MIH #1 Flashcards
(412 cards)
1
Q
Healthy people 2020-
A
provides family center care goal
2
Q
Types of families
A
Single-parent family, Nuclear family, Extended family or multigenerational, Married blended family
3
Q
Single-parent family
A
Most socially vulnerable because of no support system.
Can impact overall health, school achievement, and increase risk of high risk behaviors.
4
Q
Nuclear family
A
Husband wife children, biological or adopted children.
Live as individual unit but share responsibilities.
Number of nuclear families have decreased
5
Q
Extended family or multigenerational
A
aunts, uncles, grandparents, cousins.
Provide social support, financial support to one another
6
Q
Married blended family
A
Married couple with children from pervious relationship
7
Q
Nursing Theory- Family systems theory:
A
Family pays a vital heath.
A change in one family member impacts the entire family.
Beliefs and values play the most powerful role in the actions of individuals and families.
Significantly patient centered.
Provide respect an include in plan of care- family
8
Q
Nursing Assessment- Low risk vs high risk family
A
Pregnancy low risk- stable, financial income, bottle level of Maslow’s being met, no comorbidities, no social concerns
High risk family- lack of support, comorbidities, abuse, low income, nutrient, insurance, transportation, communication problem, immigrant, alcoholism, drug abuse
9
Q
Look at family planning, preconception care, prenatal care, intrapartum care, postpartum care, And
A
care of the infant/newborn through 1 year
10
Q
Family definition
A
Whoever the patient says is family
Structural unit that functions and society- fundamental social unit.
Assumes responsibility for transmitting cultural background and core values
11
Q
Culture
A
Communication, Subculture, Acculturation, Assimilation, Ethnocentrism, Family roles, Time orientation
12
Q
Communication-
A
Interpreters, find out the language they speak, assess teaching (variety of methods). provide privacy. Document utilizing an interpreter.
13
Q
Subculture-
A
culture within a culture. Mexican America, Asian American.
14
Q
Acculturation-
A
One culture retains old culture and obtains apart of another culture. Occurs when people from one culture meshes with people from another
15
Q
Assimilation-
A
Total loss of ones own culture, lose cultural identity become part of larger culture
16
Q
Ethnocentrism-
A
believing that own culture is they best. Values and belief are the only right way. Hard to navigate during a nurse. Learn to agree to disagree
17
Q
Family roles-
A
depending on the culture, parents are more involved or not.
18
Q
Family roles European American family-
A
spouse is more involve in birth
19
Q
Family roles Hispanic-
A
Maternal grandmother is involved in the care
20
Q
Family roles Native American-
A
whole family involved in care
21
Q
Family roles Asian American-
A
father is not involved in child birth practices
22
Q
Community Health
A
Vulnerable Populations, Care management, Home Care
23
Q
Vulnerable Populations-
A
Women, racial or ethnic minorities
Adolescent girls- pregnancy, STD risk
Incarcerated women- risk of stds, communicable diseases, influence on drugs. Homeless- increased risk of infectious disease, lack of prenatal care, substance abuse, chronic diseases,
24
Q
Care management-
A
Assess safety of the home.
Pay attention to infection control
25
Home Care-
Growing need for women's health.
Utilized for birthing practices.
Nursing home care can shorten hospital stays.
Expensive, what is considered covered, reimbursement concerns.
26
Levels of Preventive Care
Primary, Secondary, Tertiary
27
Primary-
prevent something from happening- immunizations, exercise, care seats, nutrition
28
Secondary-
Screenings come into play, mammogram, breast self exams.
Targeting at risk populations.
Genetic testing- older than 35 yrs old
29
Tertiary-
Pt always has disease.
Tx or rehabilitation to prevent further deterioration
30
Assessment is key, 51 percent of the population are
Women
31
Rural-
vulnerability of readily available access to care
32
Urban-
increased access to care
33
Family focused concerned about the
mom and the baby
34
What is Maternity and Women’s Health Nursing in the 21st Century?
Maternity Care, Women’s Health Care, Role of nurses in Women’s Health care, Significant advances in care AWON
35
Maternity Care-
includes prenatal care intrapartum care and postpartom care
36
Women’s Health Care-
physical aspects and psychological aspects, Within look at social needs-defines Maslow's
37
Role of nurses in Women’s Health care-
concerned about well being of the woman and infant
38
Significant advances in care AWON-
set forth standards and goals that maternity nurses should meet
39
Contemporary Issues and Trends- Healthy People 2020 Goals
33 of these goals are directly related to maternal, infant and child health.
Overall being of the population. Different aspects. Specific goals that target women and infants. Nurses are involved, starts with us.
