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Med Surg 2


What happens in the first step in menses? Anterior pituitary releases follicle-stimulating hormone (FSH)
What happens in the second step in menses? Egg matures within graafian follicle
What happens in the third step in menses? Estrogen from maturing graafian follicle causes vascularization of uterine lining
What happens in the fourth step in menses? Anterior pituitary gland releases luteinizing hormone (LH)
What happens in the fifth step in menses? Corpus luteum is formed from old follicle
What happens in the sixth step in menses? Corpus luteum releases estrogen & progesterone
What happens in the seventh step in menses? Corpus luteum disintegrates, causing a decrease in progesterone
What is the final step in menses? Lining of uterus is shed as menses
What are factors that may be associated with early menopause? Smoking, family history, living in high altitudes, and surgical interventions
What factors may contribute to older women being reluctant to seek medical care for problems of reproductive system? Embarrassment, cultural factors, and lack of knowledge
What is a pelvic exam? Visualization of external organs; vulva, perineum, & vagina
What is a bimanual pelvic exam? Visualization & palpation of internal organs; vagina, cervix, ovaries, and uterus
What is a colposcopy? Direct visualization of cervix & vagina
What is a Papanicolaou Test (Pap Smear)? Simple way to detect cervical abnormalities in women
What is a biopsy? Samples of tissue are taken for evaluation to confirm/locate lesion
What is the simplest way to detect cervical cancer? Papanicolaou Test (Pap smear)
When should women begin regular pap exams? Within 3 years of becoming sexually active, no later than age 21
What would occur if a pap exam revealed abnormal findings? Colposcopy with biopsy
Why would a biopsy be performed? To confirm or locate a lesion
What is a hysterogram /hysterosalpingogram? Images of the uterus and fallopian tubes to confirm tubal abnormalities, presence of foreign bodies, congenital malformations & leiomyoma's, and traumatic injury
How is a hysterography / hysterosalpingography performed? Patient is placed in lithotomy position, speculum is inserted into vagina, contrast medium is injected through cervical cavity, uterus, & fallopian tubes; images are viewed & taken w/fluoroscope
What discomfort may arise from air being injected to facilitate visualization during hysterogram/hysterosalpingogram? Air may travel through the tissue causing pain in shoulder from diaphragmatic irritation
What is amenorrhea? Absences of menstrual flow
What is dysmenorrhea? Painful menstruation
What is menorrhagia? Bleeding that is excessive in amount and duration
What is metrorhagia? Bleeding between menstrual periods
What is Climacteric? Phase of the aging process in men & women who are transitioning from reproductive to non-reproductive stage of life
What is perimenopause? Experienced by most women as they near middle adulthood, level of estrogen begins to fall
Why is hysterosalpingography/hysterography done? To determine whether or not the fallopian tubes are open or occluded
What is pelvic inflammatory disease (PID)? Any acute, subacute, recurrent, or chronic infection that may involve the cervix, uterus, fallopian tubes, or ovaries, and may extend to connective tissues
What is toxic shock syndrome (TSS)? Acute bacterial infection caused by staphylococcus aureus
Why does TSS occur? Women who use superabsorbent tampons which are left in too long, allowing staph infection to absorb into blood stream
What are the signs and symptoms of TSS? Elevated temperature (102 F), vomiting, dizziness, headache, diarrhea, myalgia, hypotension, and signs suggesting onset of septic shock
What subjective data would you collect assessing a patient for TSS? Determine whether the patient has recently used tampons & how long she used a single tampon before changing it
What is the cause of endometriosis? Endometrial tissue appears outside of the endometrial cavity
What is the medical treatment for endometriosis? High dose hormones, pregnancy, laparoscopy to remove endometrial implants & adhesions, surgical removal of uterus, ovaries, and fallopian tubes
What is a potential side effect of Lupron? Irregular vaginal bleeding
What is the cause of vaginal fistula formation? Ulcerating process resulting from cancer, radiation, weakening of tissue by pregnancies a surgical interventions
What problems are associated with relaxed pelvic muscles? Displaced uterus, prolapsed uterus, cystocele, urethrocele, rectocele, enterocele
What is a fistula? Abnormal opening between two organs
What types of fistula's are there? Urethrovaginal, vesicovaginal, and rectovaginal
What is a cystocele? Bladder prolapse into the vagina because vaginal walls relax
What is a rectocele? Rectum prolapse into the vagina because vaginal walls relax
What is the postoperative care for a patient who underwent a colporrhaphy? Check v/s and observe for hemorrhage. Foley is placed, small amounts of stool softeners, early ambulation, and no sex for 6 weeks
Why is a foley placed in a patient who had a colporrhaphy? Foley allows for bladder to remain empty to prevent pressure on the sutures
What factors place women at greatest risk of cervical cancer? Women who are sexually active in their teens, who smoke, have multiple sex partners, and who have hx of chronic infections & erosions of cervix
What is Gardasil? Vaccine that reduces the incidence of cervical cancer due to infection with the HPV types
Who is Gardasil given to? Men & women
What is the age of administration for Gardasil? 11-18 yrs
When should Gardasil be given? Prior to the start of sexual activity
What is the timing of administration of Gardasil injections? 3 injections over 6 month period
What is the patient teaching for Gardasil? Complete entire series of vaccinations, and seek prompt medical advice for any abnormal vaginal bleeding
Who does cancer of the endometrium affect? Postmenopausal women, usually an adenocarcinoma (tumor originating from the glandular epithelial cells)
What is the first sign of endometrial cancer? Abnormal bleeding in uterus (premenopausal & postmenopausal women)
