Female Reproduction 1 Flashcards
(135 cards)
1
Q
Ovarian Cycle also known as
A
Menstrual cycle
2
Q
Define Menarche
A
the FIRST menstrual period in a female adolescent.
3
Q
What consists of the FEMALE REPRODUCTIVE CYCLE
A
- Ovarian cycle
- Uterine or Endometrial cycle
- Menstruation
- Menopause
4
Q
Ovarian Cycle consists of
A
- Follicular phase (FSH & LH)
- Ovulation
- Luteal phase
5
Q
What is FSH? What does it do?
A
- Follicle-stimulating hormone (FSH) released by the pituitary gland
- FSH is primarily responsible for stimulating the ovaries to secrete estrogen.
6
Q
What is LSH and what does it do?
A
- luteinizing hormone (LH)
- LH is primarily responsible for stimulating progesterone production.
7
Q
What to know about the LUTEAL PHASE
A
- Under the combined stimulus of estrogen and progesterone, the endometrium reaches the peak luteal phase, in which the endometrium is thick and highly vascular.
- In the luteal phase, which begins after ovulation, progesterone is secreted by the corpus luteum.
8
Q
Uterine or Endometrial cycle:
Explain Proliferative Phase
A
- in the BEGINNING OF THE CYCLE just AFTER MENSTRUATION.
- It is the enlargement of endometrial glands.
- Cervical mucus becomes thin, clear, stretchy, & more alkaline
- Starts about D5 of menstrual cycle
- Lasts till time of ovulation.
9
Q
Uterine or Endometrial cycle:
Explain Secretory phase
A
- near the middle portion of the cycle (day 14 in a 28-day cycle)
- Ovulation to 3 D before menses
– endo thick, glandular, vascular
- LH output increases and ovulation occurs.
10
Q
Uterine or Endometrial cycle:
Explain ischemic phase
A
- Consists of Progesterone & Estrogen
- Arteriole spasms
– Rupture of arterioles
11
Q
EXPLALIN ‘MENSTRUATION’
A
Sloughing & discharge of lining of uterus
- If NO conception
- Q 28 D in reproductive yrs.
- Lasts 4-5 D
- Avg menarche 12.8 yrs. (U.S.) (genetics plays a role)
12
Q
Cultural & Psychosocial Considerations for MENSTRUATION
A
Nurse needs to …
*Be open-minded
*Educate in a culturally sensitive manner
*Convey confidence & openness
13
Q
Menstrual Disorders
A
- PERIMENOPAUSE
- MENOPAUSE
14
Q
What is Menopause?
A
- The stage of life that marks the PERMANENT cessation of menstrual activity.
- Usually occurs between ages 45-55.
- It is a natural biological process.
15
Q
2 STAGES of Menopause.
Name them
A
- Perimenopause
- Menopause
16
Q
When does Perimenopause occur?
A
2-8 years BEFORE menopause
-As early as age 38
- possible for women to become pregnant.
17
Q
When does Menopause occur?
A
50-51
18
Q
S/S of PERIMENOPAUSE
A
*Hot flashes
*Night sweats
*Irregular menstrual cycles
*Sleep disruptions
*Fatigue
*Forgetfulness
*Mood disturbances, Depression, *Irritability
*Decreased fertility
*Weight gain & bloating
*Changing bleeding patterns
*Headaches
*Decreased vaginal lubrication
*Vaginal atrophy
19
Q
S/S of Menopause
A
Vasomotor symptoms:
*Sensations of heat, cold sweating
*Headache
*Insomnia and irritability
Physiologically
*Vaginal dryness, irritation, & itching
*Dyspareunia
*Dysuria
*Urinary frequency & urgency
20
Q
What to look for when DX menopause
A
age
symptoms (R/O other conditions)
elevated serum FSH (>40 mIU/mL
21
Q
Menopause SYMPTOM TX:
Lifestyle changes examples
A
- Get 8 hours of sleep per night,
- Eat a balanced diet- decrease fat and caloric intake; increase intake of whole grains, fiber, fruit, and vegetables.
- Consider weight-bearing exercises, calcium (1000-1200mg), vitamin D (400-600IU), vitamin E (100 mg daily), smoking cessation, and avoidance of alcohol to treat or prevent osteoporosis.
- Regular breast examinations and mammograms are essential. Local estrogen creams can be used for vaginal atrophy.