40
Healthy People 2020 Goals Examples include:
Reduce the rate of fetal and infant deaths
Reduce the rate of maternal mortality
Reduce preterm births
Reduce cesarean births among low risk women
41
Goal is to improve access to care and quality of care
Healthy People 2020
42
What determines healthy people goals-
mortality rates for infants and women, specified to specific race or ethnicity
43
Why is there an increase in African American mortality rate-
Unconscious bias.
Be aware and individualize patient care.
Data driven it shows high mortality rate in African American women
44
Contemporary Issues and Trends- Problems with the U.S. health care system
Structure of the health care delivery system, Reducing medical errors, High cost of health care, Limited access to care, Health Literacy
45
Structure of the health care delivery system-
fragmented and the structure of it makes it inaccessible to people.
Access to care issue
46
Reducing medical errors-
3rd leading cause of death in the US.
47
High cost of health care-
Economy driven, Intensive care = increases price
48
Limited access to care-
Transportation, Teenage Pregnancies, Child care, Finances, Support, Insurance
49
Health Literacy-
Understanding about their health, simplified education, teach back, demonstrating, describing, interpreter.
People are afraid to advocate for themselves.
Providing basic care we can utilize a lay interpreter.
Any consent for procedure, med info, diagnostics- need a licensed interpreter.
Use resources.
50
Trends in Fertility and Birth Rates
Trends, Low birth weight and preterm birth, Infant mortality in the United States, International infant mortality trends, Maternal mortality trends, Maternal morbidity
51
Trends:
Fertility and rates, c section rates, vary from year to year.
Decrease in unnecessary c sections over the last 5-6 year, comes from patient advocacy.
52
Low birth weight and preterm birth-
Diet, substance use, prenatal care, multiple fetal gestation, comorbidities, ethnicity. Low weight <2500 grams.
Non Hispanic black infants 2x more likely to die in the first year (nonmodifiable risk factor)
53
Infant mortality in the United States-
Can be reflective in care. Congenital issues can arise at any time
54
International infant mortality trends-
US higher occurrence of low birth rates than any other country
55
Maternal mortality trends-
Better access to prenatal care- resources-clinics, certified nurse midwife, OBGYM travel to the location, telemed
56
Maternal morbidity- Obesity
one-third of women in the U.S. are obese.
57
Obesity Increases the occurrence of diabetes and hypertension-
further leads to complications during pregnancy, congenital anomalies, miscarriages, infertility, and fetal death
58
Trends in Fertility and Birth Rates- Can still have
hypertension, infection, hemorrhage, fetal death risk for any healthy individual
59
Perinatal Health Care Services
Ambulatory care, Community-based care, High technology care, Telehealth advances, Disadvantages, Social Media influences
60
Ambulatory care-
Basic care.
Receive for prenatal care.
Notice abnormality or high risk, then progressive higher level of care= more interventions.
Determine higher level of care= assessment
61
Community-based care-
Home health care (bed rest), Income based care.
Planned parent hood. WIC clinic- helps with nutritious food, formula, etc
62
High technology care-
Preconception counseling helps women determine if they are able to have children or risk of fertility, congenital malformations.
Our health care system emphasizes high-technology care because we cannot operate without technology
63
Telehealth advances-
Equipment to care for mom and baby is high tech. Vital signs, contractions, lab tests, genetic screenings. Any time of intensive care= tech
64
Disadvantages-
Need to have phone, laptop, internet. Cannot do Physical assessment, using senses
65
Social Media influences-
Misinformation- don’t believe everything you see, not one size fits all, confirm with HC provider. Nurses are first line of education.
66
Equipment to care for mom and baby is high tech
Vital signs, contractions, lab tests, genetic screenings
67
Any time of intensive care=
High tech
68
Childbirth Practices
Prenatal care, Certified nurse-midwives, Physicians, Family-centered care, Bonding intervention
69
Prenatal care-
Promotes better pregnancy outcomes, supports healthy behaviors, and utilized as early risk assessment tool.
Provided by obstetrician, certified nurse midwife, women's HC nurse practitioners, physicians assistance specialized in obstetrics care
70
Certified nurse-midwives-
More focused on non invasive interventions.
Associated with lower C section rate.
Midwives who are not nurses.
RN has masters- Certified nurse-midwives.
Lay midwife- did not have formal medical training. Focused on home births.
Doula- another support person, advocate in L&D room.
71
Physicians-
Comorbidities focused
72
Family-centered care-
significant other, siblings, anybody who the women determines is family
When determining family centered care be involved.
Includes education.