What are symptoms for ovarian cancer? Vague abdominal discomfort, flatulence, mild gastric disturbances, pressure, bloating, cramps, sense of pelvic heaviness, feeling of fullness, and change in bowel habits
What type of exam may help to identify pelvic mass? Bimanual pelvic exam
What is the difference between a total abdominal hysterectomy and laparoscopic hysterectomy with bilateral salpingo-oophorectomy? Surgeon can visualize and assess entire pelvic cavity with abdominal procedure; Surgeon has limited view of pelvic cavity with laparoscopic procedure
What is a panyhysterosalpingo-oophorectomy? Removal of uterus, fallopian tubes, and ovaries
When is a vaginal hysterectomy not advised? Ovaries & fallopian tubes have to be removed & when there is a need to visualize intrapelvic & intra-abdominal organs
What is the post operative assessment for a patient that had an abdominal hysterectomy? Performed every 4hrs, assess v/s, lung sounds, bowel sounds, & urine output. Encourage patient to splint incision, turn, cough & deep breathe, us I/S, early ambulation to prevent thrombus, assess incision for exudate & infection
Why is the placement of a foley so important following a hysterectomy? Trauma to the bladder is unavoidable & incidence of urinary retention is higher than any other type of surgery
What are the benefits of early ambulation? Prevents thrombus and promotes bowel activity
What is post op patient teaching re: vaginal drainage the nurse should provide to the patient who has had a hysterectomy? Report any unusual bleeding to HCP (normal drainage will occur 2-4 weeks post op)
What is post op patient teaching re: weight bearing activities the nurse should provide to the patient who has had a hysterectomy? Restrict heavy lifting, no more than 10lbs, no walking up & down stairs, no prolonged riding in cars (may cause pelvic pooling & development of thrombus in legs)
When should pre-menopausal women complete BSE? Monthly, preferable 1 week after menses, starting at age 20
When should post-menopausal women complete BSE? Monthly, on the same day of the month
Why is mammography less sensitive in younger women? Breast tissue in younger women is of greater density
What does Tamoxifen do? Blocks estrogen receptor sites of malignant cells
What are the side effects of Tamoxifen? Hot flashes, nausea, vomiting, vaginal discharge
What position is best to place a patient who has undergone a modified radical mastectomy once their v/s are stable and why? 45 degree fowlers position to promote drainage
What is patient teaching re: elevation of are on operative side following mastectomy? Patient can elevate on a pillow with hand and wrist higher than elbow, and the elbow higher than shoulder joint
Why must a patient who has had a mastectomy avoid BP's, injections, or blood draws in the operative arm? Lymph nodes have been removed; it increases the risk of lymphedema, and defense mechanisms are lessened
How does exercise help reduce lymphedema? Isometric exercises are helpful for increasing the circulation and developing the collateral lymph system
How is grief experienced following a mastectomy? Occurs as the result of the loss of a body part; this is an acute crisis that may last 4-6 weeks
When will the symptoms of epididymitis may occur? Can occur after trauma to the genital area, after instrumentation of the urethra & cystoscopy & after physical exertion or prolonged sexual activity
How do you distinguish a hydrocele from a cancerous testicular mass? Strong light is directed from a point behind the scrotum. If light passes through, it is a hydrocele. If light does not pass through, it indicates a solid mass
Describe varicocele? Occurs when veins within the scrotum become dilated, usually following internal spermatic vein reflux
What age group does testicular cancer frequently affect? 15-35
What age is best to start self testicular exam (STE)? Monthly at onset of puberty
When is the best time to perform the STE? After warm shower/bath when scrotal sac is relaxed
What are normal visual findings during a STE? Color, contour, & skin breaks
What are normal palpable findings during a STE? Firm, resilient, smooth & mobile
Who is most at risk of contracting a sexually transmitted infection? Young, single, urban, poor, male, & homosexual
What are the signs and symptoms that often accompany primary genital herpes? Vesicles may rupture & develop into shallow, painful ulcers, marked by erythematous with marked edema & tenderness
What is patient teaching re: transmission of genital herpes? Sex during outbreak increases risk of transmission & is painful. Patients should inform HCP & future sexual partners of recurring or latent infections. Condoms should be used. Stress, poor nutrition & insufficient rest can increase recurrences
What are signs of gonorrhea? Urethritis, purulent discharge, edema, dysuria, yellow discharge from cervix, urinary frequency, purulent discharge from urethra, pruritus, burning & pain in vulva, vaginal enlargement, abdominal pain & distention, muscular rigidity & tenderness
Why is it important form patients with STI's to contact present and past sexual partners? All sexual contacts can be treated simultaneously to avoid the "Ping-Pong" effect (re-exposure)
When is a women considered free of gonorrhea? Women has had three consecutive negative smears of the cervix & Bartholin's & Skene's glands are obtained
What is Flagyl used for? Treatment of trichomoniasis
What is the patient teaching for the use of Flagyl? Avoid alcohol and urine may turn brown
What are the signs and symptoms of cervicitis? Vaginal pruritus/burning, dull pelvic pain, low grade fever, vaginal discharge, and irregular bleeding
What is chlamydia? Gram negative, intracellular bacterium, causes several common STI's. Cervicitis and urethritis are most common, but like gonococci, chlamydial organisms also cause epididymitis in men and salpingitis in women
What is the prognosis for patients with chlamydia? With treatment, infection is curable. Reinfection occurs is sexual partners are not treated simultaneously. Infections can be transmitted to infants during delivery, causing conjunctivitis & pneumonia
Created by: tandkhopkins