- Exercise-reduces stress, enhances well-being, improves self-image
- Avoid caffeine and alcohol
- Avoid cigarette smoking and secondhand smoke-lower risk of heart disease
22
Q
Menopause SYMPTOM TX:
examples of Alternative medicine OR Complementary and Alternative Medicine (CAM)
A
*Black cohosh, dong quai
*St. John’s wort, hops
*Wild yam, ginseng
*Evening primrose oil
*Acupuncture, Aromatherapy
*Reflexology, Meditation
23
Q
Menopause SYMPTOM TX:
Pharmacologic options
A
- HT unless contraindicated
- Estrogen and androgen combinations
- Progestin therapy (Depo-Provera injection every 3months)
- Clonidine - anti-HTN (central alpha-adrenergic agonist) weekly patch
- Propranolol (beta-adrenergic blocker)
- Brisdelle: FDA-approved nonhormonal medication
- Short-term sleep aids: Ambien, Dalmane
- Gabapentin (Neurontin): antiseizure drug
- SSRIs: venlafaxine (Effexor) and paroxetine (ANTIDEPRESSANTS)
24
Q
Menopause SYMPTOM TX:
HORMONTE THERAPY OPTIONS
A
- Estrogen alone - NO uterus
- Combo - Lowers risk of endometrial ca
- Progestin Only - Depo
25
Menopause SYMPTOM TX:
Contraindications for patients who have
H/O breast cancer
Vascular thrombosis
Impaired liver function
Uterine cancer
Abnormal vaginal bleeding
26
Role of Nurse for Menopause patients
1. Recognize & Analyze Cues (Assessment & Dx)
2. Hypothesis (Patient problems)
- Altered sleep, Irritable or Depressed mood, Thinning bones, Low libido, Low self-esteem, Muscle & joint pain, Excess sweating, Skin dryness, Painful sexual intercourse, Anxiety, Hot flashes, Mood swings
3. Solution (Goal or Plan)
4. Actions (Interventions)
- Primary Prevention (Education & counselling - R/T preventable conditions due to menopause)
- Secondary Prevention (Screening)
- Tertiary prevention Prevention (Manage to slow progression or stop)
5. Evaluation (Outcomes)
27
NAme The 5 COMMON **MENSTRUAL DISORDERS**
1. Menopause/Perimenopause
2. Irregular Periods
2. Endometriosis
3. Abnormal Uterine Bleeding (AUB)
4. Premenstrual syndrome (PMS)
5. Premenstrual dysphoric disorder (PMDD)
28
What are the 9 types of **Irregular periods**
1. *Amenorrhea - 'NO'
2. *Oligomenorrhea (Infrequent)
3. *Polymenorrhea (Frequent)
4. *Hypomenorrhea - Light
5. *Metrorrhagia - Heavy
6. *Menorrhagia - Spotting
7. *Dysmenorrhea - Painful
8. *Anovulation – NO
9. *Oligoovulation – irregular or infrequent
29
*Type of Irregular period:*
Absence of periods
Amenorrhea
30
*Type of Irregular period:*
Infrequent periods (long cycles)
Oligomenorrhea
31
*Type of Irregular period:*
Frequent periods (short cycles)
Polymenorrhea:
32
*Type of Irregular period:*
Light periods
Hypomenorrhea
33
*Type of Irregular period:*
Spotting between periods
Metrorrhagia:
34
*Type of Irregular period:*
Painful periods
Dysmenorrhea:
35
*Type of Irregular period:*
Absence of ovulation
Anovulation:
36
*Type of Irregular period:*
Irregular or infrequent ovulation
Oligoovulation:
37
Define:
The **absence** of menstrual flow, is a symptom of a variety of disorders and dysfunctions.
Amenorrhea
38
There are 2 types of Amenorrhea
Primary Amenorrhea
Secondary Amenorrhea
39
Types of Amenorrhea:
WHICH ONE AM I?
* Delayed Menarche
1. Situation where a young woman who by age 15 yrs : Absence of menses and has NOT began to development secondary sexual characteristics
or
1. Who by age 16 years or older who has NOT developed either secondary sex characteristics NOR started menstruations (menses).
