Nipples 4 drainage, cracking, edema, redness…Tissue do self exam, lungs.
What do u assess in the genitalia
have 2 people room, assess pubic hair texture is it the same no bald spots & no lice, skin no lesions look 4 tears, external structures, speculum exam.
Pelvic inflammatory disorders
inflammation from pathogens in the fallopian tubes or ovaries or both, may involve other structures except uterus spreads upward.
What 3 things cause Pid
Streptococcus, staphylococcus, gonococcus.
What PF contribute to Pid
Freq intercourse, multiple sex partners, Iud’s & child birth.
Oral Abt: tetracycline hcl, ampicillin, flagyl, sulfa creams: sultrin, triple sulfa, antiviral creams qd or bid for 6-14 days.
Chlymadia
s/s are asymptomatic. Complications are infertility.
What dx test is done to diagnose chlymadia
Vaginal c & S.
Med tx for chlymadia
Oral abt for 7 days & then repeat c & s.
What causes postmenopausal vaginitis
Decreased estrogen levels.
S/S of postmenopausal vaginitis
Dyspareunia, irritation, burning and itching.
Med tx for postmenopausal vaginitis
Estrogen replacement: po, patch(transdermal), and vaginal.
Teaching for postmenopausal vaginitis
Wear cotton panties, do not sit in wet bathing suit in warm weather, treat quickly, 8 oz of yogurt po qd w/ abt.
Things 2 assess 4 in postmenopausal vaginitis1
Bubble baths, panty hose, type of panties, hx of s/s, hx of menses, contraceptive methods, abt use
Things 2 assess 4 in postmenopausal vaginitis2
recent illness, sexual hx, Dm, usual hygiene, pregnancy hx, use of deodorant tampons or pads, c,c,a,o of discharge, scratches, irritation.
What is toxic shock syndrome(tss)
A condition most associated w/ staph
Cause of Tss
Staphylococcus aureus.
Pf’s of tss
Tampon use, women under 30 yrs old.
S/s of tss
Temp of 102 or greater, vomiting, diarrhea, flulike s/s malaise, muscle weakness, sore throat, and headache, macular erythematous rash (red, flat) followed in 1-2 wks by peeling of the palms & soles, dehydration, disorientation.
Med tx of tss
Iv fluids, mechanical ventilation, Cpap used to force O2 in to the lungs.
Tampon use: freq of change duration of use, sore throat, ha, myalgia, fatigue, erythematous rash, edema, peeling of the palms & soles, hypotension Loc, nonpurulent conjunctivitis, hyperemia of the vagina and oropharynx.
What are 2 types of benign neoplasms
Fibrocystic breast disease & fibroid tumors.
What is fibrocystic breast disease
Hyperplasia of the epithelial cells leads to an icrease in fibrous tissue aka chronic cystic mastitis or lumpy breast syndrome.
What are the causes and pf’s of fbd
Unknown, caffeine.
S/s of fbd
Yellowish greenish sticky discharge from nipples.
Hyperplasia
Over growth is the # of the cells.
Hypertrophy
Over growth in the size of cells.
Dx test used to diagnose fbd
Mammogram, bse pap smear on nipple discharge, biopsy (will tell if tumors are present either benign or malignant.
Benign
not a threat to life or long-term health especially by being noncancerous.
Malignant
Likely to cause harm or death cancerous.
Surgery for fbd
Aspiration or incision to excise the tissue
Rx used for fbd
Vit e qd
Things to assess in fbd
Most recent mammogram, caffeine intake freq of bse, increased pain in lumps w/ menses, moveable lumps on breast exam.
What is fibroid tumors leiomas
An overgrowth of cells in & around the uterus.
What are the pf’s of fibroid tumors leiomas
Older than 30 yrs old & nulliparous.
Nulliparous
Never having delivered infant after 24 wks gestation.
S/s of fibroid tumors leiomas
Menorrhagia, increasing pelvic, pressure, dysmenorrheal, abdominal enlargement (b/c the fibroids are growing), constipation.
Complications of fibroid tumors leiomas
Preterm delivery, fast growth (spreads & takes up a lot of space).
Medical tx and surgery 4 fibroid tumors leiomas
Observe growth, myomectomy, d & c, & hysterectomy.
