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LSC Ch 74 Gyn Prob
LSC Nursing
| Question | Answer |
|---|---|
| Primary Dysmenorrhea | "painful menstrual flow" occurs after ovulation begins 6m after menarche, excess prostaglandin, spasms of myometrium, lower back & legs, GI symptomsfrom stim of other smooth muscles |
| Secondary Dysmenorrhea | Endometriosis adhesions, PID, ovarian cysts, tumors, fibroids |
| Interventions for Primary Dysmenorrhea | as soon as symptoms start, NSAIDs: decrease prostaglandins, Acetaminophen-mild, oral contraceptives (increase risk DVT's), Heat packs lower ab, dietary: low fat vegie diet, Thiamine B6, Ca, Mg. Vit E & Fish oil |
| Pre Menstrual Syndrome | 2wks before: luteal phase of cycle, affective sx, physical dyscomfort, cognitvie, tell up front-avoid me now!, go off deep end, affects relationships, decreased libido, TX Exercise 30min 3x/wk,stress mgmt, rest massage, fluids |
| Nutritional Intake/Avoid during Pre Menstrual | Limit: Sugar, Red Meat, ETOH, Chocolate, Salt, Tea/coffee, sodium DO: 6 meals/day, Calcium 1300mg, Mg (decrease fluid retention) Chasteberry Femaprin (not if pg) |
| Drug Therapy for Premenstrual Syndrome | Oral contraceptives: decrease breast pain & bloating, Gonadotropin Releasing hormone Agonist: Lupron Depot: stops ovulation, can cause menopausal SEs, Decrease bone density & libido; Transderm Estradiol Patch & Antidepressants 1st 10-14days of cycle; |
| Endometriosis | Endometrial tissue outside uterus, Pain just before menstrual flow, painful intercourse, defecation, GI problems, low bachache, infertility, rectal pressure (rule out PID, STD's) |
| Interventions for Endometriosis | Hormonal contraceptives x6mos, GnRH: cause atrophy of ectopic tissue, Heat therapy Surgical Interventions: Laser, TAH-BSO |
| Dysfunctional Uterine Bleeding | Excessive bleeding or frequency, beginning or end of reproductive years |
| Interventions for Dysfunctional Uterine Bleeding | Estrogen IV, Contraceptives, D&C, Endometrial ablation-remove lining, hysterectomy |
| Menopause | "normal" end of menstrual periods, None for 12 months, Eleveated FSH & LH, Hormonal Replacement Therapy (low dose don't if cardiac hx) risk of DVT's, Estrogen Cream-vaginal dryness, |
| Amenorrhea | Primary causes: congenital anomalies, Hypothalamic & pituitary disorders, systemic disease: thyroid & adrenal dysfunction, Diabetes, extreme malnutrition, malform repro tract, 2ndary: Pregnancy, Menopause, Lactation, cervical stenosis, |
| Perimenopause transition | unpredictable changes in periods, hot flashes, affects mood, cocentration, scattered, ability to fall asleep, vaginal dryness, stress incontinence, Menstrual irregularity |
| Vulvovaginitis | Inflammation of the vagina & vulva, d/c & itching can be chronic cycle, erythema, Primary infection: Herpes, HPV, warts; 2ndary: Candidiasis, lice, scabies, douching |
| Tx for vulvovaginitis | Sitz baths, hydrocortisone cream, change in laundry detergent, laser therapy for severe vulvitis |
| Pt Education For Vaginal Infections | Increased risk w/multiple partners, no intercourse or have partner wear a condom during infection, sexual partner may need tx too, get examined by a health care provider, take medicine as prescribed |
| Toxic Shock Syndrome | staph infection in menstral blood stasis, tampons, contraceptive sponges, diaphrams, Abrupt onset fever, HA, flu-like sx, severe hypotension, fainting, sunburn, rash in eyes,skin,capillaries |
| Tx for Toxic Shock Syndrome | Remove source of infection (tampon), drugs to manage hypotension, transfusions due to low platelet count, corticosteroids for platelet count |
| Grade I Uterine Prolapse | Uterus bulges into the vagina, cervix does not protrude through the entrance of the vagina |
| Grade II Uterine Prolapse | Uterus bulges farther into the vagina, cervix protrudes through the entrance of the vagina |
| Grade III Uterine Prolapse | The body of the uterus and cervix protrude through the entrance of the vagina, the vagina is turned inside out |