PRIMARY Amenorrhea
40
Causes of PRIMARY AMENORRHEA
1. Genetic
2. Systemic –
- Wt. – gain/loss
- Chronic stress
- Hypothyroidism
- CNS disease
3. Turner Syndrome
4. Anorexia
5. Other - Drug abuse
41
Type of Amenorrhea:
WHICH ONE AM I?
an absence of menses for three cycles OR 6 months after a normal menarche
SECONDARY AMENORRHEA
42
Causes of SECONDARY AMENORRHEA
may be caused by:
1. functional hypothalamic amenorrhea
2. pituitary disease
3. primary ovarian failure
4. pregnancy
5. breast-feeding
6. menopause
7. too little body fat (about 22% required for menses)
8. eating disorder: OBESITY OR MALNUTRITION
9. thyroid disease
10. polycystic ovary syndrome
11. Chemotherapy
43
Diagnostics for **BOTH** primary and secondary Amenorrhea
*US-(ULTRA SOUND) -Cyst
*Quantitative hCG
*Thyroid Function
*Prolactin level
*Increase FSH (Ovarian) & LH level (Gonadal dysfunction)
*Increase 17-ketosteroids (adrenal tumor)
44
Management (RX) for Primary Amenorrhea
Name 3.
* Correct abnormalities
* Estrogen HRT - dev. of sec. sex characteristics
* Educate patient
45
Management (RX) for Primary Amenorrhea
* R/O (Rule out) pregnancy **(HCG Test)**
*E**ducation & Counseling**
***Anovulation **- Cyclic progesterone or OCs
***Bromocriptine** - hyperprolactinemia
***Nutritional**- anorexia, bulimia, or obesity
***GnRH -** Depo-Provera q 3 M
***Thyroid replacement** – hypothyroidism
46
Define:
* Abdominal cramping or discomfort with menstrual flow
* is thought to result from excessive production of prostaglandins, which causes painful contraction of the uterus.
Dysmenorrhea
47
*Dysmenorrhea:*
Which phase is:
* SPASMODIC
* No identifiable pelvic pathology
* Increase prostaglandins
Primary Dysmenorrhea
48
*Dysmenorrhea:*
Which phase is:
* Congestive
* Related to pelvic pathology - these contribute to symptoms
Secondary Dysmenorrhea
49
Secondary Dysmenorrhea's Pelvic pathology include
1. Endometriosis
2. Endometrial polyps
3. Fibroids or PID (Pelvic inflammatory disease)
4. Congenital Abnormalities
50
S/S for Dysmenorrhea
1. Onset of menses – last 48-72 hrs
2. Painful uterine cramping
3. Lower abd pain – may radiate to low back, thighs
4. GI S/S – n/v, bloating, diarrhea
5. Nervousness, HA, syncope
6. Breast tenderness
51
Diagnostic Studies to ID structural abnormalities, hormone imbalances and pathological conditions in DYSMENORRHEA
*CBC, UA, ESR, HCG
*Cervical culture to exclude STI
*Stool guaiac
*Pelvic and/or vaginal ultrasound
*Diagnostic laparoscopy and/or laparotomy
52
Nursing Management for Dysmenorrhea
*Prevention
*Education & support
*Medications - NSAIDS & Low-dose OCPs
*Nutrition - B6, Ca, Mg, protein
*Exercise
*Heat
*Biofeedback, hypnosis, relaxation
*Dietary or herbal supplements
53
What is Abnormal Uterine bleeding (AUB)?
* irregular, painless bleeding of endometrial origin that may be excessive, prolonged, or without pattern.
* Dysfunctional uterine bleeding can occur at any age but is most common at opposite ends of the reproductive lifespan.
* It is usually secondary to anovulation (lack of ovulation) and is common in adolescents and women approaching menopause.
*NO known cause or systemic disease
* R/T hormonal Disturbances
54
What are Causes for Abnormal Uterine Bleeding (AUB)
Remember PALM COEIN:
**PALM (structural)**
- polyp
- adenomyosis
- leiomysosis
- Malignancy
**COEIN (other)**
- coagulopathy
- Ovulatory dysfunction
- Endometrial
- Latrogenic
- Not yet classified
55
Diagnostic studies for AUB (ABNORMAL UTERINE BLEEDING)
*CBC: to detect anemia
*PT/INR: to detect blood dyscrasias, *Pregnancy test to r/o spontaneous abortion or ectopic pregnancy
*TSH: to screen for hypothyroidism
*transvaginal ultrasound to measure endometrium
*Pelvic Ultrasound: to assess for structural abnormalities
*Endometrial biopsy: to check fo intrauterine pathology
*Dilation & Curettage (D&C): preop assess pts knowledge of procedure.
