Flashcards in Ch. 46 & 47 Female Reproductive Disorders Deck (77):
What is done in a pelvic examination?
Inspecting the cervix; Obtaining pap smears and other samples; Inspecting the vagina; Bimanual palpation; Cervical palpation; Uterine palpation; Adnexal palpation; Vaginal and rectal palpation
What are some of the diagnostic exams and tests done to detect female reproductive disorders?
Pelvic exam; pap smear; Colposcopy and cervical biopsy; Cyrotherapy and laser therapy; Cone biopsy and loop electrosurgical excision (LEEP); Endometrial biopsy; Dilation and Curettage (D&C); Laparoscopy (pelvic peritoneoscopy) and hysteroscopy
List some menstrual disorders.
Premenstrual syndrome, dysmenorrhea, amenorrhea, and abnormal uterine bleeding
What does PMS stand for?
Painful cramping during menstruation.
Absence of menstruation.
What is classified as abnormal uterine bleeding?
Menorrhagia, metrorrhagia, and postmenopausal bleeding
What are some medications for PMS?
Diuretics (spironolactone)(for bloating), hormones, SSRIs (prozac, paxil, zoloft)(mood changes), NSAIDs (for pain)
What does TSS stand for?
Toxic Shock Syndrome
What causes TSS?
Caused by a toxin produced by certain types of staphylococcus bacteria. Streptococcus pyogenes (group A strep) or Staphylococcus aureus (staph)
Who can get TSS?
Women using tampons, children, postmenopausal women and men
What are the risk factors for TSS?
Current S. aureus infection, foreign bodies or packing (such as those used to stop nosebleeds), menstruation, surgery, tampon use (particularly if you leave in for a long time), use of barrier contraceptives such as a diaphragm or vaginal sponge
What are the s/s of TSS?
HA (most common), confusion, high fever (possibly with chills), low BP, petechiae, organ failure (usually kidneys and liver), redness of eyes/mouth/throat (common), seizures, and widespread rash that looks like a sunburn (skin peeling occurs 1-2 weeks after the rash, particularly on the palms of the hands or bottom of the feet
How can you prevent TSS?
Change tampon q4hr, substitute pads, wash hands, care with barrier contraceptives, report symptoms promptly
Permanent physiologic cessation of mensus associated with declining ovarian function; no mensus for 1 year
What is the medical management of menopause?
HRT; risks (increase risk of MI, stroke, blood clots, and breast CA) and benefits (decreases hot flashes and risk for fracture due to osteoporosis)
What are some alternative therapies used for hot flashes?
Vitamin B6 & E, Paxil, Effexor
What nutritional adjustments need to be made for a woman in menopause?
Decrease fat and calories & increase calcium, whole grains, fiber, fruit, and vegetables; Calcium and vitamin D supplementation may be helpful
A couple's inability to achieve a pregnancy after 1 year of unprotected intercourse.
What are some factors that play a role in infertility?
Ovarian and ovulation (PCOS, not ovulating at all or irregularly), tubal (scar tissue), uterine (lining not thick enough, endometriosis), semen (decreased sperm count), other male factors (varioceles and varicose veins around testicles increases temperature and decreases semen quality)
Describe the management of infertility.
Pharmacologic therapy, artificial insemination and in vitro fertilization
What are some complications of pharmacologic therapy?
Potential for multiple pregnancies and ovarian hyperstimulation syndrome (OHSS)
What is ovarian hyperstimulation syndrome (OHSS)?
Characterized by enlarged multicystic ovaries and is complicated by a shift of fluid from the intravascular space into the abdominal cavity
What are s/s of ovarian hyperstimulation syndrome (OHSS)?
Bloating and cramping; Fluid shifting that can result in ascites, pleural effusion, and edema
What is the most common sexually transmitted disease among active young people?
Human papillomavirus (HPV)
What is HPV linked to?
Cervical CA and cervical dysplasia (need annual PAP smears)
What is commonly treated along with HPV?
Does Herpes type 2 infection (herpes genitalis) ever go away completely?
No. It is a recurrent lifelong viral infection with flare ups and remissions
What are the s/s of herpes genitalis?
Causes painful itching and burning herpetic lesions
Which antiviral agents suppress the symptoms of HSV-2?
acyclovir (Zovirax), valacyclovir (Valtrex), and famiciclorir (Famvir)
What are recurrences of HSV-2 associated with?
Stress, sunburn, dental work, inadequate rest and inadequate nutrition
Is there a risk to an infant born vaginally to a mother who has HSV-2?
Yes, therefore cesarean section delivery may be performed
What are the 2 main interventions for a pt that has HSV-2?
Measures to prevent reinfection and spread of infection and measures to reduce anxiety
What is pelvic inflammatory disease (PID)?
An inflammatory condition of the pelvic cavity that may begin with cervicitis and may involve the uterus (endometriosis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, or pelvic vascular system
What are some causes of cervicitis?
Infection (most common), devices inserted into the pelvic area (cervical cap, device to support the uterus, and diaphragm), an allergy to spermicides used for birth control or to latex in condoms, and exposure to a chemical
How common is cervicitis?
Very common, affecting more than half of all women at some point during their adult lives
What are some risk factors for cervicitis?
High-risk sexual behavior, hx of sexually transmitted disease (STD), many sexual partners, sex (intercourse) at an early age, and sexual partner (s) who have engaged in high-risk sexual behavior or have had an STD
Which STDs can cause cervicitis?