Make sure baby within the mom as often as possible.
Skin to skin contact- family centered care.
Promotes bonding encourages breastfeeding's.
73
Bonding intervention-
skin to skin.
After baby is born woman can let whoever to cut the umbilical cord- family centered care
74
Other Issues in Women’s Health Nursing
Involving consumers and promoting self-management, Domestic violence, International concerns, Women’s health
75
Involving consumers and promoting self-management-
Women are healthy during pregnancy we want them to maintain health.
Encourage well balanced diet and activity, monitor intake, smoking, alcohol drugs.
76
Domestic violence-
Don’t feel safe at home, cannot meet needs, taking care of self or baby, harm to mom and baby.
Leads to fetal death.
Ask with desertion- privacy.
77
International concerns-
Female genital mutilation and human trafficking in the US- sexual assault, miscarriages, sell the baby and stem cells.
78
Women’s health-
Increase risk for hypertension, breast cancer, cardiovascular disease, domestic violence- the incidence battery increases during pregnancy (tension, financial burden, drama)
79
Standards of Practice and Legal Issues in Provision of Care: What is Standard of Care?
Level of care would provide in a similar situation
80
Standards of Practice and Legal Issues in Provision of Care: Standards defined by several organizations
defined by various organizations. Special interest in nursing or W/I health
81
ANA-
American Nurses Association
82
AWHONN-
Association of Women's Health, Obstetric and Neonatal Nurses
83
ACNM-
American College of Nurse-Midwives
84
NANN-
National Association of Neonatal Nurses
85
We have to know
facility standards
86
How to know to reference care book if
unsure about a procedure
87
Always reference an experienced nurse but always look at
policies and procedures for that facility
88
Standards of Practice and Legal Issues in Provision of Care: Risk management
System of checks and balances. Anytime an adverse effect occurs a risk management nurse looks at the situation. Decreasing risk of harm.
89
Standards of Practice and Legal Issues in Provision of Care: Sentinel events
that should not have happened.
Preventable event.
Fecal impaction is a sentinel event (lack of intervening).
Something that causes pt temporary or permanent harm from lack of intervening.
90
Standards of Practice and Legal Issues in Provision of Care: Failure to rescue
Neglect, ignoring.
Clinical judgement impaired.
Follow Chain of command to report.
Call provider.
When we exhausted all of our intervention and failed to reach out to other people. Document, Advocate.
Medical director is physician not good.
All NSG interventions used then to charge nurse, provider, medical director.
91
Standards of Practice and Legal Issues in Provision of Care: Quality and Safety Education for Nurses (QSEN)
Sets standards for nursing practice.
92
Standards of Practice and Legal Issues in Provision of Care: Evidence Based Practice
Providing care based on data collected that proves to be efficient and effective. Determined by research and clinical trials.
93
Standards of Practice and Legal Issues in Provision of Care: Outcomes oriented practice
compared clinical standards with current care practices
94
Ethical Issues in Perinatal Nursing and Women’s Health Care
Reproductive technology, Allocation of resources, Older-age pregnancies, Third-party payers, Induced ovulation and in vitro fertilization, Multifetal pregnancy reduction, Intrauterine fetal surgery, Treatment of very low-birth-weight infants.
95
Reproductive technology-
Ethical issues, Genetically modification
96
Allocation of resources-
Ethical issues, Prenatal babies have higher risk of respiratory distress in intrauterine life. Who has higher chance of survival. Team effort (opinions). Ethics committee responsible.
97
Older-age pregnancies-
Ethical issues. Higher risk for premature, genetic malformations (down syndrome), Multiples (fertility decreases), increased risk for hypertension, diabetes, obesity.
98
Induced ovulation and in vitro fertilization-
Technology used and cost (expensive)
99
Multifetal pregnancy reduction-
Health of woman vs fetus. Therapeutic or Medically necessary
100
Intrauterine fetal surgery-
Risk for death for mom and fetus. Cost = expensive.
101
Treatment of very low-birth-weight infants-
Allocation of resources
102
Research in Perinatal Nursing and Women’s Health Care
Ethical guidelines for nursing research, How do we analyze benefits and risk in ethical dilemma, Analysis of benefits and risks
103
Ethical guidelines for nursing research-
Prenatal patients= risky
104
How do we analyze benefits and risk in ethical dilemma-
American Nurse Assoication Code of ethics. Autonomy, justice, equality, beneficence
105
When managing health care for pregnant women at a local prenatal clinic, the nurse should recognize that the most significant barrier for access to care is the pregnant woman’s:
Inability to pay
106
Influences growth and development by
hormones
107
development in the female reproductive system
Estrogen and progesterone
108
Lack of these hormones cause function abnormality
Estrogen and progesterone
109
Holistic nursing care for
child bearing women
110
Preconception needs-
child care
111
Focus on health promotion and prevention
Females
112
We want to focus on preventative health care in all aspects in
Health care
113
muscular organ positioned in the pelvic cavity.