56
Nursing Management for Abnormal Uterine Bleeding (AUB)
1. **Treat** the underlying cause
2.**Estrogens**: cause vasospasm of the uterine arteries to decrease bleeding.
3. **Progestins**: used to stabilize an estrogen-primed endometrium.
4. **OCPs**: regulate the cycle and suppress the endometrium.
5. **NSAIDs**: inhibit prostaglandins in ovulatory menstrual cycles.
6.**Progesterone**: releasing IUSs: suppress endometrial growth.
7. **Androgens**: create a high-androgen/low-estrogen environment that inhibits endometrial growth.
8. **Antifibrinolytic drugs:** (tranexamic acid) prevent fibrin degradation to reduce bleeding.
9. **Iron/ blood replacement therapy**: replenish iron stores lost during heavy bleeding.
57
Name 4 SURGICAL INTERVENTIONS that can be done for ABNORMAL UTERINE BLEEDING (AUB)
* Dilation & curettage (D&C)
* Endometrial ablation
* Uterine Artery Embolization
* Hysterectomy
58
What is PMS?
*Premenstral Symptoms
*PMS is a **cluster of physical, emotional, and behavioral SYMPTOMS **
*are usually related to the luteal phase of the menstrual cycle. PMS is very common, affecting many women at some time in their lives
59
Name 5 S/S for PMS (Premenstrual Symptom)
* Mild - moderate symptoms
* Affects 80% of women at some point
* Anxiety
* Craving
* Depression
* Hydration issues (Fluid retention)
60
WHAT IS PMDD
* Premenstrual dysphoric disorder (PMDD)
* is a severe form of PMS with significant severity of symptoms
**is characterized by both PHYSICAL and PSYCHIATRIC symptoms that impact women significantly during the luteal phase of her menses **
61
Name S/S for PMDD
* More severe symptoms
* affects 5% to 8%
*
* Symptoms:
1. **Affective** (emotions): sadness, tearfulness, irritability, DEPRESSION
2. Sleep difficulties
3. Increased or decreased appetite
4. Increased or decreased sexual desire
5. Chronic fatigue
6. Headache
7. Constipation or diarrhea
8. Breast swelling and tenderness
9. Affects **Somatic**- voluntary mvmnts and sensory processing.
10.
*Relieved Day 4 -13
62
Which one interferes with work, social life, and school?
PMS or PMDD?
PMDD
63
Is there a cure or a SINGLE prescription that can help with PMS OR PMDD?
NO
*Need multiple meds or meds that can be used for other dx.
64
WHAT CAN HELP WITH PMS/PMDD
A HOLISTIC APPROACH
*Lifestyle modifications
*Pharmacotherapy
* Herbal Therapies
*Acupuncture
*CBT
**can see improvement of symptoms**
65
Education for patient to Manage PMS/PMDD symptoms.
* Journal- Keep track
* Diet
* Exercise
* Stress management
* Sleep, rest
66
What are some Meds that can be given for PM/PMDD?
1. Diuretics-spironolactone
2. Hormones-synthetic progestin (OCs)
3. Antidepressants & antianxiety
4. NSAIDS- non-steroidal anti-inflammatory drugs.
- aspirin
- ibuprofen
- naproxen
5.. Vitamins
- **Multi VIt & Vit. E** - 400 units daily
- **Ca **- 1,200 to 1,600 mg daily
- **Mg** - 200 to 400 mg daily
67
Types of CAM (complementary and alternative medicine) used for PMs/PMDD.
* Vitex agnus castus (chaste tree berry)
* Evening primrose
* SAM-e
* Hypericum perforatum (St. John’s wort)
* Angelica sinensis (dong quai)
* Paeonia lactiflora (Chinese peony)
* Ginkgo biloba
* Viburnum
* Dandelion
* Stinging nettle
* Burdock
* Raspberry leaf
* Skullcap
68
TEST PRACTICE QUESTIONS:
The nurse teaches the woman with PMS about self-help strategies to help diminish symptoms. What might the nurse suggest?
