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wvc gyn lecture
wvc gyn lecture Linda Visser
| Question | Answer |
|---|---|
| Purposes of FMG are: | rite of passage –social pressure; maintain virginity, ensure fidelity; social and sexual control of women; decrease sexual pleasure for female; -^ sexual pleasure for male; some believe their faith demands. |
| FGM Acute complications- | cellulitis ; pain; hemorrhage; bony fractures (from being held down); acute urinary retention; death; tetanus. |
| FGM Long Term Complications | recurrent UTI; infected inclusion cysts; abscess; keloids; infertility; sexual dysfunction; increase risk of obstetrical complications; |
| Domestic Violence | Definition – physical, sexual, or threats of physical or sexual abuse and emotional abuse (stalking, intimidation, social isolation) |
| Scope of DV problem 1/4 women affected in their lifetime | ; 1.3 million physical assaults/year by partner; 3 women/day murdered by partner; 30% homicides in WA are intimate partner; 47% of DV homicides occur after victim has decided to leave or recently left. IS MOST VULNERABLE TIME TO BE VICTIMIZED; |
| DV across races | all races about equally vulnerable; 50% who abuse wives, also abuse children |
| DV Costs | – medical, mental health, lost work; boys who see DV are 2X as likely to repeat the pattern in own relationships |
| Prevention of DV (CDC plan): | define the problem; ID risk and protective factors; develop and test prevention strategies; assure wide spread adaptation of strategies |
| DV Current strategy for prevention is: | increase awareness of problem; -teach healthy dating relationships, role model, monitor youth (school, medical office); -crises hotlines and shelters |
| Nurse’s Role in DV prevention | - Universal screening as we don’t understand all risk factors –see assessment forms |
| Sexual Assault Scope of problem: | 1 in 4 to 6 women; 80% occurs when <18; -of adult victims, 50% are 18 – 21 yrs -is closely associated w/ DV & other “vulnerabilities” (ETOH, substance abuse, mental illness, elder abuse, previous sexual assault) Perpetrators look for “easy” victims. |
| Sexual Assault Perpetrators | -88% of adult rapes are by intimate partners or acquaintances; 11% are by strangers; -1% are by relatives |
| Sexual Assault Injury associated with rape | bodily trauma – 51%; -genital injury – 26% |
| Help Seeking after Rape | -tell someone -56%; -see doctor – 19%; -see therapist – 31%; -report to police -18% |
| Sexual Assault Consequences to health | -PTSD; -Depression; -Dysparunia; Childbirth Trauma; Chronic pelvic pain; Irritable Bowel Syndrome – IBS; Increased use of medical resources |
| Sexual Assault Nursing Role In the Emergency Room medical exam | – assess and treat -ABC’s, pregnancy prevention (Plan B), STD prevention (antibiotics) & HIV prevention (if high risk) |
| Sexual Assault Nursing Role In the Emergency Room -psych/social eval | –be compassionate and pt’s advocate for legal referral. Assess safety of home or need for emergency housing |
| Sexual Assault Nursing Role In the Emergency Room -legal | collection of evidence – informed consent. Pt. may refuse to have it done (SANE Nurses- Sexual assault nurse examiner) |
| Sexual Assault Refer/report – | mandated if child, elder, mental illness; assist to fill out crime victims compensation form; refer to women’s support center; encourage to follow up with primary provider. |
| Sexual Assault Nursing Role in Clinic | universal screening of all women; be aware of PTSD and associated somatic complaints and relationship to abuse; educate pts on the Support Center, counseling options |
| Rape – | forced sexual penetration (objects into orifices) |
| Attempted Rape – | uncompleted attempt at forced rape |
| Indecent Liberties – | force sexual contact (breasts, buttocks, genital area) |
| Non consenting Sex – | unwanted sex while under the influence of alcohol or drugs or when unable to give or withhold consent (estimated at 80% of SA cases in WA State) |
| Child Rape – | non forced sexual penetration when less than 16 years old with a person more than 5 years older |
| Child Molestation | –non forced sexual touching when less than 16 years by a person more than 5 years older |
| History Taking Setting the Tone –Sexual Hx | Recognize own comfort/discomfort; Approach each encounter as equal partners; Interaction w/ pt. is usually a “negotiation” for setting & implementing goals; nurse has knowledge of health care & the pt. has knowledge of history & body. |
| Styles of Communication when interacting with patients | Verbal – using pt’s preferred name; Nonverbal –ways provider communicates to client – eye contact, sitting behind desk, having pt. undress before meeting them, providing privacy ;Use pt’s own words, if appropriate. |
| Be clear in what is confidential and what is not | Explain that it is part of your assessment to ask certain questions of every woman about safety. Certain STI are mandatory to report & child molestation. |
| Components of Organizing a history | Chief Comp.& Hx of CC; Med, Surg., Fam, soc. Hx (ETOH, smk, wk, living sit., fam. support); Meds/Allergies; Sexual hlth. & Hx., STI, menstrual & Preg. Hx; -Fam. Planning (method, problems, past methods); Preventative & Screening Pract.s; Vulvovag sx’s |
| Menstrual Cyle | Regulated by a feedback control system of hormones; Hypothalamic/pituitary cycle –FSH, LH, GnRH; |
| Ovarian follicle cycle – | follicular, ovulation, luteal phases |
| Endometrial cycle – | proliferative, secretory, menses |
| Menstrual Cycle Average length is | 28 days – from 1st day of menses until 1st day of next menses. |
| Ovulation occurs | 14 days before the 1st day of the next menses. Ovulation is accompanied by temperature rise and cervical mucus thinning. |
| Mittelschmerz | follicle rupture at ovulation, perhaps with a little bleeding. |
| Estrogen is responsible for: | Secondary sex characteristics; Endometrial regeneration in uterus; ^ Vit D metabolism to ^ Ca absorption; ^HDL and decreases LDL; Maintains tissue suppleness; Enhances nerve impulse conduction (memory) |
| Estradiol – | produced in ovaries, 10% of total circulating estrogen |
| Estriol – | produced in adrenals, 80% of total circulating estrogen and is converted to estrone in body fat (10% of circulating estrogen) |