Uterus
114
Where the fertilized egg is received, implanted, and retained.
Uterus-
115
Huge role in child birth process.
Uterus-
116
Responsible for female menstrual cycle.
Uterus-
117
The inner lining of the ___ is what is shed during monthly menstrual.
Uterus-
118
Muscles Actively involved in the birth process.
Uterus-
119
Fallopian Tube-
Uterine tubes. Where the ovum is fertilized by sperm.
120
Endometrium vascular lining of the uterus and is
shed during menstruation
121
Cervix-
Made of connective and elastic tissue. It is what dilates or stretches during child birth.
122
Ovary-
Produce ova (female eggs). Responsible for ovulation and hormone production.
123
Vagina-
Lies between the bladder and rectum. Passage way for menstrual flow and pathway for vaginal birth
124
Vulva-
Part of external genitalia
125
Hormone production
decreases as age
126
Female Reproductive System: Internal Structures atrophy and become
less functional
127
Mammary Gland- Two made up of
Lobules
128
placed between the 2nd and 6th rib
Lobules
129
Same size and shape.
Physiologic Alterations of Breasts
130
Although one is typically larger than one others.
Physiologic Alterations of Breasts
131
Can vary depending on age, hormone production, and hereditary.
Physiologic Alterations of Breasts
132
Nutrition can also influence alterations.
Physiologic Alterations of Breasts
133
Characteristics-Smooth no dimpling or masses (cancer).
Physiologic Alterations of Breasts
134
Estrogen stimulates growth of breast tissue
Physiologic Alterations of Breasts
135
Lactation, sexual arousal, nonmalignant nodules can develop in response to hormonal changes.
Breasts Function-
136
Menarche & Puberty- female first menstruation, typically within first yr there is Anovulation (no ova are released), typical age is
13 yrs old onset.
137
Marker of transition between childhood and puberty.
Menarche
138
Shed the lining of the uterus.
Menstrual Cycle
139
Preparing the uterus for pregnancy.
Menstrual Cycle
140
Periodic uterine bleeding which occurs 14 days after ovulation.
Menstrual Cycle
141
Length of the cycle is typically 28 days.
Menstrual Cycle
142
Varies depending on the pt. bleeding will last 5 days and accumulation of blood loss is about 50 mL, can vary.
Menstrual Cycle
143
Oxygenated fatty acids that function like hormones.
Prostaglandins (PGs)
144
Produced in most organs including the uterus.
Prostaglandins (PGs)
145
Moderate hormonal activity, do play a role in smooth muscle contractility.
Prostaglandins (PGs)
146
Play a key role in ovulation and influence the production of estrogen and progesterone.
Prostaglandins (PGs)
147
Can be influenced by environmental factors, emotions, physical factors.
Prostaglandins (PGs)
148
The release can have effect of organs and system in the body, gi system- diarrhea.
Prostaglandins (PGs)
149
CNS- generalized systemic responses (aches, headaches, increase temp, above baseline)
Prostaglandins (PGs)
150
Menopause 3 stages
Climacteric, Perimenopause, Menopause
151
Climacteric-
transition phase between ovarian function and decrease in hormone production.
152
Occurs before menopause, four year span, during menopause no estrogen is released from the ovaries.
Perimenopause
153
Ovarian function significantly decreases the production of ova also decreases.
Perimenopause
154
Females will have anovulatory menses- still bleeding but no ova are being released.
Perimenopause
155
last menstrual period, noted 1 year after no mensuration.
Menopause
156
Can occur between ages 35-60. Average age of 51.
Menopause
157
Barriers to Seeking Health Care
Financial issues, Cultural issues, Gender issues
158
Such as lack of education is preventing pt from getting jobs or receiving heath care insurance from job
Financial issues
159
Income and social status also. They need healthcare coverage until needed healthcare services. Huge barrier
Financial issues
160
different beliefs.
Cultural Issues
161
Pts may use alternative tx other than evidence based practice.
Cultural Issues
162
Provide pt with facts, respect their religion.
Cultural Issues
163
gender concordance- female pt may want female provider only and vise versa. Can be an issue.
Gender Issues
164
Most providers are male and nurses are female mostly.
Gender Issues
165
May be generational- used to seeing male providers so when seeing female providers they doubt. Still an issue.