A. Decreasing physical activity approximately 1 wk. before menses.
B. Decreasing intake of water 5 days before menses
C. Consuming large amounts of red meat
D. Engaging in yoga & meditation daily
D
69
TEST PRACTICE QUESTIONS:
A nurse is caring for a client with dysmenorrhea. Which findings are associated with the client's increased pain?
A. Increased blood pressure and heart rate
B. Increased temperature and heart rate
C. Decreased blood pressure and heart rate
D. Decreased blood pressure and increased heart rate
A
70
What is ENDOMETRIOSIS?
* Endometriosis is a **chronic disease** affecting between 7% and 10% of women of reproductive age, occurring more frequently in women who have NEVER had children
*Consists of a BENIGN LESION or lesions that contain endometrial tissue- similar to that lining the uterus- found in the pelvic cavity OUTSIDE THE UTERUS (not normal).
71
Endometriosis Syndrome:
Explain
1. Under the influence of hormones.
2. Endometrial tissue located outside the uterus, thickens, breaks down and bleeds EACH MONTH.
3. this blood CANNOT exit the body so blood becomes TRAPPED.
4. Can form Cysts OR irritate surrounding tissue.
5. If Cysts occur= scar tissue and adhesions occur leading to INFERTILITY.
6. if Irritation of surrounding tissue occurs- severe pain.
**CAN INCREASE RISK OF OVARIAN CANCER**
72
CAN ENDOMETRIOSIS BE SPREAD TO OTHER PARTS OF BODY?
YES.
Can be spread through lymphatic or venous channels (the blood).
73
What causes Endometriosis
High levels of Estrogen - becomes DOMINANT.
74
is Endometriosis considered a Chronic or Acute?
CHRONIC.
CHRONIC INFLAMMATORY.
75
What age groups are affected by ENDOMETRIOSIS
ADOLESCENCE-MENOPAUSE WOMEN (50-514YRS)
76
Risks that can cause ENDOMETRIOSIS.
Risks:
Lean body size
Smoking
Family H/O (first-degree)
Short menstrual cycle (<28 D)
Long menstrual flow (>1 wk.)
High dietary fat consumption
Early menarche (<12)
Few (1 or 2) or no pregnancies
77
Symptoms or CUES for ENDOMETRIOSIS.
* Debilitating pelvic pain
* Radiating to back or leg
* Cramping, dyspareunia (painful sexual intercourse.)
* Scarring & adhesions
* Fibrosis
* Irregular menses
* Depression
*** Infertility**
78
PHYSICAL EXAMINATIONS FOR ENDOMETRIOSIS.
1. Nonspecific pelvic tenderness
- pain when no movement or touch to pelvic. Pain starts when touching other parts first.
2. Presence of:
- Tender nodular masses
- Uterosacral ligaments
- Posterior uterus
- Posterior cul-de-sac
79
How to manage Endometriosis
1. Pelvic Exam (pelvic area: ring of bones b/t hips housing uterus, ovaries, fallopian tubes)
2. Pelvic & Transvaginal US (ultrasound) – helps find Cyst/Fibroids
3. Immunochemistry – CD10 (study of immunological proteins)
4. Laparoscopy – **DEFINITIVE DX **
80
What is a laparoscopy?
* Type of surgery that lets a a surgeon look inside body w/o doing a large cut.
* Small incision and cameras Used to diagnose and treat conditions.
* Conservative to preserve fertility
81
What are the Goals (solutions) to Manage Endometriosis?
1. Treatment using PAINKILLERS.
**NSAIDS- 1st line**
2. Hormonal Tx: suppresses endometriosis and relieves dysmenorrhea.
3. Surgical Treatment (LAPROSCOPY)- **gold standard**
82
NURSING ACTIONS FOR ENDOMETRIOSIS
* Promote healthy lifestyle
* Reduce pain & restore sexual function
* Decrease anxiety & relieve fear
* Increase knowledge through education
* Prevent self-esteem disturbance
* Referrals (OBGYN, COUNCELING, BLOGS (INTERNET)
83
Inability to CONCEIVE
AFTER at least 1 YEAR of regular intercourse
WITHOUT contraception (protection)
INFERTILITY
84
**FEMALE** factors for INFERTILITY include
* Scarred fallopian tubes
* Uterine fibroids
* Anovulation
* Reduced oocyte quality
* Turner syndrome
* Congenital anomalies of uterus
* Ectopic pregnancy
* Increased age
* Endometriosis
* Eating disorders
* History of PID
* Multiple miscarriage
* Menstrual abnormalities
85
**MALE** factors for INFERTILITY include
* Use of prescription drugs for ulcers
* Exposure of genitals to high temp.
