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Nctc Med Surg Reprod
Nctc Med Surg Reproductive
| Question | Answer |
|---|---|
| How do you obtain a menstrual history? | * ask age of menarche * date of onset of last period * number of days between periods * how long it lasts * any problems? |
| What is menarche? | * age of onset of menses |
| What are the different phases of the menstrual cycle? | * ovary releases mature ovum: ovulation * uterine lining prepared to receive ovum and nourish it if egg fertilized * if not fertilized, menstrual cycle begins and lining discharged |
| What position must the pt be placed in for a pelvic exam? | * lithotomy |
| What is the purpose of a pelvic exam? | * to inspect and palpate external genitalia and internal reproductive structures for abnormalities |
| What type of smear & cultures will the Dr. obtain during the pelvic exam? | * PAP * Papanicolaou - smear test * *for early detection of cervical CA 2 weeks after start of last menstrual period * Other cultures identify possible infections * herpes, Chlamydia and/or gonorrhea |
| What is a chlamydial infection? | * *most common STD in the US * *more noticeable in men -thin then creamy discharge; dysuria * may be asymptomatic 25-50% * females - vaginal discharge and *low abdominal pain * may be asymptomatic 65-70% * 10% may progress to infertility |
| How is a chlamydial infection treated? | * * Tetracycline - birth defects, sun sensitive * Doxycycline same as above * If pregnant or not compliant Zithromax |
| What is gonorrhea & what are the s/s? | * another common STD in the US * s/s more obvious in males than females * Males: whitish or greenish DC, dysuria * Females: vaginal DC, & redness or swelling of external genitals * s/s disappear in a few weeks, *but still highly contagious if untreated |
| What complications can occur with gonorrhea & how is it treated? | * * sterility in both sexes if untreated * *major cause of infertility * treat with Rocephin, & Tetracycline for Chlamydia * gonorrhea and Chlamydia go hand in hand so *treat for both * treat partner also |
| What pt teaching is necessary for gonorrhea? | * Use latex condoms to decrease risk of transmission * stress the importance of completing therapy * See Dr. for follow up to decrease risk of complications * *Condoms are not 100% effective protection * mutually monogamous relationships are stressed |
| Describe the different phases of syphilis | * Primary * Secondary * Latent * Late |
| syphilis S/S - Primary | * *development of lesion called chancre * shows up 1-12 weeks after infection at the site of entry * large red papule that turns into a painless red ulcer |
| syphilis s/s * Secondary | * 1-6 months after contact * rash on extremities, palms & soles * *fever, sore throat, aching |
| Syphilis s/s - Latent | no s/s-organism, invading organs * transmitted by blood exposure |
| Syphilis s/s - Late | arthritis, numbness of extremities, ulcers of skin * damage to heart & blood vessels, blindness |
| How do you treat syphilis? | * * PCN: drug of choice |
| What is the herpes simplex virus? | * HSV, type 1, causes cold sores on lips and inside mouth via contact * HSV, type 2, genital herpes * transmitted via sexual contact |
| What are the s/s of HSV, type 2? | * painful itching sores on or around genitals * starts with rash and leads to painful small blisters * flu like s/s |
| What type of treatment is available for HSV? | * *no cure for HSV * severity and frequency of break outs can be controlled by acyclovir (Zovirax) * may have mild SE: dizziness, HA, N/V |
| What *teaching would you do for the pt with HSV? | * avoid sexual contact during out breaks * wash lesions with soap and H2O * need adequate hydration and nutrition for healing |
| What causes condylomata acuminata? | * HPV * human papillomavirus * Also known as *venereal warts * Sexually transmitted |
| What is dysmenorrhea and what causes it? | * irregular, painful periods * can occur 1-2 years after menarche * Causes: Fibroids, Endometriosis |
| What advice would you give for dysmenorrhea? | * heating pads * warm baths * Tylenol * Midol * Decrease caffeine intake * Can take BCP to decrease irregularity and dysmenorrheal |
| What is endometriosis? | * small amounts of endometrial tissue that normally lines the uterus are deposited in the pelvic cavity * these cells are implanted on other structures but behave like they do in the uterus * sloughing and bleeding leads to inflammation |
| What are the S&S of endometriosis? | * pain * may be asymptomatic * dysmenorrhea * pain with defecation * emotional s/s: anger, depression |
| How can endometriosis prevent conception? | * tissue can block fallopian tubes or cause adhesions |