Gender Issues
166
Sexual orientation or gender identify can cause barriers to HC.
Gender Issues
167
How to overcome barriers- educate self on pts perspective.
Gender Issues
168
Caring for the Well Woman Across the Life Span
Approaches to healthcare:
Preconception
Pregnancy
Family Planning
Menstrual Problems
Perimenopause
169
To take care of them- Proper education, establish rapport and be relatable with them.
Adolescents
170
Educate on safe sex practices and how to prevent becoming pregnant.
Adolescents
171
Understand that they are still not mature.
Adolescents
172
The average age for sexual intercourse is 17 yrs old.
Adolescents
173
Female must have first papsmear at 21.
Adolescents
174
20-40 yrs old.
Young and Middle Adulthood
175
Need care treated to conception
Young and Middle Adulthood
176
if they wish to have children, pelvic and breasts' screening. Pap smears, breast self exam.
Young and Middle Adulthood
177
Pregnancy care is related to this age group.
Young and Middle Adulthood
178
May have chronic or debilitating conditions. Comorbidities.
Parenthood after 35 y/o
179
If they were to become pregnancy at the time, at risk for genetic anomalies esp. down syndrome.
Parenthood after 35 y/o
180
Females are born with their eggs which age as the pt ages.
Parenthood after 35 y/o
181
Experiences changes as they age. Respect.
Late Reproductive Age-
182
Can be experiencing depression because of empty nest syndrome.
Late Reproductive Age-
183
Within our scope of practice.
Late Reproductive Age-
184
Want to continue screening for cancers. Breast/ovarian/cervical cancer.
Late Reproductive Age-
185
Risk Factors to Women’s Health
Substance Abuse, Mental Health, Lifestyle, Medical conditions, Exercise, Nutrition problems
186
inappropriate Use of elicit drugs of prescription.
Substance Abuse
187
Seen as a biopsychosocial disorder.
Substance Abuse
188
Cocaine to caffeine can harm the fetus.
Substance Abuse
189
Can have impact of fertility and overall women health.
Substance Abuse
190
Depression and anxiety concern.
Mental Health
191
Ensure they have appropriate coping mechanisms and provide active listening, refer to support groups.
Mental Health
192
Nurses have skill of anticipatory guidance- helping prepare them, giving recourses and support
Mental Health
193
Practices, risky behaviors such as sexual, drug abuse, alcohol use.
Lifestyle
194
Can lead to potential for human trafficking and domestic violence.
Lifestyle
195
Environment or work place can have hazards such as chemical exposure, pathogenic agents, radiation.
Lifestyle
196
Common- heart disease, lung breast and colon cancer, chronic lung disease, and diabetes.
Medical Conditions
197
Infertility, miscarriages, preterm delivery, ovarian cysts and STI- gynecological and obstetrics concerns
Medical Conditions
198
Exercise- can prevent and help manage CVD, arthritis, diabetes, osteoporosis.
Exercise
199
Recommendation is 20-30 mins 3 times per week.
Exercise
200
Calcium- decreased bone health problems, at risk for osteoporosis.
Nutrition Problems
201
Estrogen activates vitamin d which plays a huge role in activation of vitamin D.
Nutrition Problems
202
400 mcg of folic acid daily prior for pregnancy for neural tubes.
Nutrition Problems
203
BMI greater than 30- impacts in fertility, health of pregnancy, increase risk for cancers of the repro system.
Nutrition Problems
204
Also increases risk for diabetes, CV disease, stroke.
Nutrition Problems
205
Eating disorders-anorexia, bulimia, over weight or underweight causes complications
Nutrition Problems
206
Best resource is the pt. make sure open needed questions. Make sure they can elaborate.
Health History Assessment
207
Make sure sensitive to privacy.
Health History Assessment
208
Be direct and let them know exactly what is happening.
Health History Assessment
209
If they don’t speak English validate exactly what that are saying.
Health History Assessment
210
Quickly develop rapport to create a connection. Be relatable
Health History Assessment
211
Women with Special Needs- pt that has a disability, adolescent, or victim of abuse.
Women with Special Needs
212
Be aware of situations and interaction.
Women with Special Needs
213
Communication needs to be effective.
Women with Special Needs
214
Screen all women for abuse, do not ask in front of partners/caregivers.
Women with Special Needs
215
Physical Examination-
H to T assessment covering all systems
216
Very specific to labor and delivery-To assess cervical dilation.
Pelvic Exam
217
Always get consent to examination.
Pelvic Exam
218
Prepare patient, change into gown, explain procedure, make them feel comfortable.