| Progesterone | Secreted by the corpus luteum –responsible for Endometrial thickening; Suppresses FSH and LH and prevents further ovum maturation in the cycle; Promotes sleep; Decreases anxiety |
| Androgens | Small amounts produced in the ovaries; Most androgens are produced in the adrenals |
| Testosterone- | large role in female libido; Decrease in testosterone results in lower sex drive, wt. gain, depression, muscle loss, anxiety, difficulty in concentration |
| Testosterone levels in women are | 1/10th of that found in men |
| In females, testosterone peaks 2X/month, at | ovulation and with menstruation |
| For women in their 20s | testosterone and estrogen have leveled off. Estrogen is high, leading women to seek intimacy, (touching, warmth, being understood). Intimacy releases oxytocin, the “love hormone”. |
| Males in their 20’s are strongly testosterone driven. | Male sexual peak. The conquest is important. Is why females this age seek older men, whose testosterone levels are lower. |
| For women 30’s is the “sexual power” decade. | Orgasm is more important. Many women this age are overworked ->stress-> decreased DHEA-> less testosterone and pheromone production. if can control stress ->more testosterone. |
| Women in their 40’s | Increase PMS body produces ^ levels of estrogen & progesterone to stimulate ovulation, followed by lows. Extreme emotional highs at ovulation, followed by lows before menses. Test. continues to rise-> sexual aggression & experimentation. Sexual peak. |
| Males in their 40’s | –decrease in testosterone lets estrogen dominate. More touch oriented, sensitive, receptive. Appealing to women in their 20’s. |
| Women in their 50’s | Similar to adolescence. Up and down levels of estrogen with some anovulatory cycles. Up and down mood and sexual desire –like teens. |
| Menarche – | usually occurs between 10 – 16 years of age |
| Puberty- | development of secondary sex characteristics. Begins before menarche. Average onset is 11-13 and has decreased over the years. |
| Delayed Puberty causes | –familial hx, low body fat, hormonal dysfunction, congenital structural anomalies (ambiguous genitalia) |
| Anovulatory cycles | –common 1st two years (without ovulation) |
| Climacteric | Is the time from the initial decline in ovarian estrogen to the end of symptoms; Ovarian follicles atrophy over time; as well as uterus and ovaries. |
| Perimenopause | Begins at 40 -50 years of age; Occurs about 4 years sooner in smokers and very thin women; Symptoms last about 2 -10 years. |
| Symptoms of the Perimenopause (20% of perimenopausal women seek care for symptoms) | Vasomotor symptoms –hot flashes, night sweats – 75% ; Cycle changes- d/t annovulation-short/long; Bloating, mood swings, brain fog, trouble sleeping, V libido, depression, vag. dryness |
| End of menses. | Diagnosis is made one year after last menses. Average age = 51 |
| Drop in estrogen stimulates | hypothalamus, which will stimulate the ant. pituitary to release FSH. Follicles will NOT respond and FSH soars. |
| in menopause FSH and LH levels are? | elevated |
| WARNING –post menopausal bleeding is sign of | endometrial cancer and must be evaluated! |
| Hormone Replacement Therapy Evidenced based studies show both Estrogen replacement Therapy (ET) and Estrogen plus Progesterone Therapy (EPT): | Prevents osteoporosis; Relieves vasomotor symptoms; Relieves vaginal atrophy; (least dose for as short a time as possible) |
| EPT (estrogen + progest. therapy) arm of study terminated early d/t risk greater than benefit (in 2002) | no cardio protective effects; ^ risk of breast CA by 24%; ^ risk of venous thrombosis/emboli events; decrease risk of overall fracture rate by 24% (least dose for as short a time as possible) |
| Hormone Replacement ET (estrogen replacement therapy) arm of WHI study was also terminated early (in 2005) | ^ risk of breast CA (but did not factor in obesity); no protective effect on CV system (least dose for as short a time as possible) |
| Hormone Replacement therapy Conclusions: | Prescribe lowest dose for shortest time to relieve sx.; Look at each pt’s risk: benefit ratio; REMEMBER – women with a uterus MUST have estrogen & progesterone prescribed together to avoid unopposed estrogen. |
| Unopposed estrogen | must have estrogen and progesterone together, otherwise risk of cancer is further increased. |
| Bioidentical hormones | are manufactured to have the same molecular structure as the hormones in the body. Are “natural” and are metabolized like hormones made in the body. |
| Synthetic hormones | are intentionally different than the body’s own, natural hormones because drug companies can’t patent a bioidentical structure. Premarin –from mare’s urine |
| Osteoporosis | Estrogen enhances Ca uptake into the bones |
| At menopause bone mass quickly declines | by 80 years of age, there will be a 50% reduction in bone mass! |
| Risk factors in osteoporosis | – female, Caucasian or Asian, family hx, small build, early menopause, nulliparous, sedentary, smoking, ETOH, low Ca intake, hx hyperthyroidism, long term steroid use |
| Osteoporosis Health consequences | By age 80, 25% of women will have had a hip fx; 10 – 20% will die from complications of the hip fx; 30% will need SNF care as a result of hip fx; Prevention is key! ID women at risk and treat |
| Screening: Bone Mineral Density (BMD) testing for: | All women > 65 years old; Postmenopausal women <65 with >1 risk factor; Postmenopausal women with fractures |
| Bone Mineral Density Testing DXA | DXA –dual energy x-ray absorptiometry of spine and proximal femur. Gold standard for diagnosis and monitoring effects of treatment. Results are read as a “T” score |
| DXA T-score | = pt’s BMD – young adult female (standard deviation of young adult BMD); Normal > - 1.0; Osteopenia is -1.0 to -2.5…Osteoporosis is -2.5 or less |
| DXA Drawbacks to DXA testing- | Not a standardized measurement, each lab has own reference population |
| Diagnosis for osteoporosis | DXA is the only tool used for diagnosis. |
| Other tests used with osteoporosis- | Quantitative CT or US –measure wrist, calcaneous. Predicts risk for fx., but only DXA can give the diagnosis! |
| Osteoporosis Prevention & treatment reduce Fx by 50% | Ca intake 1200 mg/day; Vit D intake 400-800 IU/day; Exercise –wt. bearing & muscle strengthening; Avoid smoking, ETOH; Treat all vertebral & hip fx with meds.; Biphosphonates- Fosamax, Actonel, Boniva – |
