Female Reproductive Conditions Flashcards
(100 cards)
1
Q
What is menorrhagia?
A
excessive (heavy or lengthy) bleeding during recurrent menses
classified as >80mL/cycle
2
Q
With women with menorrhagia, what labs/condition is most important to check for?
A
H&H and anemia
3
Q
Causes of menorrhagia:
A
- hormonal imbalance
- disease
- neoplasm (new excessive growth of tissue)
- infections
- contraception (IUD)
4
Q
What is oligomenorrhea?
A
infrequent menses, occurring greater than every 35 days OR scant flow at regular intervals
5
Q
Main cause of oligomenorrhea:
A
OCPs
6
Q
What is the term for a woman who bleeds < every 22 days?
A
polymenorrhea
7
Q
metrorrhagia/intermenstrual
A
spotting between periods
8
Q
Define endometriosis
A
when endometrial-like tissue grows outside the uterine cavity
9
Q
Name 3 common places to find endometrial tissue outside of uterus
A
PELVIC CAVITY, peritoneal cavity, bladder, lung
10
Q
What is the most common symptom for endometriosis?
A
pain that is increased with menses
*may have chronic pain
11
Q
What is causing the pain in other areas?
A
The “displaced” endometrial tissue is bleeding in response to hormones of menstrual cycle and this causes inflammation, scarring, and tissue adhesion.
12
Q
True or False:
The cause of endometriosis is unknown.
A
TRUE.
13
Q
True or False:
Endometriosis is the leading cause of infertility and difficulty conceiving.
A
TRUE.
14
Q
How does the pt with endometriosis commonly present?
A
- abnormal menses
- abdominal, vaginal, sacral, rectal pain
- diarrhea or constipation
- urinary complaints
- infertility
15
Q
True or False:
The steps for diagnosing endometriosis include:
- pt history
- physical exam (external and internal - tender uterus, palpable nodules)
- laparoscopy w/ biopsy
A
TRUE
16
Q
What is the best (gold standard) for dx of endometriosis?
A
lap with biopsy
17
Q
True or False:
Endometriosis is curable.
A
FALSE.
Rationale: There is no cure for endometriosis, only management of symptoms and spread of tissue.
18
Q
What are the three goals when treating a woman with endometriosis?
A
- control pain (NSAIDs?)
- slow progression of tissue growth
- restore fertility
19
Q
What treatments are available for endometriosis?
A
- removal of growths, which significantly decreases pain
- hormones
- hysterectomy with bilateral salpingo-oophorectomy
20
Q
What are the four types of hormone therapy used for tx of endometriosis?
A
- OCPs (if not wanting to get PG)
- progestins SQ x3months (causes atrophy of tissues)
- GnRH x6months (combats estrogen release)
- Mirena IUD x5yrs (thickens mucus and atrophies endometrium)
21
Q
Can testosterone/aldosterone be used in tx of endometriosis?
A
YES.
Rationale: inhibit endometrial growth by suppressing ovulation and causing amenorrhea
22
Q
What is the best time for a woman with endometriosis to try to get pregnant?
A
ASAP after treatment - this is when the condition is best controlled and she is most likely to conceive
23
Q
What condition causes “chocolate” cysts?
A
endometriosis
24
Q
cystocele
A
anterior bulge in the uterus due to displacement of the bladder - may appear in the vaginal canal
25
What causes cystocele, rectocele, uterine prolapse?
Pelvic floor relaxation - support structures no longer hold the organs in place
26
rectocele
posterior bulge caused by weakness of pelvic floor muscles (between rectum and vagina)
27
uterine prolapse
uterus drops into the vaginal canal
28
Causes of pelvic floor relaxation/ What causes cystocele, rectocele, uterine prolapse?
- aging
- constipation
- chronic coughing
- childbirth
29
Tx of pelvic floor relaxation
- KEGAL's
- topical or systemic estrogen
- pessaries
30
Toxic Shock Syndrome
febrile condition that occurs during or within 5 days of menses or following childbirth
31
Prevention of TSS
- change tampons 3-6hrs
- avoid wearing tampons overnight
- avoid tampons for 6-8wks postpartum
32
True or False:
If a woman has had TSS, she can continue to use tampons and barrier birth control.
FALSE.
Rationale: She needs to avoid tampons and all barrier methods.
