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Maternity Exam 1
Chapter 4: Common GYN Issues (what they are, symptoms & treatments?)
| Term | Definition |
|---|---|
| Amenorrhea | Amenorrhea simply means absence of menses. It is a symptom, not a diagnosis. Amenorrhea is normal in prepubertal, pregnant, postpartum, and postmenopausal females. |
| Dysmenorrhea | Dysmenorrhea refers to painful menstruation and is a highly prevalent problem among menstruating women. This condition has also been termed cyclic perimenstrual pain. Dysmenorrhea is caused by the activation of the prostaglandin and leukotriene cascade in the uterine wall. |
| dyspareunia, | dyspareunia (difficult or painful sexual intercourse) |
| PMS & Premenstrual dysphoric disorder (PMDD) | Premenstrual syndrome (PMS) describes a constellation of recurrent physical, emotional, and behavioral symptoms that occur during the luteal phase or last half of the menstrual cycle and resolve with the onset of menstruation. Wide range of recurrent symptoms More severe variant: premenstrual dysphoric disorder (PMDD) Etiology: unknown Therapeutic management Multidimensional approach Vitamin supplements, diet changes, exercise, lifestyle, medications |
| Abnormal uterine bleeding (DUB) | Painless endometrial bleeding that is prolonged, excessive, and irregular and not attributed to any underlying structural or systemic disease Similar to and may overlap with other uterine bleeding disorders Occurs most often at beginning and end of reproductive years Etiology related to hormone disturbance Treatment involves treating the underlying cause Nursing management involves client education |
| Endometriosis | Endometriosis is a complex syndrome characterized by an estrogen-dominant chronic inflammatory process that affects primarily pelvic tissues, including the ovaries. It is caused when tissue similar to that of the endometrium implants outside of the uterus, most commonly throughout the abdominal cavity Etiology: risk factors; exact cause unknown Therapeutic management Surgery Medication therapy Nursing assessment: infertility and pain; nonspecific pelvic tenderness; tender nodular masses on utero |
| Infertility: Risk factors | risk factors causes, effects treatment options IVF, GIFT, Insemination) |
| Infertility: Causes for women | n women, ovarian dysfunction (40%) and tubal/pelvic pathology (40%) are the primary contributing factors to infertility Risk factors for infertility in women include: Overweight or underweight (can disrupt hormone function) Scarred fallopian tubes from infections Uterine fibroids Tubal blockages Anovulation Cervical stenosis Reduced oocyte quality Chromosomal abnormalities Congenital anomalies of the uterus Immune system disorders Chronic illnesses such as diabetes, thyroid disease, asthma S |
| Infertility: Treatment options: IVF | In vitro fertilization (IVF) Oocytes are fertilized in the lab and transferred to the uterus. Usually indicated for tubal obstruction, endometriosis, pelvic adhesions, and low sperm counts |
| Contraception Method: Barrier | Barrier • Condom (male and female) • Diaphragm • Cervical cap • Sponge |
| Contraception Method: Hormonal | Hormonal • OC • Injectable contraceptive • Transdermal patch • Vaginal ring • Implantable contraceptive • Intrauterine contraceptive • Emergency contraceptive |
| Contraception Method: (IUD’s & warning signs) | intrauterine contraceptive (IUC) is a small T-shaped object that is placed inside the uterus to provide contraception. It prevents pregnancy by making the endometrium of the uterus hostile to implantation of a fertilized ovum by causing a nonspecific inflammatory reaction and inhibiting sperm and ovum from meeting. |
| Emergency contraception: | Emergency contraception (EC) reduces the risk of pregnancy after unprotected intercourse or contraceptive failure such as condom breakage. It is used within 72 to 120 hours of unprotected intercourse to prevent pregnancy. The sooner ECs are taken, the more effective they are. They reduce the risk of pregnancy for a single act of unprotected sex by almost 90% |
| Contraception: Sterilization (vasectomy and tubal ligation) | Sterilization refers to surgical procedures intended to render the person infertile. Laparoscopic, abdominal, and hysteroscopic methods of female sterilization are available in the United States, |
| Abortions | Clinical termination of pregnancy |
| Abortions: Therapeutic | The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons. |
| Abortions': Elective abortion | A therapeutic abortion is the interruption of a pregnancy before the 20th week of gestation because it endangers the mother's life or health or because the baby presumably would not be normal. |