| Biphosphonates- | Fosamax, Actonel, Boniva –treatment and prevention Decreases hip and vertebral fxs by 50% |
| Fosamax – | Take on empty stomach with water, without other fluids or food for 30 to 60 minutes, sitting up, after fasting. Even with perfect compliance, it is still poorly absorbed. (can cause problems in the esophagus) |
| SERMs | selective estrogen receptor modulators (allows more estrogen to make it in) Evista is an example of this drug class. |
| Evista (raloxifene) prevention and treatment | -No effect on hip fxs. Decreases vetebral fx.; -Side effects –hot flashes, VTE -Benefit –decreases breast cancer rate |
| Calcitonin Treatment only - | Inhibits osteoclast activity; 50 – 60% response rate to treatment; Of responders, bone mass increases 8 – 10% in one year, then plateaus; Does NOT decrease hip fx rate; DRAWBACK to all treatment – once medication stops, bone loss rates resumeL |
| Calcitonin action | inhibits the breakdown action of the osteoclasts. |
| Brain Changes in menopause | seratonin balance; HRT –probably not protective against Alzheimer’s; “Use it or lose it” – work crossword puzzles, learn a new language or instrument, stay mentally active |
| Atrophic Vaginitis | Shrinkage of uterus, cervix, ovaries, labia, clitoris; Vagina narrows & shortens; vaginal mucosa is thin and dry -> increase risk of infections (STI, monilia) & dysparunia; Muscular support to plvs weakens -> urinary incont d/t poor bladder tone (kagles) |
| Atrophic Vaginitis Treatment options | vaginal lubricants –Replens, KY Gel, Slippery Stuff; estrogen creams or rings (Estring); “use it or lose it” ……(chemotherapy or other disorders may be responsible) |
| Cardiovascular Disease After menopause | woman’s risk approaches that of age matched men; Decrease in HDL; Increase in LDL; Increased risk diabetes |
| Contraception and Menopause | Continue for one year after menopause - defined as no menses for one full year |
| FSH levels can fluctuate wildly in the perimenopausal woman and | ovulation can occur. |
| To test for menopause in pt. who is on birth control | check FSH level 2 weeks after last hormone taken. If on Depoprovera birth control, wait until last month of 90 day use. |
| Contraceptive Methods | Abstinence ( partner availability?, sexual orientation?); Fert. Awareness – Cycle Beads, BBT; Barrier methods; Male condom; Female condom; Diaphragm; Cervical Cap; Sponge; Tubal ligation; Essure; hormone use. |
| Spinnbarkheit | thin/ sticky/ stretchable nature of cervical mucus which will allow easier passage of the sperm to the egg (at the time of ovulation). |
| Hormonal Methods estrogen & progesterone | OC (traditional use/ extended use/ continuous use); Transdermal patch – Ortho Evra; NuvaRing; |
| Progesterone Only birth control | Depo Provera –Medroxyprogesterone Acetate (woman gets every 3 months); Implanon –etnogestril (implanted for three years) ; OC – Micronor –norethindrone; IUS –Mirena- levonorgestril (progesterone only placed in uterus) |
| Hormonal Methods estrogen & progesterone extended use | 84 days without a period and then 7 days of period. 4 periods per year. |
| IUD | Paragard – copper coil – 10 years; Mirena – progesterone -5 years |
| Birth Control Counseling | Match up method to individual needs and life style |
| Consider efficacy and drug interactions of hormonal birth control- | PCN, Rifampin (makes BC ineffective), Phenobarb. (reduces effectiveness of phenobarb.) , Phenytoin (reduces effectiveness of phenytoin) |
| Contraindications to hormone birth control – | Hx DVT, thrombophlebitis, BrCA, liver tumor, stroke, undiagnosed vaginal bleeding, HTN, CAD, women >35 years who smoke –Absolute vs. relative contraindication. |
| Menstrual Period Assessment | LMP; Bleeding – how much, how often, associated symptoms, dizziness; Pain – associated with bleeding ; dysmenorrhea (50% of all women report dysmenorrhea) |
| Completely saturated pads = how much volume | about 100 mls |
| Primary dysmemorrhea | – occurs when ovulation is established, usually within 1 – 2 years of menarche, believed to be caused by Prostaglandins. Usually occurs day 1- 2 of menses (symptoms – cramping, backache, N/V, diarrhea, fatigue, nervousness ) |
| Secondary Dysmenorrhea | –caused by pathology – anovulation, endometriosis, dilation of ovarian/uterine veins, fibroids, PID, polyps |
| Treatment for Dysmenorrhea | –conservative –heat, massage, relaxation, exercise, acupressure; hormonal birth control decreases lining in proliferative phase leads to less prostaglandin release (NSAIDs –antiprostaglandins ibuprofin); surgical – for secondary to correct pathology |
| Premenstrual Syndrome | PMS cyclic symptoms that occur after ovulation & before menses, in luteal phase, stop w/ menses & pt. is free of sx’s for at least 7 days. May increase w/ aging until menopause. 85% of women have one sx & 10% will qualify for severe PMS |
| PMS- | one affective and one somatic symptom |
| PMDD –Premenstrual Dysphoric Disorder s/s | Irritable; tender breasts; Anxious; bloating; Confused; headache; Outbursts; edema; overwhelmed; backache; (5 affective and one somatic) |
| Etiology of PMDD –Premenstrual Dysphoric Disorder | – theory –seratonin changes in luteal phase affect mood, changes in aldosterone affect water/salt retention, ^ prolactin -> breast tenderness |
| Conservative treatment for PMDD –Premenstrual Dysphoric Disorder | –exercise, decrease Na, increase Ca and Vit D, well balanced diet, control blood sugar, education, counseling/support |
| Medical treatment for PMDD –Premenstrual Dysphoric Disorder | – hormonal contraceptives, NSAIDS, SSRIs (Serafem/Prozac –fluoxetine), St. John’s Wort, GnRH agonists (Lupron) |
| Primary amenorrhea – | No onset of menses by age 16. Cause is often due to anomalies in genital tract (imperforate hymen, absent uterus) or glandular disease – not common |
| Secondary amenorrhea – | No menses for 90 days. Cause is hormonal – very common |
| Causes of secondary amenorrhea: | pregnancy; Lactation; Menopause; Metabolic syndrome; Severe anorexia/bulimia; Excessive exercise/ extremely low body fat; Progesterone only methods of birth control; Premature ovarian failure. |
| Amenorrhea Assessment | Menst. hx – preg.? lact.?; OB hx – infertility? metabolic syn.?; Sex. Hx; STI risk? PID?; Contrcptv. Hx – Depo, Implanon; Medical Hx- thyroid, brain surgery, trauma; Eating Hx – anorexia/bulimia; Exercise Hx – extreme; Menopausal Sx’s-, other sx hiristura |