| What is the treatment for mild & severe endometriosis? | * analgesics for pain * NSAID’s * Gonadotropic releasing hormones and synthetic androgenic steroids lead to amenorrhea and atrophy of endometrial tissue * cause masculinizing characteristics |
| What is PID and what causes it? | * primarily caused by STD organism * can be caused by non-STD organisms * an infection process that causes scarring & adhesions in fallopian tubes that can lead to partial or total obstruction * it is a major female reproduction health problem in US |
| What are the S&S of PID? | * may be asymptomatic for awhile * gradual onset of steady low abdominal pain, or sudden onset of severe abdominal pain * chills, fever * dysuria * irregular bleeding * foul smelling vaginal discharge |
| What medical tx's & nursing interventions are appropriate for PID patients? | * rest, application of heat, sitz baths * analgesics * broad spectrum ATB * avoid sexual intercourse during treatment Partner may have to be treated |
| Nursing Interventions for PID | * BR, inactivity * Administer ATB and observe for SE * Analgesics as ordered * Pt teaching RT early care and treatment * Teach to decrease risk factors: * # of sexual partners * douching * poor nutrition |
| How could PID prevent a pregnancy? | * blockage of fallopian tubes |
| Why would a woman with PID or endometriosis be more susceptible to an ectopic pregnancy? | * partial blockage keeps egg from being released into the fallopian tube, but may still be fertilized |
| What is orchitis and what causes it? | * inflammation of one or both testicles * Mumps * Pneumonia * TB |
| How is orchitis treated? | * Analgesics * Antipyretics * BR * Scrotal support * Local heat |
| What is a laparoscopy? | * laparoscope used to visualize abdominal organs, or to enable minor surgery such as tubal ligation |
| What can cause pain post op laproscopy? | * *gas injected in abdomen causes shoulder pain and rib pain * will go away when absorbed * elevate feet, encourage activity |
| What is a follicular ovarian cyst? What are the s/s? | * dominant ovarian follicle fails to be released so keeps growing & cyst forms * asymptomatic if small * pelvic aching and heaviness if large * sudden, severe pain if ruptures |
| What treatment is necessary for cysts? | * usually disappears spontaneously in 2-3 months * monitor if necessary: laparoscopic cystectomy or drained with needle aspiration |
| What is vaginitis and what causes it? | * inflammation of vagina |
| * Candida albicans | * fungus or yeast infection * *discharge is foul smelling, cottage cheese appearance |
| * Trichomonas vaginalis | * protozoal infection * profuse, frothy, yellow-grey drainage with fishy odor |
| What is the treatment for vaginitis? | * treat with appropriate antifungal or antiprotozoal agent * wear cotton panties, non-restrictive clothing * sitz baths * avoid scratching * avoid sexual intercourse or use condoms |
| What is the purpose of a Pap smear? | * for detection of cervical CA, dysplasia, cultures for STD’s |
| What pre-exam instructions should be given prior to a Pap smear and why? | * no douches |
| Just before having her pelvic exam, what important measure would you have this patient take? | * relax * express concerns |
| What is a vesicovaginal fistula and how does it differ from a rectovaginal fistula? | * an abnormal pathway between vagina and bladder * rectovaginal is an abnormal pathway between vagina and rectum |
| What is a colposcopy? | * colposcope is used to inspect cervix under magnification to detect abnormal cervical tissue |
| What is the difference between climacteric and menopause? | * climacteric may describe men & women * decreased sexual activity & arousal in men * end of reproductive function in women * menopause marks end of reproductive function in women |
| What are the most common complaints offered by women in menopause? | * hot flashes accompanied by perspiration * vaginal dryness * insomnia * joint pain * HA * nausea * *Make sure pt realizes that can still become pregnant several months after end of periods * should use birth control X 1 year |
| Which therapy is most prescribed for symptomatic women in menopause? | HRT with estrogen |
| What is menorrhagia? | * menstrual periods characterized by profuse or prolonged bleeding |
| What is metrorrhagia? | * spotting between periods |
| What is a pelvic ultrasonogram? | * sonogram of pelvis, all structures |
| What instructions will a pt. preparing for a pelvic sonogram need to comply with? | * fill bladder to use as a reference point |
| What is a hysterosalpingography and why would it be ordered for this patient? | * visualize uterus and fallopian tubes to have a better picture of uterine masses |