Pelvic Exam
219
Place in correct position- Lithotomy position.
Pelvic Exam
220
Can assess external genitalia without pelvic exam.
Pelvic Exam
221
Screening for STIs
Laboratory and Diagnostic Procedures
222
Collect specimen from pelvic exam to help identify organisms. Pap smears- pelvic exam, scrape cells from cervix and other mucous membranes, assessed for malignancy.
Other Serum lab tests
223
Anticipatory Guidance for Health Promotion and Illness Prevention
Nutrition
Exercise
Stress Management
Substance use cessation
Sexual Practices that reduce risks
224
As nurses, we must focus on
health screenings, health risk preventions, and health protection.
225
Nurses can make a difference in stopping violence against women and
preventing further injury.
226
Question: When obtaining a reproductive health history from a woman, the nurse should:
D. Explain the purpose for the questions asked and how the information will be used. To develop rapport, relatable and collect data.
227
Amenorrhea-
absence of menstrual flow.
228
Primary Amenorrhea-
absence of menses by the age of 15 with normal growth and development.
229
Secondary Amenorrhea-
absence of menses within 5 year of breast development or if absence of menses female gets menses then absence for 6 months. Typically caused by underlying disorder.
230
Isnt classified as a disease but is a sign of one.
Amenorrhea
231
Common problems that cause Amenorrhea -
pregnancy, endocrine disorders.
232
Amenorrhea- Female athlete can experience female athlete triad.
1-eating disorders 2- osteoporosis 3- decreased estrogen which is Related to training too hard and poor nutrition.
233
Menstrual Disorders Clinical signs-
Growth and development Breasts and labia structures
234
Menstrual Disorders Assessment-
Gather through interview process, and rule out any underlying conditions such as pregnancy and thyroid problems.
Look at pregnancy test and CBC, TSH. Prestodol, prolactin and pelvic diagnostic studies.
235
Menstrual Disorders Counseling + Education-
Menstrual disorders can diminishes quality of life, effect abelites to conceive.
236
Menstrual Disorders Management-
Caused by hypothalamic disturbances- decreasing stress, oral contraceptives, and diet modification. Onset is 13 for menses.
237
Dysmenorrhea-
Pain during or shortly before menstruation.
Causes- can impact quality of life, very overlooked.
238
Pain during or shortly before menstruation.
Dysmenorrhea
239
Associated with ovulatory cycle
Primary Dysmenorrhea
240
Caused by excessive release of prstaglands that cause uterine arterioles to vasospasm,
Primary Dysmenorrhea
241
Heat to abdomen causes vasodilation which prevent or control spams, exercise same reason.
Tx for Primary Dysmenorrhea
242
Relaxation techniques, low sodium diet, natural diuretics (increase in fluid volume increases abdominal pressure.
Tx for Primary Dysmenorrhea
243
Low fat diet, saturated fats can exacerbate inflammation.
Tx for Primary Dysmenorrhea
244
Vitamin E supplements are alternative.
Tx for Primary Dysmenorrhea
245
Forms of birth control can also tx and the use of NSAIDs which provide optimal relieve (effects prostaglandins)
Tx for Primary Dysmenorrhea
246
Develops later in life. After 25 year of age.
Secondary Dysmenorrhea
247
Associated with pathology such as endometriosis or fibrates.
Secondary Dysmenorrhea
248
Feeling of bloating or pelvic fullness.
Cause back pain that radiates to the legs. Significant.
Secondary Dysmenorrhea S/Sx
249
Pelvic ultrasound
Secondary Dysmenorrhea Diagnostics
250
Remove fibroids, etc.
can Incorporate interventions for primary but not super effective especially if fibroid is causing the pain.
Secondary Dysmenorrhea tx
251
Can have excessive bleeding
Menorrhagia
252
Defined as an excessive amount of menstrual
Menorrhagia
253
Hormones
Contraception
Menorrhagia causes
254
Systemic diseases Systemic diseases- Hypothyroidism, Lupus.
Menorrhagia causes
255
Neoplasms cancerous tumors
Menorrhagia causes
256
Infection- underlying cause, Endometritis is cause of excessive bleeding.
Menorrhagia causes
257
Medications- Contraceptives, chemotherapy agents, and anticoagulants
Menorrhagia causes
258
___ is normal amount of blood lost
50mL
259
Poorly understood condition (stigmatized and non consitant).
Premenstrual syndrome (PMS) Cyclic symptoms
260
Combination of physical, psychological and behavioral symptoms.
Premenstrual syndrome (PMS) Cyclic symptoms
261
Fluid retention, pelvic fullness, breast tenderness, weight gain, depression, irritability, impaired concentration, cravings, headache and fatigue.