| Treatment for amenorrhea | – Hormones – Oral Contraceptives (to regulate menses); Provera- to provoke withdrawal bleeding; Clomid – if desires pregnancy –provokes ovulation |
| Endometriosis | Endometrial tissue implanted outside of the uterine cavity. Usually on ovaries and in posterior cul de sac. Occurs in 1-2% of reproductive aged women. Found in 15 -25% of infertile women. |
| Endometriosis Causes – theoretical | Backflow through fallopian tubes; Endometrial cells transported thru vascular/lymph systems; Born this way (the degree of pain is not associated with the degree of endometriosis) |
| Endometriosis symptoms | Pain during menstruation, @ site where endometrial tissue implants, blood has nowhere to go & reabsorbed leading to scarring & adhesions Pain w/ menses, ovulation, intercourse & w/ BMs; Infertility- adhesions at tubes, fimbria, uterus |
| Endometriosis Assessment- | WBC to R/O PID (pelvic inflammatory disorder); Laproscopy is diagnostic |
| Endometriosis Patient Teaching points | –Laproscopy done 5 days after menses – no risk of pregnancy; may have shoulder pain after procedure d/t CO2 rising |
| Endometriosis Treatment – depends on childbearing goals | Reduce pain – NSAIDS, OCs ; Improve sexual functioning- NSAIDS, OCs; Alleviate anxiety – educate re:fertility; Ovarian suppression with Danazol “reversible medication oophorectomy”. |
| Danazol for endometriosis | – expensive, severe side effects - acne, hirsutism, wt. gain, hot flashes, CV disease, decrease breast size, and decrease in bone density by 6 months of use |
| Endometriosis Treatment surgical | Removal of endometrial adhesions and implants; - Removal of ovaries and uterus |
| Ectopic Pregnancy | Implantation outside of the uterus, usually in fallopian tube (95% of ectopics)Increased risk in women with Bi lateral Tubal Ligation, pregnant with IUD, smokers, hx of previous ectopic, STI |
| Symptoms of ectopic pregnancy | – sharp abd./pelvic pain and spotting; if ectopic ruptures at 6 -12 weeks -> medical emergency –> shock, peritonitis |
| Ectopic Diagnosis – | made by sx & serum pregnancy test. HCG levels will be lower than expected for gestational age & may give negative urine pregnancy test results. Ultrasound might be helpful in diagnosis. Methotrexate will dissolve pregnancy |
| Treatment of ectopic pregnancy | –medical – methotrexate to “dissolve” pregnancy if early enough; surgical –removal of tube and/or ovary |
| Dysfunctional Uterine Bleeding DUB – also called abnormal uterine bleeding (AUB) Cause – | usually an endocrine abnormality resulting in anovulatory cycles. A disruption in hypothalamic-pituitary-ovarian axis; Usually occurs at beginning & end of reproductive functioning, when anovulation is common & can be normal. |
| Hypermenorrhea/ Menorrrhagia | to much flow |
| Hypomenorrhea | decresed flow |
| Oligomenorrhea | menses more than 40 days apart, usually irregular. |
| Polymenorrhea | menses closer than 22 days. Regular or irregular pattern. |
| Metromenorrhea | normal amount of menses at irregular intervals. |
| Menometrorrghia | excessive amount at irregular intervals |
| DUB - Assessment | Menst. Hx ?/ Contrcptv./OB/sex. hx ?- General hx/ Fam. hx/ ?Labs ( Basic & essential)– HCG, CBC, Pap, GC /CT cultures/ endometrial biopsy/ D&C –vaginal/pelvic ultrasound/ CT scan/ Skull x-ray or CT/ Hysteroscopy or Hysterosalpingogram (HSG) |
| DUB - treatment | Hormonal –Depo, Provera, OCs, Mirena IUS (67% can avoid surgery w/ this IUD); Progesterone decreases endometrial lining ; IV estrogen q4 hours – inpatient for severe bleeding/ Endometrial ablation – laser, hot balloon, microwaves; cryo-ablation is used. |
| DUB Surgical Treatment | Hysterectomy – 95% women still satisfied with this treatment 3 years after procedure for DUB/ See I&W pp. 1696 -1698 |
| ABDOMINAL HYSTERECTOMY | Intestinal obstruction (paralytic ileus); Thromboembolism; Atelectasis; Pneumonia; Wound dehiscence (especially in obese patients); Urinary retention |
| VAGINAL HYSTERECTOMY | Hemorrhage; Urinary tract complications, especially infection or retention; Wound infection; Urinary retention |
| Polycystic Ovarian Syndrome (PCOS) – | 12 or more maturing follicles at once, causing large “polycystic” ovaries. Commonly, but not always seen in Metabolic Syndrome; PCOS d/t androgen excess & increased testosterone |
| Symptoms of Polycystic ovarian syndrome | – amenorrhea and/or oligomenorrhea, hirutism (hair growth) of lip, chin, chest and thighs |
| Uterine Prolapse | Definition -Descent of the uterus into vagina due to weakened supportive ligaments. Are classified into 1st, 2nd or 3rd degree prolapse |
| Causes of uterine prolapse | – childbirth, age related atrophy, trauma to nerves, increase in intra abdominal pressure (obesity, chronic cough, heavy lifting), medications, disease/debility |
| Uterine Prolapse Treatment | Pessary ; Kegels; Vaginal hysterectomy |
| Cystocele Definition | – protrusion of bladder through anterior vaginal wall..Causes – same as uterine prolapse, (especially age and obesity) and radiation |
| Treatment of cystocele | -Pessary ; -Kegels; -Anterior colporrhaphy, TVT “sling”(tie/sling under the urethra) (both have 58% failure rate), Perigree-lower failure rate ( mesh sling under the blader) |
| Rectocele Definition | – protrusion of rectum through posterior vaginal wall; Causes – genetic, hx difficult labor and delivery, constipation, and same as uterine prolapsed; Symptoms – feels “full” in rectum or vagina |
| Rectocele - Treatment | ^ fiber, stool softeners; Surgery; -Posterior colporrhaphy (-Apogee mesh support procedure); Prevention Counseling; Wt. management; Avoid smoking; Kegel instruction; topical hormone therapy (estrogen); Good body mechanics |
| Post-surgical Teaching for Prolapses | No lifting over 5 lbs.; 6 weeks of pelvic rest – avoid intercourse; Avoid strenuous exercise or straining; Signs and sx’s of infection – fever, pain, foul discharge; Sitz baths; Pain meds; Encourage follow-up appointment |
| For rectocele – | low fiber diet to prevent BMs until repair heals |
| Fistulas Definition – | abnormal opening between 2 adjacent organs |
| Symptoms of fistulas | – see text - I&W, page 1694 |
| Causes of fistulas | – trauma (birth), problems w/repair, radiation |