Myomectomy
Surgical removal of uterine fibroids from the uterus.
Diet for fibroid tumors leiomas
High in iron.
Things 2 assess 4 in fibroid tumors leiomas
Ask about s/s, # of sanitary pads used in an hour, clots in menses, decreased hct, pale, hypotension, tachycardia.
What is breast cancer
An overgrowth of mutated cells in the breast tissue. 2nd leading cause of death in women.
Pf’s of breast cancer
Late menopause, onset of menses before 10y/o, high fat diet, moderate alcohol intake, smoking, over 65 y/o family hx, nulliparous, 1st pregnancy after 30y/o, hx fibrocystic breast disease obesity, never having breast fed, <1% of men.
Dx test done to diagnose breast cancer
Pe, mammogram, bse.
Stage 1 of breast cancer
Tumor smaller than 2cm, no lymph nodes test + for cancer cells, no evident metastases.
Stage 2 of breast cancer
Tumor is between 2 & 5cm, 0-1 lymph nodes test + for cancer cells, no evident metastases.
Stage 3 of breast cancer
Tumor is larger than 5 cm no lymph nodes test + for cancer cells/ no evident metastases or tumor is between 0 & 5 cm & lymph nodes test positive for cancer cells with no evident metastases.
Stage 4 of breast cancer
Tumor is of any size, lymph nodes may/may no test + for cancer cells, evident metastases into other areas lungs, bone, brain, liver.
s/s of breast cancer
Painless mass or thickening lump, pain or discharge from the nipple, unilateral change in breast size, dimpling or puckering orange peel appearance, microclusters tiny palpable clusters of calcium that feel like rocks
Removal of the tumor & a small portion of breast tissue.
Modified mastectomy
Removal of the entire breast and nearby lymph nodes.
Radical mastectomy
Removal of the entire breast, lymph nodes and underlying pecoralis muscle.
Post op care for breast cancer surgery
Do not carry anything on affected side including a purse, do not draw blood, get shots or take bp on affected side, always wear med alert tag, may get prosthesis or reconstruction done.
Rx for breast cancer pts
Antieoplastics: antiestrogens, androgens, alkalating agents, antitumor antibiotics, antimetabolites, steroids used in combo before or after or.
Things 2 assess for in breast cancer
Lumps, discharge from nipples, unilateral changes, how longs, tender or non painful, less w/ menstrual cycle, last mammogram, v/s, wt, bse, last mammogram check, check s/s.
Things 2 assess post op for breast cancer
v/s, incision, check emotional needs.
What is cervical cancer
An overgrowth of mutated cells in the cervix of the uterus.
Dysplasia
An early stage of the cancer a change in the size or shape of the cervical cells classified as mild, moderate or severe.
Dx test for cervical cancer
Abnormal pap smear classified from 1 thru 5. 1 is considered normal 5 indicates a malignant condition.
Pf’s of cervical cancer
Multiple sexual partners, hpv 35-55y/o, maternal use of dithylstibestrol during pregnancy.
S/s of cervical cancer
Initially asymptomatic, abnormal bleeding, thin watery progressing to bright red, contact bleeding after intercourse, odor, pain in the lower back & groin, difficulty voiding, hematuria, rectal bleeding.
Med tx of cervical cancer
Antibiotic cream or colposcopy followed by repeat pap depends on staging.
Cervical stage 1
No spread only on the cervix.
Cervical stage 2-5
Metastasis to bladder, vagina, or other pelvic organs.
Surgery for cervical cancer1
Conization which is a surgical excision of a cone shaped section of the abnormal cervical tissue best for pts that wish to have kids.
Surgery for cervical cancer2
If cervical lesions are easily visible laser, cryosurgery (freezing w/ liquid nitrogen), cauterization(burning)
Metastasis cervical cancer
Total hysterectomy or radical pelvic surgery (which is if it has spread outside the repro tract, laparotomy may be done to stage the disease.
Therapies done for cervical cancer
Radiation therapy, radium implants and chemotherapy.
Things 2 assess for w/ cervical cancer1
Spotting, post coital bleeding, foul smelling vaginal discharge, increased bloody discharge, wt loss, radiating pain to lower legs and back.
Things 2 assess for w/ cervical2
Abnormal pap w/ cellular changes w/ progression, wt loss, anemia.
