Women’s Health

1. Women’s Health

2. Early detection of breast cancer: • Monthly SBE • Annual professional breast exam • mammogram

3. Before a pelvic exam, a woman should not: 1. douche 2. have sexual intercourse for @ least 24 hrs. Should also schedule between menses

4. Menstrual Disorders: • Amenorrhea – absence of menstrual flow • Primary – failure to menstruate by age 16 • Secondary – cessation of menses for @ least 3 cycles • Thin women may have amenorrhea because fat is necessary for estrogen production

5. Menstrual Disorders: • Dysmenorrhea – uterine pain with menstruation; “menstrual cramps” • Metrorrhagia – appearance of uterine bleeding between regular menstrual periods or after menopause • Menorrhagia – excessive bleeding @ time of regular menstrual flow

6. Premenstrual Syndrome • S&S – irritability, depressed mood, ↑’d sensitivity, feeling overwhelmed, food cravings, breast tenderness, bloating, weight gain, headache • Treatment – analgesics (NSAIDS), BCP, regular exercise, ↓ intake of caffeine, chocolate, alcohol, ↓ smoking, adequate rest

7. Infertility • Inability to conceive after 1 yr. of sexual intercourse without birth control measures • Potential causes: impaired sperm or ovum production, occlusion in reproductive system, infections of reproductive system • Reactions include shock, guilt, isolation, depression, stress on the relationship

8. Infertility Options • Therapeutic insemination • In vitro fertilization • Gamete intrafallopian transfer (GIFT) • Zygote intrafallopian transfer • Donor oocyte • Surrogate mother • Gestational surrogate • Intra-cytoplasmic sperm injection

9. Pelvic Inflammatory Disease • Any acute, subacute, recurrent, or chronic infection of cervix, uterus, fallopian tubes, & ovaries that has extended to the connective tissues lying between the broad ligaments. • Common cause of PID = asymptomatic STD’s • Antibiotics (IV or IM); control infection & prevent spread to other body systems • Fowler’s position to facilitate drainage • Comfort measures

10. Toxic shock syndrome • Acute bacterial infection caused by staph aureus usually occurs in menstruating women who are using tampons • Risk factors: high-absorbency tampons; diaphragm or cervical cap • S&S – fever, flu-like symptoms, hypotension, sunburn-like rash, skin peeling from palms & soles

11. Toxic shock syndrome • Teaching: • Tampon use: wash hands, change @ least Q4hrs., do not use super-absorbency tampons, use pads when sleeping • Diaphragm/cervical cap: wash hands, do not use during menses, remove as directed

12. STD’S • Factors keeping STD’s among most communicable diseases: • Unprotected sex • ATB resistance • Delays in treatment • Sexual behavior patterns & permissiveness • STRESS THAT ALL SEXUAL CONTACTS MUST BE COMPLETELY TREATED EVEN IF ASYMPTOMATIC!!!

13. STD’s • Adolescents @ risk d/t: • Multiple sexual partners • Failure to use protection • Delay in getting treatment • Do not tell partners when develop symptoms • Nurse must ask re: knowledge of STD’s, sexual history

14. STD’s • Teaching adolescents re: STD’s- • Treatment • Prevention • Complications • Importance of treating partners • Cases of STD’s must be reported to local health department

15. STD’s • If an STD is found in a preadolescent child – should suspect SEXUAL ABUSE!

16. Genital Herpes • Clusters of painful vesicles on vulva, perineum, & anal areas; vesicles rupture 1-7 days & heal in ~ 12 days • No cure; treat with antivirals (Valtrex, Zovirax); during pregnancy – hygiene & sitz baths • May result in: spontaneous abortion, stillbirth, neonatal CNS problems • Delivery by C-section with active disease

17. Syphilis • @ first painless chancre in genitals & anus; then can dev. enlarged liver & spleen, H/A, anorexia, rash, wart-like growths on vulva; after many yrs. can cause heart & nervous damage • Serology testing – RPR, VDRL • Treat with PCN (if allergic – Doxycycline, Tetracycline, Erythromycin) • Transmitted across placenta – congenital syphilis, stillbirth, spontaneous abortion

18. Gonorrhea • Purulent discharge, painful urination, painful intercourse • ATB therapy; all newborns receive prophylactic eye care • Transmitted to newborn’s eyes during birth – causes blindness

19. Trichomoniasis • Thin, foul-odored greenish yellow discharge, itching, edema, redness • Flagyl; if pregnant – Clotrimazole • Doesn’t cross placenta; can cause postpartum infection