| Management of fistulas | – hygiene, sitz baths, Depends (if leakage of urine or feces), A&D ointment |
| Surgical repair of fistulas– nursing care focus: | prevent infection & avoid stress* on repaired area |
| Urinary Stress Incontinence Definition | – involuntary loss of urine which is objectively demonstrable & a social or hygienic problem. Affects 13 million Americans, 85% of whom are women. Over 50% of post-menopausal women have sxs. nocturia ^’s risk for hip fracture |
| Stress Incontinence – | cough, sneeze, run |
| Urge Incontinence – | “gotta go, gotta go, gotta go”, associated with overactive bladder |
| Mixed Incontinence – | both types, together (urge & stress) |
| Incontinence Risk factors | – parity, obesity, hysterectomy, stroke, diabetes, COPD |
| Stress Incontinence Treatment- | – Kegels, pessary, biofeedback, surgery, electric stimulation, TVT sling |
| *****Urge Incontinence Treatment- | – medications – Ditropan (muscarinic antagonist), Detrol, Enablex (antispasmodic/anticholenergic) |
| Cervical Polyps (Benign Neoplasms ) | – almost always benign, but need to be removed and biopsied; Sx’s – irregular bleeding. Are very vascular and bleed easily (friable) with trauma (sexual intercourse, tampons, etc.) |
| Ovarian Cysts – type Follicular – | follicle fails to rupture. Are fluid filled. Asymptomatic unless torsion of ovary occurs or spontaneous rupture, then will have severe pelvic pain. Pain resolves on own in a few days. May need surgery if torsion occurs. |
| Ovarian Cysts – type Corpus Luteum Cyst | – Follicle ruptures and excessive physiologic bleeding occurs in the corpus luteum, termed a “hemorrhagic” cyst, causing severe pain. |
| Ovarian Cysts – type Dermoid Cyst | Formed of embryonic germ cells that develop “in the wrong place”. They contain hair, teeth, skin, cartilage in the ovary. Are about 25% of all cysts. Sx’s – feeling “full” in pelvic area or pain from torsion |
| Ovarian Cysts -Treatment – | removal as 1 -3% may become malignant. |
| Diagnosis of Cysts | R/O appendicitis, ectopic pregnancy; Labs - CBC, HCG; Imaging – US or CT; |
| Fibromas - Ovarian | Benign, solid, white tumors. Usually surgically removed, due to risk of becoming symptomatic (Become painful). |
| Leiomyomas: ( also called Fibroids or myomas) | Myomas/fibroids – arise from muscle cells. Estrogen responsive. Identified by name according to location. Benign (Incidence – 30% of women will have by age 50. Regress after menopause (‘fed’ by hormones) |
| Leiomyomas Symptoms – | asymptomatic, irregular bleeding (can have heavy bleeding, this is what brings them in), pressure on bladder, rectum, kidneys. Degeneration can cause pain. |
| Treatment of Leiomyomas | Myomectomy; Uterine Artery Embolization ; TVH – total vaginal hysterectomy, pg 1696, Iggy; BSO (bilateral salpingo-oophorectomy )-TAH (total abdominal hysterectomy); See patient teaching after TAH, Iggy, page 1698; Uterine Artery for Embolization |
| Endometrial Cancer | – begins in the lining of the inside of the uterus then spreads to myometrium, then through lymph to local structures (ovaries) then by blood to lungs, liver, bone. Irregular bleeding is a first sign. |
| Risk factors for endometrial cancer | – age (age 40 to 50 are 10-40 cases per100,000 women. Age 70 are 110 cases per 100,000 women.), family hx, diabetes, obesity, nulliparity, late menopause, unopposed estrogen |
| Endometrial Cancer Symptoms – | irregular bleeding **any post-menopausal woman with vaginal bleeding needs a work up for endometrial CA** |
| Endometrial Cancer Diagnosis | – Endometrial Biopsy or D&C –best if done in last half of menstrual cycle – luteal phase – to examine secretory endometrial lining -*BUT* - do pregnancy test before procedures! |
| Endometrial Cancer Treatment | Hysterectomy; (Women who wish to preserve their fertility may be given a trial of progesterone to shrink the lesion.) Radiation/chemo – if advanced |
| Cervical Cancer Squamous Cell | – 85% of cervical CA, usually slow growing. |
| Cervical Cancer Adenocarcinoma – | 10-15% of cervical CA. Is faster growing than squamous cell CA. (Squamocolumnar Junction (at the opening of the cervix) first sees the changes of cervical cancer) |
| Risk Factors for Cervical Cancer | HPV – human papilloma virus – associated w/ 99% of cervical cancers. There are 12 types of HPV which are at high risk of developing into cervical CA. CDC estimated 20 million people in U.S. with HPV in 2005. (gardasil vaccine for HPV) |
| Gardasil Vaccine (HPV) | – Series of 3 vaccines for use in females age 9 -26, preferably before onset of intercourse. Protects against HPV types 6, 11, 16, and 18 that cause about 70% of cervical cancers. |
| Cervical Cancer Risk Factors | Onset of sexual IC before age 18; Multiple lifetime partners (more than 2); Hx STIs; HIV – decreases immunologic response; Smoking; DES (diethylstilbestrol) exposure in utero; Poverty – access to prevention and early detection services |
| DES | (diethylstilbestrol) a tetraogen to in utero (was used to prevent mischarage) raises risk for cervical cancer. |
| Cervical Cancer Prevention | Modify risk factors – educate; HPV Vaccine; Condoms have some benefit; Papanicolau Smear – “pap” – screening test. |
| Papanicolau Smear – “pap” – screening test. | Began in 1943. Cervical CA is second leading cause of female deaths, worldwide, in mostly developing countries d/t lack of preventative services. |
| Patient Teaching for Pap Smear (Unable to take sample if on menses) | ; Avoid douching, creams/r meds in vagina 24 – 48 hours BF testing; Avoid sex 24 – 48 hrs BF test; Teach relaxation techniques for “easier” exam; Teach what to expect during exam- speculum, bimanual exam, positioning |
| Recommendations for Pap Screening 2006 Guidelines | Begins 21 or 3 yrs after 1st intercourse; Annually after until 30; After 30, every 3 years if has had 3 consecutive normal, annual Paps; If high risk, continue yearly test; Stop @ 65 – 70, if had hysterectomy for non cancerous reasons |
| Abnormal Pap Results (Typing of DNA test of cervical sample) | To determine presence of high-risk types |
| colposcopy (how) | Apply acetic acid to cervix; Examine cervix w/ magnification w/ light; Biopsies are taken; If atypical cells, endocervical curettage; May need LEEP (loop electrosurgical excision); After biopsy confirms diagnosis, may have conization Cervical Conization |