What is endometrial cancer
An overgrowth of mutated cells in the endometrial lining.
Pf’s of endometrial cancer
Post menopausal women, estrogen replacement therapy for more than 5 yrs, nulliparous, Caucasian, middle class, no intercourse, jewish descent.
S/S of endometrial cancer
Asymptomatic until advanced stages.
Dx test used to diagnose endometrial cancer
Endometrial biopsy.
Medical tx for endometrial cancer
Estrogen progesterone combination therapy
Surgery for endometrial cancer
D & c (2 remove tumors).
What is ovarian cancer
Overgrowth of mutated cells in the ovaries.
Pf’s of ovarian cancer
45-65yrs old, nulliparous, smoking, slcohol, infertility, high fat diet, breast cancer, family hx, possibly related 2 the presence of ovarian cysts ( may be @ higher risk for ovarian cancer).
Ovarian cancer
Freq metastasizes before dx in colon, stomach, diaphragm.
Fatigue, diarrhea, constipation, pelvic pressure, frequency of urination, loss of appetite, nausea, wt loss, vaginal bleeding or spotting w/ intercourse.
Things 2 assess for w/ ovarian cancer2
Malaise, foul smelling vaginal discharge, pain in the lower back, health hx, reproductive hx, palpable mass, pap smear >11, abnormal biopsies.
Pelvic pain that can radiate before or at the onset of menstrual period caused by uterine spasms, narrowingof the cervical canal, emotional factors, Pid, Iud, endometriosis.
Rx used for dysmenorrhea
Analgesics, prostaglandin inhibitors(helps control of pain), oral contraceptives.
What is amenorrhea
Absence of menstruation.
What are the 2 types of amenorrhea
Primary & secondary
Primary amenorrhea
No menses by 17 y/o causes- anatomical or genetic abnormalities
Secondary amenorrhea
6 mths of normal menses & then stops or 12 mths of abnormal menses, then it stops.
Causes of secondary amenorrhea
Anorexia nervosa, excessive exercise w/ decrease in body fat, endocrine dysfunction, emotional disturbances, s/e of meds, pregnancy, lactation, hormone imbalance, nutritional deficits, pituitary tumors.
D & C, hysterectomy, blood transfusions, iron supplements.
Things to assess for in Pom2 d/o
describe bleeding (onset, timing, number of pads, pain, clots), hx of meds, contraception, pregnancy, stressors, health probs, v/s & labs.
Premenstrual syndrome(pms)
Group of s/s experienced during the secretory phase of the menstrual cycle.
Pf’s of Pms
Stress, poor nutrion, rx or s/e from bcp, sedentary lifestyle, marital status, hx of preeclampsia, muliparity, and hormone imbalance.
Dx test of Pms
Physical exam, keep calendar of s/s, labs to assess levels of: estrogen, progesterone, glucose.
S/S of Pms
Has over 150 s/s, Onset 7-10 days before menses & ends w/ start of flow, wt gain, bloating, irritability, edema, ha, edema, mood swings, inability to concentrate, food cravings, acne.
Complications of menopause (climacteric) cessation of menstruation
Cessation of menstruation
Cause of menopause
Hormone decline
Pf’s menopause
45-60 y/o
S/S of menopause
gradually inc. over 1 yr relaxation of pelvic support structures decrease in skin elasticity & turgor, thinning hair, vaginal dryness, thinning of vaginal mucosa, wt gain, dry skin, hot flashes, stress incontinence, inc risk for fractures, depression, in
Rx for menopause
Estrogen replacement therapy: po, cream, or patch, keep ota for 10-15 secs before application given for 10-15 yrs after menopause, progesterone suppositories.
Diet for menopause
Increase calcium, magnesium, decrease fat, vit e, primrose oil, calcium supps.
Things to assess for in menopause
Hx of s/s, hx of menses, physical exam, pap smear.
Cystocele
Downward displacement of the bladder into the anterior vaginal wall.
Urethrocele
Downward displacement of the urethra into the vagina.
Rectocele
Anterior displacement of the rectum into the posterior vaginal wall.
Prolapsed uterus
Downward displacement of the uterus into the vagina.
Cause of CURP
Multipariety 3rd to 4th degree perineal lacerations from child birth, weaking of the pelvic muscles from aging.