20. Candidiasis • Itching & burning on urination, “cottage cheese” appearing discharge, inflammation of genital area • Antifungals - Miconazole, Clotrimazole, Nystatin, Diflucan • Can infect newborn @ birth

21. Chlamydia • Yellowish discharge, painful urination • Often asymptomatic – delays treatment • Azithromycin, Doxycycline, Erythromycin • Newborn prophylactic eye care against this also • Transmitted via birth canal – conjunctivitis & pneumonia in newborn

22. Human Papilloma Virus (HPV) • Dry, wart-like growths in perineal area • Remove with cryotherapy, electrocautery, or laser • Growth may obstruct birth canal; infant may have laryngeal papillomas

23. AIDS • Initially asymptomatic; later will develop weight loss, fever, chills, night sweats, fatigue, enlarged lymph nodes, skin rash, diarrhea; late S&S = immune suppression, opportunistic infections, malignancies • No cure available; are drugs available to slow progression (Zidovudine, Didanosine); during pregnancy – Lamivudine • Avoid breaks in skin during birth; bottlefeed infant; may have been transmitted antepartally

24. Endometriosis • Condition in which endometrial tissue appears outside of the uterus • Thought to occur thru lymphatic circulation, menstrual backflow into fallopian tubes & pelvic cavity, or thru congenital displacement of the endometrial cells • S&S – lower abd. & pelvic pain; S&S more acute during menses

25. Fistula – abnormal opening between 2 organs • Urethrovaginal – opening between urethra & vagina • Vesicovaginal – opening between bladder & vagina • Rectovaginal – opening between rectum & vagina • Recognized by exudate, bladder infection, vesicovaginal – constant trickling of urine into vagina; rectovaginal – feces & flatus enters vagina

26. Uterine prolapse – prolapse of uterus thru pelvic floor & vaginal outlet • Cystocele – relaxation of tissues, muscles, & ligaments of the bladder; causes displacement of bladder onto vagina • Rectocele – relaxation of supporting tissues to the rectum; causes rectum to move toward posterior vaginal wall

27. Leiomyomas: benign tumors of female genital tract; “fibroids” • Myomectomy – removal of tumor; uterus left in place • Hysterectomy if severe bleeding • Ovarian cysts – benign tumors; do not become malignant; may be from a cystic corpus luteum • May disturb menstruation • Removed by cystectomy

28. Urinary incontinence – incontrollable leakage of urine from the bladder • Stress incontinence – leakage caused by sudden ↑ in intraabdominal pressure; occurs during coughing or sneezing • Urge incontinence – inability to control the urge to urinate because of overactive bladder

29. Urinary incontinence • Treatment: • Kegel exercises • Medications • Ditropan XL • Detrol • Tofranil • Bentyl • Cystospaz • TENS unit

30. Fibrocystic breast • Benign tumors of breast • Usually between ages 30 & 50; rare in postmenopausal women • Increases risk of developing Breast CA • Diagnosis confirmed by biopsy

31. Female Reproductive Cancers

32. Cervical CA • Squamous cell carcinoma • Mets to vagina, pelvic wall, bladder, rectum, & lymph nodes unless caught early • “silent” in early stages ; irregular vaginal bleeding or spotting b/w menses, bleeding increases as progresses, develop foul odor d/t necrosis of tissue; advanced – severe pain in back & legs • Diagnosed by pap smear & cervical biopsy; additional testing to determine extent of mets

33. Cervical CA • Treatment: • Early – hysterectomy, radiation • Late – radical hysterectomy w/pelvic lymph node dissection • Prognosis: • Good if caught early • Early diagnosis & treatment vital for survival

34. Endometrial (uterine) CA • Adenocarcinoma • Usually localized • May mets to cervix, bladder, rectum, nodes • S&S: postmenopausal bleeding, abd/pelvic fullness or pressure; late – pelvic & back pain, postcoital bleeding • Diagnosed by pelvic exam; biopsy

35. Endometrial CA • Treatment: • Chemotherapy • Radiation • Surgery • Prognosis: • Is slow growing with late mets • 5 yr survival rate for stage I > 94%

36. Ovarian CA • Leading cause of gynecological death in US • Most common 55-59 years • Asymptomatic or vague S&S in early stages – usually mets by time is diagnosed; mets to peritoneum, omentum, bowel surfaces; later stages – ascites, abd distention, flatulence • Pelvic exam; CT scan if papable mass; confirmed by biopsy; aspiration of ascites containing CA cells; ↑ CA-125 levels

