through sexual contact, blood exposure or close bosy contact with lesions

what are lesions called with someone with Syphilis

Chancre sores (Canker)

clinical manifestations of Syphilis

Chancre at the site of transmission, round rash at the soles of feet and palms of hands

stages of Syphilis

Primary, secondary and tertiary

what is each stage mean for syphilis

Primary: localized. secondary: systemic illness. Tertiary: late systemic disease

what is Neurosyphilis and what stage does it occur in syphilis

this means syphilis in the brain that can cause meningitis (headache, stiff neck), vision/hearing loss and brain/spinal cord dysfunction causing impaired gait, uncoordinated movements, personality and mood changes. This can occur during any stage of syphilis.