| Menopause: Common symptoms of menopause | With its dramatic decline in estrogen, menopausal transition affects not only the reproductive organs, but also other body systems: Brain and central nervous system: hot flashes, disturbed sleep, mood, and memory problems Cardiovascular: lower levels of high-density lipoprotein (HDL) and increased risk of CVD Skeletal: rapid loss of bone density that increases the risk of osteoporosis Breasts: replacement of duct and glandular tissues by fat Genitourinary: vaginal dryness, stress incontinence |
| Menopause: osteoporosis | Menopause predisposes women to osteoporosis due to declining estrogen levels. This results in a decrease in bone mineral density and an increase in fractures. Osteoporosis has been recognized as a significant worldwide public health problem. Osteoporosis is the state of diminished bone density. This disorder is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility |
| Menopause: diagnosis | As menopause approaches, more and more of the menstrual cycles become anovulatory. This period of time, usually 2 to 8 years before cessation of menstruation, is termed perimenopause. In perimenopause, the ovaries begin to fail, producing irregular and missed periods and an occasional hot flash. When menopause finally appears, viable ova are gone. Estrogen levels plummet by 90%, and estrone, produced in fat cells, replaces estradiol as the body’s main form of estrogen. The major hormone produced by the |
| Menopause: Prevention | Nursing assessment Screening for osteoporosis, cardiovascular disease, and cancer risk Lifestyle to plan strategies to prevent chronic conditions |
| Menopause: Treatments | Health maintenance education; risk reduction Lifestyle modifications Stress management |
| Primary amenorrhea | is defined as either the: absence of menses by age 15, with absence of growth and development of secondary sexual characteristics; or absence of menses by age 16, with normal development of secondary sexual characteristics (Creighton et al., 2018). |
| Secondary amenorrhea | is the absence of regular menses for three cycles or irregular menses for 6 months in women who have previously menstruated regularly. |
| Etiology Primary amenorrhea has multiple causes, including | Extreme weight gain or loss Congenital abnormalities of the reproductive system Stress from a major life event Excessive exercise Eating disorders (anorexia nervosa or bulimia) Cushing disease Polycystic ovary syndrome Hypothyroidism Turner syndrome—defective development of the gonads (ovary or testes) Imperforate hymen Chronic illness—diabetes, thyroid disease, depression Pregnancy Cystic fibrosis Congenital heart disease (cyanotic) Ovarian or adrenal tumors |
| Etiology Secondary amenorrhea has multiple causes, including | Pregnancy Breastfeeding Chronic prolonged stress Pituitary, ovarian, or adrenal tumors Depression Hyperthyroid or hypothyroid conditions Malnutrition Hyperprolactinemia Rapid weight gain or loss Chemotherapy or radiation therapy to the pelvic area Vigorous exercise, such as long-distance running Kidney failure Colitis Chemotherapy, irradiation Use of tranquilizers or antidepressants Postpartum pituitary necrosis (Sheehan syndrome) Early menopause (Klein et al., 2019) |
| Therapeutic Management for primary amenorrhea | Therapeutic intervention depends on the cause of the amenorrhea. The treatment of primary amenorrhea involves the correction of any underlying disorders and estrogen replacement therapy to stimulate the development of secondary sexual characteristics if they are absent. |
| Therapeutic Management for secondary amenorrhea | Cyclic progesterone, when the cause is anovulation, or oral contraceptives (OCs) Bromocriptine to treat hyperprolactinemia Nutritional counseling to address anorexia, bulimia, or obesity GnRH, when the cause is hypothalamic failure Thyroid hormone replacement, when the cause is hypothyroidism |
| Primary Dysmenorrhea | Primary dysmenorrhea (spasmodic) refers to painful menstrual bleeding in the absence of any identified underlying pelvic pathology. It is caused by increased prostaglandin production by the endometrium in an ovulatory cycle. |
| Secondary Dysmenorrhea | Secondary dysmenorrhea (congestive) is painful menstruation due to pelvic or uterine pathology. It may be caused by endometriosis, pelvic adhesions, adenomyosis, fibroids, pelvic inflammatory disease (PID), an intrauterine system, cervical stenosis, or congenital uterine or vaginal abnormalities. |