| Cystocele | A protrusion of the bladder through the vaginal wall, can lead to stress incontinence & UTI's, frequency urgency, difficulty emptying bladder |
| Rectocele | Protrusion of the rectum through a weakened vaginal wall - constipation, impaction, hemorrhoids, rectal or vaginal fullness |
| Prolapse Interventions | Kegel Exercises, Pessaries or spheres worn in the vagina to elevate the uterus |
| Surgical Procedure: Anterior Colporrhaphy | better bladder support, avoid lifting over 5#'s, strenuous exercise, intercouse x6wks, |
| Surgical Procedure: Posterior Colporrhaphy | Reduces rectal bulging, Postop: same for rectal surgery (low residue diet, don't strain, sitz bath, pain med before 1st BM) |
| Fistulas | Abnormal Opening between 2 organs, often related to trauma/childbirth; assess: leakage of urine/flatus/feces in vagina, irritation/excoriation of vulva & vaginal tissues, fecal/or urine odor in vagina |
| Treatment for Fistulas | Aggressive perineal hygeine, A&D Ointment to irritated tissues, surgical repairs: similar to cyctocele or rectocele care |
| Uterine Cyst | arise on uterine wall, r/o cancer, disappear over time, surgically removed/lap, if Diabetic, and on oral meds, switch to insulin if want to get pg |
| Uterine Leiomyoma (Fibroids) | stim. by estrogen, progesterone,& growth hormone, uterine enlargement, rarely malignant |
| Assessment for Fibroids | Heavy bleeding/between period bleeding, ask #of pads/tampons used/day, pelvic pressure, paiful intercourse, infertility |
| Lab & Dx for Fibroids | Low Hgb, iron deficiency anemia, endometrial biopsy r/o cancer, US, Hysteroscopy or Lap, MRI, |
| Nursing Dx for Fibroids | Anxiety, Fear, Acute pain, Grieving, sexual dysfunction, ineffective coping; Collaborative Dx: Potential for Hemorrhage |
| Interventions for Fibroids | Outcome: Free from bleeding & pain, Asymptomatic: not tx, Non surgical: fibroids shrink w/menopause unless on HRT, NSAIDS, Hormonal contraception, or IUD, Uterine artery (fibroid) emboliztion: blocks circulation to fibroid, unable to conceive cramps 2-4da |
| MIS: Myomectomy for Fibroids | early phase of cycle, causes scarring-future deliveries: C-section |
| Transcervical Endometrial Resection via hysteroscopy | Hysteroscope into uterus, diathermy or radio-abalationto destroy endometrium |
| Hysterectomy | Vaginal- vag hyst, smaller fibroids, TAH: fibroids >16wks pregnancy, MIS or bikini incision, ligiments attached to vaginal cuff to maintain vagina |
| Pre Op Hysterectomy | Impact on child bearing, femininity, surgical menopause, if younng, estrogen replacement, vaginal changes-estrogen cream |
| Post Op Complications from Hysterectomy | Intestinal Obstruction, Thromboembolism, Atelectasis, Pneumonia, Wound dehiscence, Urinary Retention; Vag Hys: Hemorrhage, UTI or retention, wound infection |
| Post OP Hysterectomy | Peri Pad is still needed for vag bleeding, Monitor abd incision, Vag Hyst: peri pad, Foley Cath, Peri Care, Sitz Bath or ice packs |
| Community Based Care - Hysterectomy | D/C 1-2 days after TAH or same day after MIS, Limit stair climbing, driving several weeks, Psychological reactions, take temp 2x/day for first 2wks, 5# rule, |
| Bartholin Cyst | Swelling perineal area, local pain, vulva, drainage-test for STD's, Culture, Ruptures spontaneously 3 days, I&D or remove |
| Endometrial Cancer History | Most common gyn malignancy ages 50-70, family hx, DM, HTN, Obesity, Uterine Polyps, Late Menopause, Nulliparity, Smoking |
| Endometrial Cancer Assessment | Most common symptom: post menopausal bleeding, check # of tampons/pads used/day, watery d/c, low back-pelvic pain, CA-125 Tumor Marker |
| Community Based Care | Report vaginal/rectal bleeding, foul d/c, abd pain or distention, High dose radiation-sterility, Chemo-side effects, Emotional & physical effects, death |
| Cervical CA | pap smear, HPV, PAINLESS Vaginal bleeding |
| Ovarian CA | spreads & damages before it is found, serum marker CA-125 |
| Vulvar CA | Irritation/sore in vulva, Chemo topical F5U |
| Vaginal CA |
Created by:
ginabeana
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