37. Ovarian CA • Treatment: • Chemotherapy • Radiation • Surgery • Prognosis: • Poor • Over 60% diagnosed with advanced disease • 5 yr. survival rate by time diagnosed usually <20%

38. Breast CA • Most common malignancy in women in US • 1 in 8 women will develop Breast CA • Cause may be hormonal; mets to bones, lungs, CNS, liver; spreads by lymph • Tumors are small, solitary, irregularly shaped, firm, nontender, immobile; change in skin color, puckering/dimpling, nipple discharge, axillary tenderness

39. Breast CA • >90% detected by patient • Diagnosed by biopsy • Treatment: • Chemotherapy • Radiation • Surgery • Prognosis: • Survival decreases rapidly with mets; stage most important factor in prognosis

40. Breast CA Surgeries • Lumpectomy – removal of circumscribed area along with tumor • Partial Mastectomy – quadrant of breast in which tumor is located is removed • Subcutaneous Mastectomy – removal of malignant breast tissue; leave skin surface & nipple in place • Simple Mastectomy – removal of entire breast; retain skin flap • Modified Radical Mastectomy – all breast tissue, overlying skin, pectoralis minor muscle; samples of axillary lymph nodes & fascia under breast

41. Post-op care r/t breast surgery • Teaching: • No BP, blood draws, IVs, injections in affected arm • No sleeping on involved arm • Elevate arm • Arm exercises • Drain & dressing care • Fowler’s position • PCA Morphine for pain x 12-24 hrs, then PO meds

42. Hysterectomy – removal of entire uterus • Vaginal approach • Abdominal approach • Subtotal hysterectomy – removal of body of uterus; leaves cervical stump in place • Total hysterectomy – removal of entire uterus including cervix; leaves fallopian tubes & ovaries in place • TAH-BSO – removal of entire uterus, fallopian tubes, & ovaries

43. Family planning • Nurse’s role: • Answer questions re: contraceptive methods • Explain methods available • Teach correct use of methods chosen • Abstinence = voluntarily refraining from sexual intercourse; 100% effective in preventing pregnancy & STD’s

44. Oral contraceptives • Progestin (minipill) • Combination of estrogen & progestin • Low failure rate • Take @ same time each day • Contraindications: thromboembolic d.o., CVA, MI, smoking, breast CA, undiagnosed vaginal bleeding, pregnant, impaired liver function

45. Oral contraceptives • Warning signs: • A: abdominal pain • C: chest pain, dyspnea • H: headache, weakness, numbness • E: eye changes – blurred or double vision • S: severe leg pain, swelling, speech disturbance • Meds that decrease effectiveness: • Antibiotics • Anticonvulsants • barbituates

46. Other hormonal contraceptives • Norplant • Depo-Provera • Transdermal patches (Ortho-Evra) • Vaginal ring (Nuva Ring) • IUD’s • 3 kinds: paragard, levonorgestrel, progesterone • Care & teaching: verify placement, check tail Qwk x 4 wks then Qmonth; report S&S infection or ectopic pregnancy

47. Barrier methods of contraception • Diaphragm – 87% effective • Must be refitted after pregnancy, wt gain & loss • Insert any time before intercourse; remove 6-8 hrs after • Cervical cap – 87% effective • Cannot be used with cervical inconsistencies or PID • Condoms – 85% effective • Male • female

48. Spermicides: foams, creams, suppositories • Often used in conjunction with other methods • SE: local irritation in vagina or penis; may lead to cracks -  risk of STD transmission • Natural family planning – “fertility awareness” • Basal body temperature • Cervical mucus • Rhythm • Sterilization = permanent birth control • Vasectomy • Tubal ligation • Emergency contraception – method of preventing pregnancy after unprotected sex

49. Unreliable methods of birth control: • Withdrawal – “coitus interruptus” • Douching • Breastfeeding • Ovulation may be inhibited only if baby is nursing @ least 10 times in 24 hrs. • Ovulation will occur before having menses – can become pregnant before having 1st menses

50. Menopause • Cessation of menstrual period for 12 months d/t changes in estrogen production • S&S: hot flashes, vaginal dryness, mood swings, irritability, chills, palpitations, sleeping problems, Δ in sexual desire • Complimentary therapies: • Yam root • Soy products • Vitamin E • Black cohosh