A small, molded, plastic or rubbery apparatus that fits into the vagina to provide support for the uterus.
Surgery for CURP
Prolapsed uterus
Colporrhapy
Surgical narrowing of the vagine done vaginally to put bladder, urethra, or rectum back in place.
MMK
Marshall, marchette, kranz, attaches the bladder to the inferior surface of the pubic bone.
Things 2 assess for with CURP
Stress incontinence, frequency, urgency, constipation, childbearing hx, onset of s/s, ua w/ exam can visualize bulging of the bladder, urethra, or rectum into the vagina.
Infertility
The inability to produce offspring.
Cause of infertility
Endocrine, anatomic, or immune systems d/o, decreased progesterone levels can cause spontaneous abortion, cause spontaneous abortion.
Infertility in couples
40% female, 40% male, combo 20%.
2 types of infertility
Primary-never been pregnant, secondary-inablity to conceive after having a child.
Dx test for infertility
Do full workup after having tried to conceive for 6-12 mths, basal body temp chart for 3 mths 1st half cycle-<98 degrees, 2nd half of cycle >98 degrees, endometrial biopsy, laparoscopy, endocrine imbalance tests, artificial insemination.
Artificial insemination
Place semen into the cervix or uterus w/ a small flexible catheter & syringe.
In vitro fertilization1
Gamete intra fallopian transfer- ovum & semen mixed in a catheter is injected into the fallopian tube.
In vitro fertilization2
Zygote Intra fallopian transfer or ivf-er (embryo transfer) several ova are mixed with sperm in a special fluid, wait 2-3 days, transfer fertilized ova into the fallopian tube.
Abstinence, rhythm method-no intercourse form 3 days before until 3 days after ovulation.
Barriers
Block the path of sperm, diaphragm, cervical cap, male & female condoms.
Spermicides
Kill sperm, work best in combination w/ barriers, do not use w/ apply @ least 15 mins before intercourse.
Intrauterine device (Iud)
Device irriates the uterine cavity (dalcon shield), in place for 1-7yrs s/e, bleeding & infection.
Hormonal methods
Oral contraceptives (bcp’s) suppress ovulation, make the body think that it is pregnant, 1:200 chance of pregnancy .
Bcp’s contraindicated if
No established menstrual, cycle, htn, dm, cvd, thrombophlebitis.
S/E of bcp
Ha, breast tenderness, nausea, wt gain, cva, thrombophlebitis.
Norplant
Levonorgestrel 6 pellets inserted under the skin in the arm, works for 5 yrs.
Depro Provera
Medroxyprofesterone acetate injection, IM q 12 wks suppresses ovulation, 3 weeks before effective s/e breakthrough bleeding.
Sterilization
Tubal ligation- laparoscopy to tie fallopiantubes, generalor epidural, 30-60 mins, vasectomy- surgical resection of the vas deferns.
Post op for vasectomy
Ice, rest, no strenuous activity, effective in 6 mths.
Marshall, marchette, kranz, attaches the bladder to the inferior surface of the pubic bone.
Things 2 assess for with CURP
Stress incontinence, frequency, urgency, constipation, childbearing hx, onset of s/s, ua w/ exam can visualize bulging of the bladder, urethra, or rectum into the vagina.
Infertility
The inability to produce offspring.
Cause of infertility
Endocrine, anatomic, or immune systems d/o, decreased progesterone levels can cause spontaneous abortion, cause spontaneous abortion.
Infertility in couples
40% female, 40% male, combo 20%.
2 types of infertility
Primary-never been pregnant, secondary-inablity to conceive after having a child.
Dx test for infertility
Do full workup after having tried to conceive for 6-12 mths, basal body temp chart for 3 mths 1st half cycle-<98 degrees, 2nd half of cycle >98 degrees, endometrial biopsy, laparoscopy, endocrine imbalance tests, artificial insemination.
Artificial insemination
Place semen into the cervix or uterus w/ a small flexible catheter & syringe.
In vitro fertilization1
Gamete intra fallopian transfer- ovum & semen mixed in a catheter is injected into the fallopian tube.
In vitro fertilization2
Zygote Intra fallopian transfer or ivf-er (embryo transfer) several ova are mixed with sperm in a special fluid, wait 2-3 days, transfer fertilized ova into the fallopian tube.
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