Chlamydia, Gonorrhea, Herpes virus (genital herpes), HPV (genital warts), trichomoniasis and bacteria (such as staph and strep) and too much growth of normal bacteria in the vagina (bacterial vaginosis)
What is the most common cause of cervicitis?
What is salpingitis?
Inflammation of the fallopian tubes
What is endometritis?
An inflammation or irritation of the lining of the uterus (the endometrium)
What are the causes of endometritis?
Infections such as chlamydia, gonorrhea, tuberculosis, or mixtures of normal vaginal bacteria. More likely to occur after miscarriage or childbirth, especially after a long labor or c-section
What are the risk factors for developing endometritis?
Increased risk in a medical procedure that involves entering the uterus through the cervix. This includes a D&C, hysteroscopy, and placement of an IUD
What are some other pelvic infections that can occur at the same time as endometritis?
Acute salpingitis, acute cervicitis, and many STDs
What are the s/s of endometritis?
Abdominal distention or swelling, abnormal vaginal bleeding or discharge (may be purulent), discomfort with bowel movement (constipation may occur), fever (100-104), general discomfort/uneasiness/ill feeling (malaise), and lower abdominal or pelvic pain (uterine pain)
What s/s will be present in a physical and pelvic exam for endometritis?
The lower abdomen may be tender, BS may be decreased, tenderness in the uterus and cervix, and cervical discharge
In diagnosing endometritis, what cultures from the cervix might be performed?
Chlamydia, gonorrhea, and other organisms
What are some diagnostic tests performed for endometritis?
Cultures (STDs), endometrial biopsy, ESR (sedimentation rate), laparoscopy, WBC, and wet prep (microscopic exam of any discharge)
Why is douching not good?
It affects the pH levels of the vagina and then it's not protected from infection
What are the risk factors for PID?
Multiple sex partners, STDs, substance abuse, frequent douching, and IUD use
What are the s/s of PID?
Abdominal pain, purulent vaginal discharge, pain with intercourse, N/V, and pain on urination
What are some interventions done for PID?
Antibiotics (used to treat and prevent complications of endometritis), laparoscopic surgery for adhesions and scar tissue, STD testing (may also need to test and treat sexual partners), fluids through IV, rest, and education (on how they developed PID)
What is a cystocele?
Bladder sags into the vaginal space due to lack of structural support
What are the causes of a cystocele?
Childbirth (most common) or hysterectomy
What are the s/s of a cystocele?
Pelvic pressure and stress incontinence
What are some alternatives to surgery for a cystocele?
Kegel exercises, insertion of a pessary, and HRT
What is a pessary?
A device that is inserted into the vagina to help support the pelvic organs. They come in different shapes and sizes and must be fitted to the pt by a physician
What does HRT do for a cystocele?
Hormones may improve the quality of the supporting tissues in the pelvis
What is a rectocele?
Portion of the rectum sags into the vagina as a result of weakening of the posterior vaginal wall
What are the s/s of a rectocele?
Pelvic pressure, backache, constipation (pt may actually have to insert fingers into the vagina to push feces up to defecate)
What is a uterine prolapse?
Abnormal position of the uterus protruding downward into the vagina
How is a uterine prolapse diagnosed?
What causes a uterine prolapse?
Obstetric trauma and overstretching of the musculofascial supports
What are the s/s of a uterine prolapse?
Pain (back and pelvic), pressure and heaviness in the vaginal region, and bloody discharge
What are some therapeutic interventions used for a prolapsed uterus?
Pessary, surgical correction (suspension and hysterectomy) and Kegel exercises
What are the causes of uterine fibroid tumors?
Unknown. However, fibroid growth seems to depend on the hormone estrogen. As long as a women with fibroids is menstruating, a fibroid will probably continue to grow
What are the s/s of uterine fibroid tumors?
Irregular bleeding (usually menorrhagia), pain from pressure on other organs, and fatigue due to anemia
What does treatment of uterine fibroid tumors depend upon?
Age, general health, severity of symptoms, type of fibroids, whether you are pregnant, and if you want children in the future
What are some treatments for the symptoms of uterine fibroid tumors?
Birth control pills (oral contraceptives) to help control heavy periods; IUDs that release the hormone progestin to help reduce heavy bleeding and pain; Iron supplements to prevent or treat anemia due to heavy periods; NSAIDs such as ibuprofen or naprosyn for cramps or pain; Hormonal therapy (GnRH agonists or Depo Leuprolide injections) may be used to help shrink the fibroids but only on a short term basis
What are the treatments for uterine fibroid tumors?
Hormone suppression because they are estrogen sensitive; Myomectomy (removal of tumors); Hysterectomy if severe pain or bleeding
What is endometriosis?
Endometrial cells are carried to other parts of the body via the blood and lymph nodes. Ovarian hormones initiate the cycle of cell sloughing in the uterus as well as those cells that have traveled to other parts of the body. Bleeding will then occur in the abdominal cavity causing pain, swelling, damage to abdominal organs, and development of scar tissue
What is the cause of endometriosis?
What are the s/s of endometriosis?
Pain, swelling, organ damage, scar tissue, infertility, and long mensus
What is retrograde menstruation?
The endometrial cells loosened during menstruation may "back up" through the fallopian tubes into the pelvis. Once there, they implant and grow in the pelvic or abdominal cavities