| Tips for Managing Dysmenorrhea | Exercise to increase endorphins and suppress prostaglandin release. • Limit salty foods to prevent fluid retention. • Increase water consumption to serve as a natural diuretic. • Increase fiber intake with fruits and vegetables to prevent constipation. • Use heating pads or warm baths to increase comfort. • Take warm showers to promote relaxation. • Sip on warm beverages, such as decaffeinated green tea. • Keep legs elevated while lying down or lie on your side with knees bent. • Use stress manageme |
| Nursing Management of Dysmenorrhea | Nursing assessment Past medical history, sexual history, menstrual history; bimanual pelvic examination Manifestations: pain, nausea, vomiting diarrhea, fatigue, fever, headache, dizziness; bloating, water retention, weight gain, muscle aches, food cravings, breast tenderness Client education Comfort measures: heat, lifestyle changes, pain relief |
| Abnormal uterine bleeding (DUB) Therapeutic treatment | Therapeutic management: goal is to normalize the bleeding, correct the anemia, prevent or diagnose early cancer, and restore quality of life pharmacotherapy or insertion of a hormone-secreting intrauterine system surgical intervention: dilation and curettage (D&C), endometrial ablation, uterine artery embolization, or hysterectomy Nursing assessment Nursing management |
| The most common causes of AUB can be classified using the PALM-COEIN acronym: | PALM (structural) Polyp Adenomyosis Leiomyosis Malignancy COEIN (other) Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified |
| Treatment Options for PMS and PMDD | • Lifestyle changes • Reduce stress • Exercise three to five times a week • Eat a balanced diet and increase water intake • Decrease caffeine intake • Stop smoking and limit the intake of alcohol • Attend a PMS or women’s support group • Vitamin and mineral supplements • Multivitamin daily • Vitamin E, 400 units daily • Calcium, 1,200 to 1,600 mg daily • Magnesium, 200 to 400 mg daily • Medications • NSAIDs taken a week prior to menses • OCs (low dose) • Antidepressants (SSRI |
| Categorizing Premenstrual Syndrome Symptoms | Nursing assessment: irritability, tension, dysphoria (most prominent and consistent symptoms) A: anxiety C: craving D: depression H: hydration O: other ACOG criteria Mood disorders: main symptoms of PMDD |
| Infertility | Infertility is defined as the inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception Secondary infertility is the inability to conceive after a previous pregnancy. |
| Infertility: Causes for men | Exposure to toxic substances (lead, mercury, x-rays, chemotherapy) Cigarette or marijuana smoke Diabetes Heavy alcohol consumption Use of prescription drugs for ulcers or psoriasis Exposure of the genitals to high temperatures (hot tubs or saunas) Hernia repair Cardiovascular disease Obesity associated with decreased sperm quality Cushing syndrome Frequent long-distance cycling or running STIs Undescended testicles (cryptorchidism) |
| Infertility GIFT: | Oocytes and sperm are combined and immediately placed in the fallopian tube so fertilization can occur naturally. Requires laparoscopy and general anesthesia, which increases risk |
| Infertility Insemination: | The insertion of a prepared semen sample into the cervical os or intrauterine cavity Enables sperm to be deposited closer to improve chances of conception Husband or donor sperm can be used. |
| Contraception | The terms “contraception,” “family planning,” and “birth control” are used interchangeably when referring to the intentional prevention of pregnancy through the use of various devices, agents, drugs, sexual practices, and surgical procedures. |
| Contraception: Behavioral Methods | Behavioral • Abstinence • Fertility awareness–based methods (FAMs) • Withdrawal (coitus interruptus) • Lactational amenorrhea method (LAM) |
| Contraception: Sterilization: Vasectomy | Male sterilization is accomplished with a minor surgical procedure known as a vasectomy. The procedure involves making a small incision into the scrotum and cutting the vas deferens, which carries sperm from the testes to the penis |
| Contraception: Sterilization: Tubal ligation | Tubal ligation, the sterilization procedure for women, can be performed postpartum, after an abortion, or as an interval procedure unrelated to pregnancy. Mini-laparotomies and laparoscopies are the two most common techniques. In the laparoscopy procedure, the abdomen is filled with carbon dioxide gas so that the abdominal wall balloons away from the tubes to provide a view of the fallopian tubes. They are grasped and sealed with a cauterizing instrument or with rings, bands, or clips, or cut and ti |
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bonitasoul
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