* Hernia repair
* CVD
* Cushing syndrome
* Frequent long-distance cycling or running
* Cryptorchidism
* Mumps after puberty
86
OTHER RISK FACTORS FOR INFERTILITY **OUTSIDE** MALE AND FEMALE FACTORS.
1. Obesity & eating disorders
2. Chronic illnesses
- DM
- Thyroid disease,
- Asthma
3. Immune disorders
4. STIs
5. Smoking/alcohol
6. Marijuana
7. Exposure to chemicals
8. Psychological stress
87
What things should be ASSESSED in MALES for Infertility
1. Assess sexual characteristics
- Body hair distribution
- Adam's apple
- Muscle development
2. Repro. organs
- Nodules
- Irregularities
- Varicocele
3. Development of testicles
4. Prostate tenderness or swelling
88
DIAGNOSES FOR **MALES** to check for INFERTILITY
1. SEMEN analysis – IMPORTANT indicator (must refrain from sex 2-5 days B4 giving a sample)
- > 20 million/ML count (normal)
- > 50% motility (must be)
2. Hormone levels
3. UA after ejaculation
89
DIAGNOSES FOR FEMALES to check for INFERTILITY
1. Assess ovarian function & pelvic organs
2. PAP Smear (test for cervical cancer)
3. Cervical culture - STIs
4. Hysterosalpingography – MRI/UltraSound
5. OVULATION Test- called ELISA - test for LH in urine
6. CLOMIPHENE CITRATE CHALLENGE TEST (infertility blood test)
- 100 mg clomiphene citrate on CD 5 to 9.
- FSH levels : CD 3 & 10
- If FSH level is > 15 = ABNORMAL
7. HYSTEROSALPINGOGRAPHY (HSG) - XRAY to view inside uterus and fallopian tubes **- gold standard FOR patency - fig. 4.4**
8. LAPAROSCOPY (surgery)
90
TX OPTIONS FOR INFERTILITY
1. Fertility Drugs:
*Clomiphene citrate (Clomid)
*Human menopausal gonadotropin (HMG) (Pergonal)
*Artificial insemination
2. Assisted Reproductive Technologies such as:
*In vitro fertilization (IVF)
*Gamete intrafallopian transfer (GIFT)
*Intracytoplasmic sperm injection (ICSI)
*Donor oocytes or sperm
*Preimplantation genetic diagnosis (PGD)
*Gestational carrier (surrogacy)
91
*CULTURE AND INFERTILITY*
Accept most infertility Rx
Conservative & reform Jewish
92
*CULTURE AND INFERTILITY*
* Couples may face problems in infertility
* May not engage in marital relations during periods & till following 7 “preparatory days.”
* Wife given ritual bath (mikvah) before resuming relations
Orthodox Jewish
93
*CULTURE AND INFERTILITY*
* Usually support In Vitro Fertilization (IVF) IF husband’s sperms used
* Less supportive of surrogacy & use of donors
Most Protestant & Muslims
94
*CULTURE AND INFERTILITY*
* Believe that Assisted Reproductive Techniques (ART) are unnatural and that they remove the spiritual or divine nature of creation from conception.
African Americans
95
*CULTURE AND INFERTILITY*
* Do not permit surgical procedures or IVF but do permit insemination with husband and donor sperm.
*Seek to understand the woman’s spirituality
*Encouraged to consult their minister, rabbi, priest, or other spiritual leader for advice.
Christian Scientists
96
*CULTURE AND INFERTILITY*
* Are often spiritual and may consider infertility a test of faith, leading them to seek spiritual counseling
*May find themselves living with partner tensions, criticism from relatives, and stigmatization from the community
Hispanic Culture
97
Role of the Nurse with Infertility
1. Educate on medications & procedures
2. Stress management & anxiety reduction
3. Referral to a peer support group (RESOLVE)
4. Understand woman’s spirituality
5. Encouraged to consult spiritual leader
6. Partner tensions & criticism from relatives
7. Social stigma
98
Test question:
A client calls the fertility clinic to schedule a HYSTEROSALPINGOGRAM. Which does the nurse instruct the patient to do?
a. Schedule the procedure on the 10th day of her ovarian cycle.
b. Avoid prostaglandin synthesis inhibitors 48 hrs before the procedure.
c. Remain NPO for 8 hrs prior to the procedure.
d. Schedule the procedure 4 days AFTER ovulation.