| What is a fibroid tumor? | * known as myomas or leiomyomas * benign masses * cause unknown, very common |
| What are the most common symptoms of fibroid tumors? | * may be asymptomatic * menorrhagia and dysmenorrheal |
| What is the treatment for fibroids? | * myomectomy * removal of tumor only * hysterectomy |
| What is a cervical biopsy? | * Removal of tissue specimen from cervix |
| * Cervical cancer | * early-asymptomatic * may invade other tissues * may be associated with STD’s |
| Ovarian cancer | * asymptomatic until well advanced * slow growing * *highest rate of mortality |
| What is a Hyst with BSO? | * Hysterectomy with bilateral salpingo-oopherectomy * removal of uterus, fallopian tubes, & ovaries |
| What should discharge teaching include following the removal of the radiation pack? | * cleansing vaginal douche as ordered * may resume normal activities * *no longer source of radiation |
| What is a mammography and why are they recommended a regular intervals? | * radiologic exam to detect cysts or tumors * baseline between age 35 – 39 y.o. * *should done annually after 50 y.o. |
| Where are the majority of breast malignancies found? | * *½ of all tumors located in upper, outer quadrant |
| What are the *risk factors for breast cancer? | * Female * Family hx * Caucasian * >45 * Obesity * Increased alcohol intake * High fat diet * Hx of other malignancy * 1 out of 8 women will be diagnosed with breast cancer |
| What are the treatment options for a malignant breast tumor? | * surgical excision * Chemo * radiation |
| simple mastectomy | removal of entire breast |
| radical mastectomy | removal of all breast tissue, overlying skin, axillary lymph nodes, and underlying pectoral muscles |
| modified radical mastectomy | removal of all breast tissue, overlying skin, axillary lymph nodes |
| What medications are started after surgery for breast cancer? | * *Tamoxifen if ER + * selective estrogen receptor modulator * blocks circulating estrogen from reaching receptor cells * currently also used for pts “at risk” for breast CA |
| What post-op nursing interventions are needed for a breast cancer patient after surgery? | * explore pt’s feelings and allow to express concerns * if lymph nodes removed, *elevate arm to height above heart * no BP’s, IV’s or sticks on affected site * no deodorant or shaving of affected side * progressively exercise affected side |
| What is benign prostatic hypertrophy and what S&S are commonly seen? | * enlargement of prostate * *common, normal, age related change * decreased size and force of urinary stream * *inability to empty bladder, frequency, hematuria, urinary retention |
| How is BPH treated? | * *Meds * testosterone ablating or sparing agents * Alpha-adrenergic blockers * used to relax smooth muscle * Flomax |
| How does benign prostatic hypertrophy differ from prostatitis? | * Prostatitis is inflammation of prostateq |
| How is acute prostatitis treated? | * ATB * Analgesics * Sitz baths * *Increase fluids * bedrest |
| What does a palpable mass of the prostate gland suggest? | * possible prostate CA |
| What *lab value might be elevated with a prostate malignancy? | * PSA * Acid phosphatase |
| What is the danger of a malignant prostate mass rupturing? | * hemorrhage * metastasis |
| * Suprapubic prostatectomy | * incision in bladder, low abdominal * done this way when prostate very large |
| * *Transurethral prostatectomy (TURP) | * most widely used procedure * no external incision |
| * Perineal prostatectomy | * incision between scrotum and anus |
| * Retropubic prostatectomy | * incision in front of prostate, low abdominal |
| What *post-op nursing interventions will be needed for this patient? | * assess I & O, VS, TC & DB q 2h * drainage should be light pink * bright red indicates arterial hemorrhage notify Dr. immediately continuous bladder irrigation * monitor output to avoid over distention * notify surgeon if CBI stops draining |
| In what age group are testicular tumors most commonly found? | 18-34 y.o |
| How can testicular tumors be detected early? | self examination |
| What are the warning signs of testicular cancer? | * Cryptorchidism * undescended testicles * Caucasian * Previous testicular CA |
| Why is an immediate surgery significant for testicular cancer? | * increased rate of cure |
| Who is at greatest risk for testicular CA and what are the s/s? | * White males * s/s: painless, hard tumor |
| 1. STD’s are communicable diseases. They are reported to the public health department for the primary purpose of : | Stopping the spread of disease |
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