| Cancer Staging is ‘graded’ from | the least spread (Stage I), to the most spread (Stage IV). Cancers are ‘staged’ to determine a plan of care and treatment |
| See text pg. 1702 in Iggy for staging. | For example, Stage II carcinoma extends beyond the cervix but has not extended into the pelvic wall, and involves the vagina. |
| Paps are to SCREEN for cancer. | A woman cannot be told she has cancer from a Pap result. A biopsy MUST confirm the suspicion. |
| Pelvic Exenteration | Radical treatment for recurrent cancer. Anterior/ posterior or total (colostomy and urostomy may be needed depending on which surgery) |
| Ovarian Cancer | Difficult to detect early. Vague symptoms of “fullness” or pain from an abdominal mass |
| Ovarian Cancer Labs – | CA -125 antibody marker –of limited use in diagnosis d/t elevation in benign conditions and not always elevated with ovarian CA |
| Ovarian Cancer Imaging – | US or CT is only way to detect it. 23,300 new cases/year. Low incidence makes routine US screening not worth the cost. |
| Ovarian Cancer Treatment – | remove “everything”, usually late (total hysterectomy) |
| Colon Cancer | Third leading cause of cancer deaths in U.S.; Symptoms – non painful rectal bleeding; Risk factors- low fiber diet, family hx, hx polyps, age; Screening – begin at age 50 for low risk women |
| Colon cancer testing | -FOBT (fecal occult blood test) 3x annually; -Flex sig every 5 years OR; -Colonoscopy every 5 – 10 years (whole bowel examined); Flex Sigmoidoscopy (last third of colon examined) |
| Breast Cancer | 90% of breast lumps are benign |
| 1 nursing diagnosis surrounding breast cancer is | anxiety |
| No prevention of breast cancer, so early detection is KEY! | -5 year survival for early detection is 98%/ -81% survival if spread to lymph only/ -23% survival if metastatic when detected |
| Barriers to Early Detection in breast cancer | fear& access… fear of radiation, fear of pain, lack of access to care. |
| Breast cancer awareness | increased education & value of early detection and improved outcomes since 1960’s |
| Breast Cancer Types Ductal Carcinoma | – 80% of breast cancers, grows in lining of mammary ducts, slow growing (5 -9 years to become palpable); (non invasive) |
| Breast Cancer Types Invasive – | penetrates outside of duct (orange peel skin is seen) |
| Breast Cancer Types Fibrosis – | replaces normal cells with collagen and causes “dimpling” . Orange peel skin is caused by blocked lymph nodes and subsequent edema. (slide 234) |
| Breast cancer Types Metastatic | – travels to bone, lungs, brain, liver |
| Breast Cancer Risk Factors | Fml; Older; Fam. hx – 1st degree relative (mom, sister, w/ pre menopausal Br CA )(BRCA1 or BRCA2 genes ); Rad. to thorax BF 20; Early menarche - <12 yrs; Late menopause ->55 yrs; Hx BrCa ; Nulliparous or 1st baby after 30 (estrogen) |
| Other Breast Cancer Risk Factors | Previous hx of ovarian, endometrial, colon CA; Obesity – increase in estrogen in fat cells; ETOH –more than 2 drinks/day; Hormone replacement therapy –estrogen; Caucasian |
| American Cancer Society Screening Recommendations | BSE (breast self exam) monthly, starting at age 20. GOAL – increased breast awareness; CBE (clinical breast exam) every 3 years until 40, then yearly; Mammograms – yearly beginning age 40, sooner if fam. hx or personal hx |
| abnormal finding in Breast exam | Peau d’ Orange –orange peel; dimpling; lumps |
| Preparation for Mammogram | No lotion, deodorant or creams day of test; Premenopausal – examine breasts 1 week after menstrual period; Postmenopausal – pick a day (no flux in breast size) |
| Prevention of Breast Cancer in High Risk Females | Prophylactic mastectomy; Tamoxifen-reduces reccurence risk; Evista- raloxifene -SERM – selective estrogen receptor modifier. Severe hot flashes can be a side effect |
| Staging of Breast Cancer | – see p. 770 in McKinney text. Stage IV is most advanced, with metastasis. |
| Post –op care for breast cancer | Iggy text p. 1673 and 1674 |
| breast cancer surgery Discharge Instructions, | pg 1680, 1682 Iggy raise head of bed, and elevate arm with pillows that has had the surgery on it. |
| Lymphedema | Lymphatic obstruction is a blockage of the lymph vessels that drain fluid from tissues throughout the body and allow immune cells to travel where they are needed |
| Psych/social Issues associated with breast surgery | (nurses can assist patient with:)1 – Fear of Cancer; 2 –Threat to body image, sexuality, survival; 3 –Decisional conflict re: options for treatment |
| Benign Breast Conditions Fibroadenoma- | usually in upper, outer quadrant of breast. Round, moveable, firm, non tender. Ultrasound and/or biopsy will give diagnosis. Begin and usually movable |
| Benign Breast Conditions Fibrocystic breasts – | cyclic, premenstrual fullness, nodular areas that often resolve after menses. Does NOT ^ risk of CA. Need mammo &/or biopsy if well delineated nodules. Treat with OCs, diuretics, Vits. |
| Breast Augmentation Effect on breast cancer screening- | mammogram appts. will be longer in duration. Pt. will have ^ radiation exposure d/t need for additional views. Increased risk of rupture w/ procedure.; No diff. in breast cancer outcomes for those with implants |
| STI - | a term that has been used to describe sexually transmitted infections without the social stigma of labeling them as diseases; Prevalence of STI - cases are increasing; most at risk for STI- pregnant women, adolescents & homosexual men |
| Bacterial Vaginitis | – BV- most common reason wmn seek outpt. care!!! (Causative organisms) – gardnerella, mycoplasma hominis – overgrowth of normal flora & destruction of lactobacillis (Transmission) – can be sexual. also occurs in non sexually active women |
| Symptoms of Bacterial Vaginitis | - 50% asymptomatic, abnormal discharge with fishy odor, especially w/ menses or intercourse (amine odor is released); Diagnosis – 3 of the following criteria: thin discharge w/ fishy odor, cells on wet prep, pH>4.5, fishy odor |
| Bacterial Vaginitis Sequelae if untreated – | Pregnancy –PROM (premature rupture of labor), Chorioamnionitis, Pre term labor, Post Partum endometritis |
| Bacterial Vaginitis Procedures – | associated with infections after procedure (for example IUD placement; D&C) |