Premenstrual syndrome (PMS) Cyclic symptoms
262
More severe than PMS. In order to be diagnosed-meet criteria.
Premenstrual Dysphoric Disorder (PMDD) Cyclic symptoms
263
Five or more affective and physical symptoms present in the week before menses' and begin to improve in the follicular phase of the menstrual cycle
Premenstrual Dysphoric Disorder (PMDD) Criteria
264
At least one of the symptoms is marked affective lability, marked irritability or anger, depressed mood or feelings of hopelessness, self-deprecating thoughts and/or anxiety
Premenstrual Dysphoric Disorder (PMDD) Criteria
265
One or more of the following additional symptoms is/are present: decreased interest in usual activities, subjective difficulty concentrating, lethargy, marked change in appetite, hyperinsomnia, insomnia, feeling overwhelmed, physical symptoms of breast tenderness, muscle pain, bloating, weight gain
Premenstrual Dysphoric Disorder (PMDD) Criteria
266
Symptoms interfere markedly with work orinterpersonal relationship
Premenstrual Dysphoric Disorder (PMDD) Criteria
267
Symptoms are not caused by an exacerbation of anther condition or disorder
Premenstrual Dysphoric Disorder (PMDD) Criteria
268
Must confirm that symptoms are occurring, evidenced through daily ratings
Premenstrual Dysphoric Disorder (PMDD) Criteria
269
Symptoms are not caused by physiologic effects of a substance if a specific medical treatment
Premenstrual Dysphoric Disorder (PMDD) Criteria
270
diet modification, low sodium diet(fluid retention), exercise, smoking cessation, take oil of evening primrose
Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Key management tools:
271
Essential fatty acid that converted to precursor for prostaglandins.
Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx
272
Relaxation techniques.
Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx
273
Calcium and magnesium.
Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx
274
Vitamin B6- for nerve irritability, helps with concentration.
Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx
275
Vitamin D3- Mood booster
Premenstrual syndrome (PMS) + Premenstrual Dysphoric Disorder (PMDD) Tx
276
Adhesions found throughout the body, vagina, surgical scars, vulva, perineum, bladder gal bladder, heart, everywhere.
Endometriosis:
277
presence + growth of endometrial tissue outside of the uterus.
Endometriosis:
278
Endometriosis: Symptoms-
dysmenorrhea, abnormal uterine bleeding, painful intercourse-depend on location of the adhesions, Infertility
279
NSAIDs, Suppress estrogen meds- be careful bc the S/E can mimic menopausal symptoms (weight gain, vaginal dryness, decreased libido)
Endometriosis Management
280
Oral contraceptives- have to be very low in estrogen and progesterone, take for about 6-12 months. It is expected to decrease number of adhesions.
Endometriosis Management
281
#1 cure is surgical intervention- total hysterectomy.
Endometriosis Management
282
Can worsen with each menstrual cycle
Endometriosis
283
May not have any S/Sx of it. Can be found on routine exam. Can disappear after menopause
Endometriosis
284
Menopause Physiologic Characteristics:
Anovulation, Menstrual Cycle Length, Ovulation, Progesterone, FSH
285
Anovulation-
No egg development ova
286
Menstrual Cycle Length-
Experience cycle longer than 28 days, can be extended weeks or months. Amount of blood can be different.
287
Ovulation-
Progressively occur less frequently
288
Progesterone-
production decreases. Corpus lutinum progressively diminish production of progesterone.
289
FSH-
Values are elevated. Assessed though blood sample
290
Menopause Physical Changes:
Bleeding, Genital Changes, Vasomotor instability, Moods/Behaviors,
291
Bleeding-
longer bleeding period from light to heavy
292
Genital Changes-
vaginal and urethra are estrogen sensitive, atrophy of vagina and urethra which causes sexual discomfort and increase risk of vaginitis. Likely to cause incontinence.
293
Vasomotor instability-
Hot flash. Increase in body temperature, educate on management- dress in layers, avoid caffeine and alcohol, drink ice water
294
Moods/Behaviors-
Mood swings, significant behavioral changes related to hormonal imbalance.
Emotional changes not tired to hormones- perimenopause to menopause.
295
Health Risks of Perimenopausal Women
Osteoporosis-
Coronary Heart Disease-
296
due to loss of one mass, directly related to decrease in estrogen- helps convert vitamin d
Osteoporosis-
297
as changes in hormones alter metabolism of lipids.
Coronary Heart Disease-
298
Menopausal Hormonal Therapy-
estrogen only or estrogen combo with progestin
299
Menopausal Hormonal Therapy Risks-
make sure pt taking lowest dose effective.
