NURS 2866 Ch. 4 - Reproductive Concerns

What is amenorrhea?

Absence of menstrual flow, most commonly due to pregnancy, but may result from anatomical abnormalities, pituitary or endocrine disorders, chronic disease, drug abuse, or hypothalamic-pituitary disruption.

What are causes of hypogonadotropic amenorrhea?

Stress, sudden/severe weight loss, eating disorders, strenuous exercise, mental illness.

How is amenorrhea managed?

Counseling, education, identifying root causes, and referring to specialists for endocrine causes.

What is cyclic perimenstrual pain and discomfort?

An umbrella term including dysmenorrhea, PMS, and PMDD; symptoms are cyclic and can occur before or after menstruation.

What are common symptoms of cyclic perimenstrual pain and discomfort?

Mood swings, pelvic pain, physical discomfort lasting 1–14 days.

What is primary dysmenorrhea?

Pain during or just before menstruation caused by prostaglandin release; located in the suprapubic area and may radiate.

How is primary dysmenorrhea managed?

Heat, exercise, relaxation, reduced salt/sugar intake, NSAIDs, oral contraceptives.

What is secondary dysmenorrhea?

Pain develops later in life and is associated with pelvic pathology like endometriosis, PID, or fibroids.

How is secondary dysmenorrhea managed?

Treat the underlying cause.

What is premenstrual syndrome (PMS)?

Symptoms in the luteal phase affecting lifestyle with a symptom-free period after menstruation.

What are common symptoms of PMS?

Bloating, breast tenderness, depression, irritability, cravings, headache, fatigue.

What is PMDD?

Premenstrual Dysphoric Disorder – a severe form of PMS with marked irritability, dysphoria, anxiety, and other emotional symptoms.

What is endometriosis?

Growth of endometrial tissue outside the uterus causing pelvic pain, dysmenorrhea, and dyspareunia.

How is endometriosis managed?

NSAIDs, estrogen-suppressing meds, or surgery if severe.

What are alterations in cyclic bleeding?

Changes in amount, duration, interval, or regularity of menstruation.

Define oligomenorrhea.

Infrequent menstruation.

Define hypomenorrhea.

Scant menstrual flow at regular intervals.

Define menorrhagia.

Excessive menstrual flow.

Define metrorrhagia.

Bleeding between periods.

What is dysfunctional uterine bleeding (DUB)?

Irregular uterine bleeding not related to normal menstruation.

How is DUB managed?

Oral or IV estrogen; D&C if unresponsive.

What are the CDC’s 5 Ps for STI assessment?

Partners, Practices, Prevention of pregnancy, Protection from STIs, Past STI history.

What is the most frequently reported STI?

Chlamydia.

What are complications of untreated chlamydia?

PID, ectopic pregnancy, infertility, HIV, neonatal conjunctivitis and pneumonia.

How is chlamydia diagnosed and managed?

Culture; treated with doxycycline or azithromycin; treat partners.

What are symptoms of chlamydia?

Spotting, purulent discharge, dysuria.

Who should be screened for chlamydia?

All pregnant women.

What are symptoms of gonorrhea?

Greenish-yellow discharge, menstrual irregularities.

What are gonorrhea complications during pregnancy?

PROM, preterm birth, chorioamnionitis, neonatal sepsis, IUGR, postpartum sepsis.

How is gonorrhea managed?

Rocephin (Ceftriaxone) IM x1.

How is gonorrhea screened in pregnancy?

First prenatal visit and again at 36 weeks for high-risk patients.

What are the stages of syphilis?

Primary (painless ulcer), Secondary (rash on palms/soles, fever, malaise).

How is syphilis diagnosed?

Microscopy and serology (note 1/3 may test negative in early primary stage).

How is syphilis treated?

Penicillin G.

What is pelvic inflammatory disease (PID)?

Infection of uterus, fallopian tubes, ovaries from ascending microorganisms.

What are PID risk factors?

Multiple partners, STI history, young age.

What are PID symptoms?

Pelvic pain, fever, chills, nausea, vomiting, discharge, irregular bleeding.

How is PID managed?

Prevention, broad-spectrum antibiotics, bed rest, comfort measures, avoid frequent exams.

What is HPV?

Human papillomavirus – over 100 types, some cause genital cancer.

What does HPV look like?

Soft, papillary swellings; may resemble cauliflower.

What are HPV concerns during pregnancy?

Lesions may worsen; C-section if extensive.

How is HPV managed?

No cure; treat lesions symptomatically.

What is HSV-1 vs HSV-2?

HSV-1: non-sexual; HSV-2: sexual.

What are symptoms of initial HSV outbreak?

Painful lesions, fever, malaise lasting 2–3 weeks.

How is HSV managed in pregnancy?

Acyclovir; C-section if lesions present at labor.

What is bacterial vaginosis (BV)?

Most common symptomatic vaginitis; associated with preterm labor.

What are BV symptoms?

Fishy odor, thin white/gray discharge, mild irritation.

How is BV treated?

Oral Flagyl, gel, or clindamycin cream.

What causes candidiasis (yeast infection)?

Antibiotics, diabetes, pregnancy, obesity, high sugar diet, tight clothing.

What are yeast infection symptoms?

Itching, painful urination, thick white lumpy discharge.

How is candidiasis treated?

Antifungal meds and education on risk factors.

What is trichomoniasis?

STI that may be asymptomatic; can cause frothy yellow-green discharge, itching, cervical petechiae.

How is trichomoniasis treated?

Metronidazole.

What is Group B Streptococcus (GBS)?

Normal flora that can cause neonatal sepsis.

When is GBS screening done?

35–37 weeks gestation with vaginal and rectal swab.

How is GBS managed in labor?

Penicillin G every 4 hours during labor.

What are STI effects on pregnancy?

Low birthweight, preterm birth, stillbirth.

What are fibrocystic breast changes?

Lumpiness with/without tenderness; cyclic and most common in upper outer quadrants.

What are fibrocystic symptoms?

Dull pain, pea-like nodules.

How are fibrocystic changes managed?

Ultrasound, low-fat nutrient-dense diet.

What is a fibroadenoma?

Solitary ~2.5 cm lump, increases in pregnancy, decreases with age.

How is fibroadenoma screened?

History, physical, mammogram, ultrasound, MRI, needle aspiration.

Why is nipple discharge concerning?

Could indicate endocrine disorder or cancer; needs evaluation.

What is mammary duct ectasia?

Benign duct inflammation with sticky discharge and discomfort behind nipple.

What is an intraductal papilloma?

Rare benign tumor causing unilateral bloody discharge.

What is important nursing care for breast conditions?

Assess risk factors, thorough history and physical.

What are breast cancer risk factors?

Age, family history, early menarche, late menopause, Caucasian, nulliparity, obesity, alcohol, low vitamin D.

How can breast cancer be prevented?

Chemoprevention (Tamoxifen, Raloxifene), early detection (SBE, CBE, mammograms).

What are surgical options for breast cancer?

Lumpectomy, total mastectomy, modified radical mastectomy, radical mastectomy.

What is important post-op care after mastectomy?

See Box 4.10 (exercise education) and Box 4.11 (post-op teaching).