33
Key nursing role for TSS
educate women about prevention
34
Symptoms of Toxic Shock include
- fever >102 degrees
- rash on trunk
- dizziness and HYPOtension
- vomiting and diarrhea
- peeling of skin on hands and feet
35
Sx of TS Syndrome
- pathology involves 3+ organ systems
| - coma
36
Common tx of TSS
- IV meds/fluids
- antibiotics
- oxygen
- vasopressors (constrict BVs to increase BP)
- tx of sepsis
37
What is cervical dysplasia?
abnormal changes in the cells of the cervix (considered a precancerous condition)
38
How can cancer be prevented r/t cervical dysplasia?
Early detection with Pap smear test
39
What is severe dysplasia called? What does this mean?
carcinoma in situ
the full thickness of the epithelium has been replaced with abnormal cells
40
Tx of cervical dysplasia/ carcinoma in situ?
- colposcopy
- endocervical curettage (ECC)
- loop electrosurgical excision procedure (LEEP)
41
What happens during a colposcopy?
A microscope is used to visualize the cervix. Acetic acid is introduced to the tissue, which stains the abnormal cells WHITE. These white cells are then biopsied.
42
Explain an endocervical curettage.
The lining of the cervix is scraped from internal to external os.
43
What is a LEEP and what are the risks?
A LEEP is a loop electrosurgical excision procedure that removes the abnormal cells via laser or cautery. It has an increased risk for cervical scarring.
44
As the nurse, what is important to stress to women who have undergone their first intervention for cervical dysplasia/ carcinoma in situ?
One treatment is not a cure. There is a need for follow-up care.
45
When should women start being screened for cervical cancer?
beginning at age 21, repeating every 3 years
once 30-65yrs, repeat every 5 years
46
When can a woman stop being tested for cervical cancer?
If she is >65yrs and has a negative hx for 10+ yrs
47
Case Study:
A young woman comes into the clinic and has a Pap done for cervical cancer prevention. She is frustrated cuz her friend who is the same age only gets checked every 3 years, but she gets checked annually. The young woman has a family history of cervical cancer. As the nurse, how would you educate your pt?
This pt is at higher risk for developing cervical cancer r/t her family hx of cervical cancer. Therefore, it is highly encouraged that she be checked more frequently.
48
Main cause of cervical cancer
HPV
49
Prevention of cervical cancer
- delay sex
- monogamy
- don't smoke
50
True or False:
Gardasil/ Cervarix are a lifelong preventative vaccine for HPV, but can only be given to women.
FALSE.
Rationale: The vaccines available to px of HPV only last 6-8 years (THEY ARE NOT LIFELONG). The vaccines can also be given to both females AND males, and it is encouraged for both groups.
51
When should the preventative vaccine for HPV be given?
before male or female engages in sexual activity
52
Who is at highest risk for cervical cancer?
20-50yrs
53
True or False:
Cervical cancer is very "quiet" because it shows little s/s.
TRUE - this is why annual exams and prevention are so important
54
Tx for cervical cancer
- cryosurgery (freezing with nitrogen or CO2)
- LEEP
- etc.
55
Most common abnormal growth in the uterus
uterine fibroids (leiomyomas)
56
What are uterine fibroids?
benign growth of the uterus (overgrowth of the endometrium) during reproductive years
57
Other name for uterine fibroids (common name)
polyps
58
Why are uterine fibroids so prevalent during reproductive years but not after menopause?
They are estrogen-dependent.
59
True or False:
Uterine fibroids are almost always a sign of cancer.
FALSE.
Rationale: They rarely every become malignant.
60
What two subgroups are at higher risk for uterine fibroids?
- women of color
| - obesity
61
True or False:
The most common symptom of uterine fibroids is abnormal bleeding.
TRUE.
Rationale: Other sx include bowel, bladder, or abdominal sx
62
How are uterine fibroids typically dx?
- pelvic exam
- ultrasound
- biopsy
63
Is treatment often required for uterine fibroids?
No. They are usually left alone and will atrophy with menopause. If they are affecting PG, they can be treated.
64
Tx of uterine fibroids
- myomectomy (removal of fibroids)
| - uterine artery ablation (cannot get PG after)
65
What is the most common gyn cancer? What ages are most affected?
uterine
50-70yrs
66
Risk factors for uterine cancer
- obesity
- high fat diet
- infertility
- nulliparity
- diabetes
- late onset menopause
- overuse of estrogen-only txs
67
Most common sx of uterine cancer
abnormal post-menopausal bleeding
68
How can uterine cancer be diagnosed?
- uterine ultrasound
- dilation and curettage (D&C)
- endometrial biopsy
69
What does a uterine ultrasound do?
measures the thickness of the uterine lining
70
What thickness is low risk for malignancy?
<4cm
71
What is the disadvantage of the endometrial biopsy?
It doesn't sample the entire endometrium so the biopsy could miss the cancerous area.