A
99
Name the 5 BENIGN BREAST DISORDERS
**NOT CANCEROUS**
1. LACTATION MASTITIS
2. NON-LACTATIONAL MASTITIS
3. FIBROCYSTIC BREAST CHANGES
4. FIBROADENOMA
5. INTRADUCTAL PAPILLOMA
100
What are the ACS Mammogram Guidelines
1. 40-44 optional (if has hx)
2. Ages 45-54 - done YEARLY
3. After age 55+ done biennial
Breast self exam is OPTIONAL- can start at age 20
101
What Is DUCT ECTASIA
which occurs when the milk ducts become congested with secretions and debris, resulting in periductal inflammation.
102
What Breast Disorder am I?
*An **inflammation or infection of breast tissue**, occurs most commonly in women who are breast-feeding, although it may also occur in women who are nonlactating.
*The infection may result from a transfer of microorganisms to the breast by the patient’s hands or from a breast-fed infant with an oral, eye, or skin infection. May also be caused by bloodborne organisms.
MASTITIS
103
TWO MAIN COMMON BACTERIA THAT CAUSE MASTITIS ARE
1.Staphylococcus aureus
2. Hemophilus influenzae
104
Two types of Mastitis
1. Lactational Mastitis
2. Non-Lactational Mastitis
**always ask pt if they are breastfeeding**
105
When does Lactational Mastitis occur?
* Occurs during the 1st or 2nd week of Postpartum period.
* Milk Stasis occurs (build up of milk within the breast)
106
What are OTHER associated factors contribute to **Lactational Mastitis**
* Damaged or cracked nipples
* Irregular or missed feedings
* Failing to allow empty one breast
* Oversupply & Poor latch
* Illness of mother or infant
* A tight bra
* Blocked nipple pore or duct
* Primiparous women (produced one child only)
* Maternal stress & fatigue
107
What causes **Non-Lactational Mastitis**
Can be caused by duct ectasia, which occurs when the milk ducts become congested with secretions and debris, resulting in periductal inflammation.
*Can become infected
* More commonly seen in adults with underlying condition (diabetes, RA, steroid tx)
108
Manifestations of Mastitis
1. Tough or doughy texture
2. Non-cyclical, dull to severe pain
3. Purulent or blood
4. Greenish discharge
5. Nipple retraction
6. Malaise, Nausea, Headache, 7. Leukocytosis, Fever, Fatigue, Chills.
109
**Mastitis:**
When should you call HCP
1. Increased warmth
2. Swollen area of breast
3. Redness, tenderness
110
Management or Caring for Mastitis includes
1. PCN or Cephalosporins
2. Acetaminophen
3. Warm compresses
4. Wear a snug, supportive bra 24 hrs
5. Personal hygiene
111
Follow- Ups for Mastitis include
1. Frequent checks-> Risk of cancer
2. Mammo. or UltraSound
3. CBE (clinical breast exam) (by surgeon/dr) at 6, 12, & 24 months AFTER a BENIGN breast biopsy- (biopsy has to be done when diagnosed with Mastitis)
4. After postpartum CONTINUE breastfeeding (if lactational)
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What Breast Disorder am I?
Medical term for Breast Pain
Affects 70% of all women.
MASTALGIA
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There are 3 types of Mastalgai
1. Cyclic Mastalgia
2. Noncyclic Mastalgia
3. Extramammary Mastalgia
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Which Mastalgia am I?
* Breast pain fluctuates with hormone changes from menstrual cycle.
* Most common
* Hormonal cause
* Affects bilaterally
CYCLIC MASTALGIA
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Which Mastalgia am I?
*Breast pain related to internal anatomical changes, likely injury, surgery, or cyst
* DOES NOT VARY with menstrual cycle.
* Fat necrosis
*Trauma
*Duct Ectasia
*Unknonw cause
NONCYCLIC MASTALGIA
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Which Mastalgia am I?
* Pain is felt in the breast but originates from ANOTHER location.
