Ch. 46 & 47 Female Reproductive Disorders Flashcards Preview

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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?

Premenstrual syndrome


Define dysmenorrhea.

Painful cramping during menstruation.


Define amenorrhea.

Absence of menstruation.


What is classified as abnormal uterine bleeding?

Menorrhagia, metrorrhagia, and postmenopausal bleeding


Define menorrhagia.

Heavy bleeding


Define metrorrhagia.

Irregular 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


Define menopause.

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


Define infertility.

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?

Genital warts


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?

Pelvic exam


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


What are the treatment options for endometriosis?

Hormones (oral, Depo-Provera), stop ovulation (best way because the lining doesn't thicken), reduce estrogen, analgesics for pain and cramping, surgery (laparotomy which is used to remove endometriosis and hysterectomy)