72
Dilation and curettage
the cervix is dilated and the walls of the uterus are scraped
73
Case Study:
A woman is relieved upon hearing that her test results came back negative after a D&C. You caution her about completely ruling out malignancy. Why?
Positive test results are only for specific types of cancer. Just because she is negative doesn't mean she doesn't have cancer - it means that those types were not detected.
74
What is PCOS?
Polycystic Ovarian Syndrome
endocrine disorder of ovarian dysfunction
75
What are the hormone levels in a woman with PCOS?
High estrogen, testosterone, and LH
Low FSH
76
Symptoms of PCOS
- irregular menses and/or amenorrhea
- androgen excess ie. testosterone (hirsutism, acne, deep voice)
- infertility r/t anovulatory cycles
- obesity
- insulin resistance w/ glucose intolerance and T2DM
77
Case Study:
A 18 yr old recently dx with PCOS is struggling with understanding her condition. She is frustrated because she can't keep her acne under control, she's having to wax her upper lip "constantly," and she can't fit into her favorite pair of jeans anymore. She's also mad because her period keeps "popping up out of nowhere." How would you approach the situation?
Do your best to be empathetic and understanding. Listen well and build trust.
Explain to the pt that her condition causes her hormones and androgen levels to be unbalanced. This is what is causing her acne to increase (estrogen), the hair on her upper lip (hirsutism - testosterone levels), and her irregular period (low FSH). -- Then explain that there are medications she can take to help regulate her hormone/androgen levels ie. combination OCs for estrogen/FSH, and Spirolactone for testosterone.
78
PCOS management: irregular menses
combination oral contraceptives or progesterone
79
PCOS management: androgen excess (hirsutism, deep voice)
Spirolactone or Aldactone
80
PCOS management: glucose intolerance
Metformin/glucophage
81
True or False:
A majority of ovarian masses are benign.
TRUE.
82
>50% of functional ovarian cysts are due to...
abnormal hormone production
83
True or False:
Many ovarian cysts are caused by OCPs.
FALSE.
84
A collection of fluid surrounded by a very thin wall, within the ovary.
*aka a follicle >2cm
ovarian cysts
85
What kind of cyst are women born with?
dermatoid cysts - they contain hair, bone, teeth, etc.
86
What cysts are known as "chocolate cysts"?
endometriomas - they are filled with blood
87
What is important to rule out if a woman is suspected to have an ovarian mass?
- an ectopic pregnancy
- infection
- appendicitis
*must follow-up if positive
88
Is it normal to have observative treatment for a benign ovarian mass?
Yes. Will typically observe for 1-2 months if it is small. The mass may dissolve and go away on its own.
89
If the mass is causing a lot of pain, what treatment is suggested?
OCPs for 1-2 months
90
If a benign ovarian mass is larger than 7cm, what treatment is suggested?
Laparoscope or laparotomy
91
Case Study:
A 24 yr old pt is in your office visibly upset and crying after a well-women's exam. When asked what was upsetting her, she states that her gynecologist had just scheduled her to have one of her ovaries removed r/t an ovarian mass present. She tells you that she is getting married in two months, and her and her fiancé really wanted to have kids. As the nurse, what is your response?
Comfort her and listen to everything she has to say. In this situation, the proper education was not provided to the pt when the procedure was explained. The nurse should tell the pt that even though she is to have one ovary removed, it is still possible to conceive.
92
Which is the most fatal of female cancers and why?
ovarian cancer - this is r/t the vague symptoms and likely late dx
93
Strongest risk factor for ovarian cancer
family history (breast+ovarian) and 50+yrs
94
Why is ovarian cancer so difficult to diagnose?
The symptoms are extremely vague.
Symptoms: abdominal pain, bloating, fullness after eating little, incontinence/difficulty voiding
95
True or False:
By the time ovarian cancer is found, it has usually metastasized to other areas and has a poor prognosis.
TRUE.
96
Tx for ovarian cancer
- surgical laparoscope
| - radical hysterectomy w/ chemo and/or radiation
97
True or False:
A mass found on the ovary after menopause is likely just a cyst.
FALSE.
Rationale: cysts can only arise from a follicle that has not ruptured or a degeneration of the corpus luteum - these cannot occur after menopause
**this mass should be considered cancerous until proven otherwise
98
How is a radical hysterectomy different than a normal hysterectomy?
In a radical hysterectomy, the uterus, surrounding tissue, and ligaments are removed. A bilateral oophorectomy is also done, along with a pelvic node dissection.
99
salpingectomy
removal of fallopian tubes
100
oophorectomy
removal of ovary(ies)