* Musculoskeletal
* Pulmonary
* Cardiac
Extramammary Mastalgia
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Diagnostic Studies Mastalgia
Ultra sound and mammogram
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Management for Mastalgia
1. Wear supportive bra day and night x 1wk
2. **Decrease Na+ and caffeine intake**
3. Take ibuprofen PRN
4. Vitamin E supplements
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What Breast Disorder am I?
* Caused by an overgrowth in fibrous tissues in the connective tissues
* Represents a variety of changes in the glandular and structural tissues of the breast
* Affects 50-60% of all women at some point
FIBROCYSTIC BREAST CHANGES.
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Things to know for Fibrocystic breast Changes
*Occurs bilaterally UOQ
*Seen in women 30-50
*Cystic formation in the latter stages
*Improve in pregnancy, lactation, & menopause
*Doesn’t increase risk of breast CA
* Regular mammograms are IMP.
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Fibrocystic breast Changes CLINICAL MANIFESTATIONS.
(observable symptoms)
1. Fluid-filled cysts
2. Multiple, Dense, Round, Smooth lesions
3. Well-delineated, palpable nodules (Cobblestone Consistency)
4. Move freely
5. Cyclic tenderness
6. Pain, aching, fullness, tenderness
7. Nipple discharge MAY be present
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DX studies for Fibrocystic Breast Changes
Mammography & US
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Fibrocystic Breast Changes Management: (same as Mastalgia)
1. Aspiration and biopsy
2. Low-fat diet
3. Rich in fruits, vegetables, & grains
4. Limit caffeine & Na+
5. OTC meds: ibuprofen, ASA (aspirin)
6. Wear supportive bra
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Which Breast Disorder am I?
*Most common BENIGN breast tumor that are firm, round, movable, benign tumors.
*Slow growing, solid
*Hyperplastic lesions
*Both fibrous & glandular tissue
* More common in 15-30yrs **(younger populations)**
FIBROADENOMA
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Causes of Fibroadenoma
1. unknown
2. External estrogen, progesterone
3. lactation, pregnancy
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MANIFESTATIONS OF FIBROADENOMA
1. ** UNILATERAL** (can be present in both breasts(
2. Round or oval, **firm, rubbery**
3. Smooth, Freely Mobile
4. Usually, < 3 cm, **GIANTS 5 cm**
5. May be tender on palpation
6. **No Pain or discharge**
7. Upper outer Quad.
8. Does not increase in size in response to the menstrual cycle
9. Does not respond to dietary or hormonal intervention
BOLD differentiates them from others.
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DX studies for Fibroadenoma
1. CBE
2. Mammography, US, or both
3. Biopsy
- Fine-needle aspiration
- Core needle
- Stereotactic needle
- Advanced breast biopsy instrument (ABBI)
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Management for Fibroadenoma
1. Most – NO Rx
2. Cryoablation (freezing)
3. Surgical excision
4. Follow-up
- Re-eval. in 6 M
- Monthly BSE (breast self-exam)
- Annually CBE (clinical breast exam)
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Describe Intraductal Papilloma breast disorder
1. A wart like growth
2. Glandular & fibrovascular tissue
3. In large milk ducts near nipple
4. Erosion within ducts
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Causes/Risk factors for Intraductal Papilloma
1. unknown
2. Affects Women 35-55
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Manifestations for Intraductal Papilloma
1. One large lump Near nipple
OR
2. Small multiple lumps AWAY from nipple
3. Serous or serosanguineous discharge
4. Pain/discomfort
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Diagnostic Studies for Intraductal Papilloma
* Ultrasound - Atypical hyperplasia.
* Ductogram (galactogram)
* Breast biopsy
* NO Mammograms- does nOT show papillomas
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Management for Intraductal Papilloma
1. Excision of papilloma & duct or duct system,
2. Analysis of nipple discharge
3. Long term follow-up
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Test question:
Upon assessment, the nurse identifies which symptom that indicates the client has fibroadenoma of the breast?
a. Serous nipple discharge
b. Immobile soft mass
c. Painless Mass
d. Age 35 to 55 yrs. old
Answer is C
Rationales
A - Fibroadenoma does not cause serous discharge from the nipple.
B - The client has a well-defined mass or masses. These may be round, firm, discrete, and movable. They are about 1 to 5 cm in diameter.
C - The client with fibroadenoma has well-defined mass or masses in the breast, but NO pain.
D - The client with fibroadenoma is usually in the teens or early 15-30 yrs.
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