| Bacterial Vaginitis Treatment | Metronidiazole (Flagyl) 500mg po BID X7 days; Metronidiazole gel 1 applicator to vagina daily X5 days; Clindamycin cream 2% one applicator to vagina q HS X7 days (never mix flagyl & alcohol) (contain the normal flora) |
| Bacterial Vaginitis Education | Avoid ETOH during Rx – Antabiotic effect; Avoid douching – vagina’s self cleaning; Clinda is oil based & may weaken condoms; F/U not necessary if sxs abate; Recurrence common; Tx of sex partners NOT recommended – doesn’t help to Rx partners |
| Vulvovaginal Candidiases (Yeast) | – second most common vaginitis in US. Estimated 75% of all women will have at least one episode in lifetime. Yeast Organism – usually C. albicans – an overgrowth of normal organism found from mouth to anus – in GI tract |
| Symptoms of yeast infection | Asymptomatic; Pruritis ; Dyspareunia; Dysuria; Abnormal discharge; Vulvar edema, erythema, excoriation//“conazoles” cream, suppositories, oral (Diflucan –fluconazole) |
| Risk factors for yeast infection | changes in vaginal envirn; Preg.; DM; Hormonal BC; Menopause; Steroid treatment; Antibiotics; IF persistent yeast, check for DM & do a vaginal culture to confirm organism and strain ///“conazoles” cream, suppositories, oral (Diflucan –fluconazole) |
| Diagnosis for yeast infection | – wet prep OR culture if persistent |
| Treatment for yeast infection | – “conazoles” cream, suppositories, oral (Diflucan –fluconazole) |
| PT Education for yeast infection | – Cream weakens latex. If self treating-see provider if sxs persist beyond 1 wk or if recur in < 2 months. Self Rx may delay diagnosis if not yeast //“conazoles” cream, suppositories, oral (Diflucan –fluconazole) |
| Yeast Prevention Education | Chart 74-4 page 1691 in Iggy; Cotton underwear; Wipe front to back; Void before and after sex; Avoid tight clothing; Use unscented TP; Avoid douching or feminine hygiene sprays// “conazoles” cream, suppositories, oral (Diflucan –fluconazole) |
| Trichomoniasis - | 3rd most common vaginitis & almost always a STI. 5% to 33% of women will have; Organism- T. vaginalis –anaerobic protozoan w/ flagellae. Incubation 4-28 days. Flagyl 2 GM po X 1 – 90 -95% cure; Tinidazole (Tindamax) 2 GM po X 1 – has 86 – 100% cure rate |
| Trichomoniasis Transmission – | attaches to mucous mbns., in urethra, Skene’s glands, urine and vaginal wall/// Flagyl 2 GM po X 1 – 90 -95% cure; Tinidazole (Tindamax) 2 GM po X 1 – has 86 – 100% cure rate… Treat partners |
| Trichomoniasis symptoms | Discharge with odor; Itching; Yellowish to green discharge/// Flagyl 2 GM po X 1 – 90 -95% cure; Tinidazole (Tindamax) 2 GM po X 1 – has 86 – 100% cure rate … Treat partners |
| Trichomoniasis diagnosis | Microscopy – wet prep – only 60 -70% sensitive – trich dry out and die rapidly; Culture /// Flagyl 2 GM po X 1 – 90 -95% cure; Tinidazole (Tindamax) 2 GM po X 1 – has 86 – 100% cure rate .. Treat partners |
| Trichomoniasis Treatment | (Sequelae if untreated- PROM in pregnancy), PID, associated with low birth wt. in preg.; Flagyl 2 GM po X 1 – 90 -95% cure; Tinidazole (Tindamax) 2 GM po X 1 – has 86 – 100% cure rate …Treat partners |
| Trichomoniasis Education | Avoid ETOH on Rx – Antabuse effect; Treat partners and avoid IC until sxs are gone; No f/u needed if sxs abate; Education for Prevention ALL STIs / Flagyl 2 GM po X 1 – 90 -95% cure; Tinidazole (Tindamax) 2 GM po X 1 – has 86 – 100% cure rate |
| Chlamydia trachomatis -CT | Obligate intracellular bacteria, invades epithelium; Sexually transmitted (vaginal, anal, rarely oral) and vertical transmission to baby during labor and delivery; Incubation 1 -3 weeks |
| Symptoms of Chlamydia trachomatis –CT | – asymptomatic, mucopurulent discharge, abdominal discomfort, frequency, cervical friability /// Azithromax 1 GM po X1 OR Doxycycline 100mg po BID X 7 days (teratogenic) |
| Chlamydia Diagnosis – | DNA amplification – “culture” of cervix, vagina (new self collection technique) or urine>>Sequelae if untreated – PID, ectopic preg., infertility, Chlamydial pneumonia and conjunctivitis from transmission at birth (in 5 – 12 days after birth) |
| Chlamydia trachomatis -CT Treatment – | –Azithromax 1 GM po X1 OR Doxycycline 100mg po BID X 7 days (teratogenic) |
| Chlamydia Education | Avoid IC X7 days after Rx; partners to be treated; Importance of completing treatment; Can infect others and be infected by asymptomatic infection; No test of cure required. Repeat testing in 3-4 months to check for re-infection |
| Gonorrhea – “the clap” -GC | Second most reported bacterial STI in 2006. 650,000 cases/year; Organism – gram negative intracellular diplococcus - niesseria gonorrhea. Incubation 3-10 days |
| Gonorrhea Transmission – | contact with mucous membranes –mouth, vagina, rectum, head of penis. During birth results in opthalmia neonatorium (blindness) – Erythromycin opthalmic prophylaxis within 1 hour of birth |
| Gonorrhea Symptoms | – asymptomatic, change in vag discharge, dysuria, pelvic pain (PID, endometritis, salpingitis, peritonitis) Diagnosis – culture 80-98% sensitive, 99% specific; Sequelae – infertility from tubal scaring, neonatal blindness, PID |
| Gonorrhea Treatment | Commonly co-infected with chlamydia, so treat for both CT and GC; Ceftriaxone (Rocephen) 125mg IM X1 (avoid fluoroquinolones in drug resistant gonorrhea//ciprofloxacin; ofloxacin, levofloxicn) |
| Education for gonorrhea | If positive for GC, should be tested for other STIs (syphilis, HIV). High co-infectivity rates; Reportable and partner notification is required; PID risk if not treated; Can decrease STI transmission with condom use |
| Syphilis Organism – | Treponeira pallidium – corkscrew shaped spirochete –can’t culture; Transmission – mucous membranes or skin or to newborn during pregnancy; Incubation – Primary syphilis – 10 to 90 days |
| Syphilis Diagnosis | – Definitive – direct fluorescent antibody testing of lesion or darkfield exam of exudate of lesion; Syphilis Diagnosis Presumptive –serological testing – can be false positives |
| Syphilis Serological markers | RPR (rapid plasma regain) & VDRL –Venereal Disease Research Lab. |
| Syphilis Symptoms -stages | Primary -papule ulcerates & goes away <6 weeks (MOST CONTAGIOUS). Painless ulcer at infection site.; Secondary -6 wks to 6 months primary inf. cause fever, sore throat, “flu”, skin rash, mucocutaneous lesions, lymphadenopathy |
| Tertiary Syphilis – | occurs in 4-20 years. Cardiac, opthalamic, auditory abnormalities |
| Syphilis Symptoms -stages | Latent –infections lacking clinical signs; Early latent – acquired within last year; Late latent – acquired > 1 year ago; Latent of unknown duration - +seroreactivity but no sxs |
| Syphilis Treatment | Benzathine Pen G 2.4 million units IM X1; Has been used>50 years-no studies using other doses or durations; 3 doses at 1 week intervals for late latent or unknown latent |
| Syphilis Education | If pregnant, educate re: congenital syphilis that may result in SAB, hepatomegally, ascites, hydrops, thickened placenta. Neurosyphilis can result in cognitive dysfunction, motor/sensory deficits, cranial n. palsies, meningitis; |
| Neurosyphilis | can result in cognitive dysfunction, motor/sensory deficits, cranial n. palsies, meningitis; Neurosyphilis can occur at any stage of syphilis. Dementia and behavior abnormalities |
| Test for syphilis when you have | HSV, HPV, or HIV |
| Herpes Simplex Virus - HSV | 50 Million people affected in the U.S; Organism –chronic, life long virus that lives on nerve ganglion and is reactivated by stress, menses, sunlight. Incubation is 2 to 20 days (average 1 week) |
| HSV I – | majority of oral herpes. If on genitals, reoccur less often than oral and will have less shedding of virus |
| HSV II – | majority of genital herpes |
| HSV Symptoms | Majority infected are undiagnosed, but have mild unrecognized infections that shed virus intermittently & are contagious when shedding. Classic sxs– prodrome “flu”, itchy 1-2 days then painful, multiple vesicular or ulcerative lesions that last 1 week |
| HSV symptoms primary outbreak – | first outbreak – usually quite uncomfortable and extensive |
| HSV symptoms Recurrent outbreak – | usually less severe and shorter duration |
| HSV Transmission | Active lesion; Asymptomatic shedding |
| Diagnosis of HSV | Culture of lesion; Serologic antibodies- important to know for counseling and prognosis |
| HSV Treatment Goals – | shorter length of outbreak if treatment begun within 1 day of onset of prodrome OR suppression of infection/ Meds for HSV – po Acyclovir –Zovirex / Famiclovir – Famvir / Valacyclovir - Valtrex |
| HSV Education | See Iggy page 1743 – chart 76-3; |
| HSV Transmission – | sexual & perinatal contact; asymptomatic shedding; Progression of ulcer- blister to ulcer to crusted over. Avoid sex when prodrome or lesions present; Assistance w/ coping – support groups, discuss grief process; Misconception HSV ->cervical CA |
| HBV Transmission | –mucous membrane exposure, percutaneous, pregnancy, delivery. Are lower concentrations of the virus in semen and vaginal fluid; |
| Risk factors for HBV | – unprotected intercourse (UPI) with infected partner, UPI with more than 1 partner, MSM, hx other STIs, illegal drug injection |
| Hepatitis B Prevention | – Immune globulin – HBIG after exposure; Hep B vaccine –CDC recommends at birth, 2 & 6 months of age |
| Hepatitis C | Not effectively transmitted sexually. Transmission is controversial -?15 – 20% of Hep C cases had sexual exposure? Difficulty in factoring out individual risk behaviors; Vertical transmission –from mother to baby is about 5%. |
| Human Papillomavirus -HPV | Majority of sexually active adults will harbor the virus; NOT reportable; Organism- About 100 types of wart viruses, 30 -40 infect genitals. |
| HPV Symptoms- | condylomata acuminata-> genital warts. Are papular, pedunculated growths. Also, can be asymptomatic and flat and be on cervix, causing precancerous cervical changes |
| HPV Transmission | On mucosa; Laryngeal –transmission at birth –> CA. Not clear if c/s helps prevent transmission; Incubation – variable |
| HPV Diagnosis – | DNA on cervical scrapings – “thin prep” Pap.; Acetic acid turns lesions white; Visual for genital lesions |
| HPV Treatment | No cure, often will have Resolution; Don’t know if eradicating warts helps to decrease transmission; Podofilox; Cryotherapy, repeat every 1-2 wks; TCA –trichloracetic acid-destroys epithelium, weekly treatments until gone; Laser; Interferon |
| HPV Education | Podofilox –apply with q-tip or finger, Expect tingling/pain, local skin reaction if medication touches healthy tissue; Eradicating warts may not decrease transmission; Condom use; Importance of regular Pap smears; Teach correct condom use |
| Pelvic Inflammatory Disease (PID) | (general term that can mean: Endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis…Organism - 1 –Chlamydia, 2 Gonorrhea, also BV, CMV or E. Coli; |
| Risk factors pelvic inflammatory disease | – infection spreads during IUD placement, surgical abortion, vaginal delivery, sexual intercourse; < 20 years old; multiple partners; Vaginal douches |
| Symptoms of PID | – high fever, abd. or pelvic pain, vaginal discharge, friable cervix; Sequelae – leading cause of infertility due to scaring. Increases risk of ectopic pregnancy. |
| PID treatment | Mild disease – outpatient – treat for GC and CT; Severe disease – inpatient with IV antibiotics; Treat male sex partners; Is reportable if caused by GC or CT |
| Toxic Shock Syndrome -TSS | Organism – staph aureus – produces a toxin that gives symptoms. Is related to tampon use during menstruation, vaginal sponges and diaphragms. Mechanism of infection is unknown. |
| Toxic shock syndrome Symptoms – | (staff infection) “flu”, aches, HA, fever >102, sore throat, vomiting, diarrhea, generalized rash that resembles sunburn, Decreased SBP, ARDS, changes in liver function tests. Two weeks later, soles of feet peel. |
| TSS Treatment | Antibiotics – PCN – Vanco if pen allergic; Replace fluids; Manage hypotension; Replace platelets; Steroids; Is reportable |
| Devices associated with TSS | Menstrual Cup ; Contraceptive Sponge; TSS Prevention; |
| Reportable Crimes | Sexual assault – if person was minor (<16) when activity began and now, at age 21, reports the assault, does the nurse report this? |
| A 14 year old pregnant female is at your office to begin prenatal care. Is this reportable? | How old is the partner? To whom do you report this? |
| 30 year old woman in ER for Sexual Assault. | She doesn’t have to report it, but do YOU?..no |
| Breast tumors Benign vs. cancerous | benign= sudden, bi-lateral, may or may not be painful, mobile…cancer= slow growing, uni-lateral, not painful, Non mobile – attached/fixed with dimple and color changes |
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