Does increase risk for breast cancer.
Even five years after stopping the Tx
300
Menopausal Hormonal Therapy Side effects-
Headaches, depression, N/V, brown spots on skin. Personal history of breast cancer are at an increased risk to develop again.
301
Menopause Plan of Care
Sexual Counseling, Nutrition, Exercise, Medications, Support Groups
302
Decrease production of estrogen causes structures to atrophy- vaginal dryness and painful intercourse and decrease libido which decrease sexual drive
Sexual Counseling-
303
Metabolic rates decrease. Foods should be high in giber, nutrients, and calcium/Vitamin D. Moderate in calories and low in fat. Excessive protein avoid.
Nutrition-
304
Weight bearing- walking and stair climbing, aerobics and strength training
Exercise-
305
educate risk of medications they are taking and how to take them
Medications-
306
Other meds can tx complications of menopause
Medications-
307
to decrease vasomotor instability- SSRIs, Gabapentin
Medications-
308
Soy and vitamin E can be used to help with vasomotor response too
Medications-
309
Develop a supportive network with other women with whom they can share their concerns.
Support Groups
310
A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:
Endometriosis
311
Benign Conditions of the Breasts-Anatomic variances-
Micromastia, Macromastia, Developmental anomalies
312
Micromastia-
small underdeveloped breast tissue
313
Macromastia-
large heavy breast that causes back or shoulder pain
314
Developmental anomalies-
seen with asymmetrical breast size. Significant difference. If the women deicides to breastfeed it is associated in decrease in lactate production
315
Pathophysiology of benign breast disease
Two goals of the initial evaluation:
1. distinguish between benign and malignant lesions
2. assess patients risk for malignant breast cancer
316
Cystic masses-
cystic changes are benign and are the most common type of breast changes
317
Fibrocystic changes etiology-
causes cystic masses related to estrogen and progesterone and typically occur in women that are 20-50yrs old
318
Lumps painful or pain less.
Fibrocystic changes Clinical Manifestations
319
Experience tenderness with menstrual cycles.
Fibrocystic changes Clinical Manifestations
320
Occurs 1 week before menstrual cycle and disappear one week after.
Fibrocystic changes Clinical Manifestations
321
The younger the women the more painful the cystic changes.
Fibrocystic changes Clinical Manifestations
322
Cystic changes noted are well differentiate boarders, moveable and soft.
Fibrocystic changes Clinical Manifestations
323
Diagnosis- palpation of breast. Perform breast self exam.
Fibrocystic changes Therapeutic management-
324
Ultrasounds- mass is solid (diet modification, avoid alcohol, smoking cessation and caffeine) or fluid filled(advocate for pt for aspiration of fluid to help shrink the cyst)
Fibrocystic changes Therapeutic management-
325
Meds: nsaids to treat discomfort, oral contraceptives(estrogen and progesterone influenced), alternative tx evening primrose oil.
Fibrocystic changes Therapeutic management-
326
Breast Pain-
mastalgia
327
Know pattern. Come and go with menstrual cycles.
mastalgia
328
Where is the pain (diffuse or focal) concentrated in one area of the breast?
mastalgia
329
Common for perimenopausal women.
mastalgia
330
Pain management: diet changes-avoiding caffeine, stop smoking, alcohol. Hormonal therapy. Nsaids, evening primrose oil.
mastalgia
331
Cyst can cause breast pain that’s why tx
are similar
332
Solid Masses-
Fibroadenoma
333
most common type Solid Mass.
Fibroadenoma
334
No fluid component.
Fibroadenoma
335
Not associated with increase risk in breast cancer. Common in teenagers. Liekly to experience tenderness around menses. Discrete, less than 3 cm. menstrual cycle seen increase in size but otherwise will stay the same size. Doesn’t respond to diet changes or hormonal therapy. Important that the pt has frequent observation of the mass. Evaluation is important to not miss malignancy.
Fibroadenoma
336
Common in teenagers.
Fibroadenoma
337
Likely to experience tenderness around menses.
Fibroadenoma
338
Discrete, less than 3 cm.
Fibroadenoma
339
Menstrual cycle seen increase in size but otherwise will stay the same size.
Fibroadenoma
340
Doesn’t respond to diet changes or hormonal therapy.
Fibroadenoma
341
Important that the pt has frequent observation of the mass.
Fibroadenoma
342
Evaluation is important to not miss malignancy.
Fibroadenoma
343
Infections of the breast
Cellulitis (inflammation of the skin/breast
344
Red inflamed thick warm skin.
Cellulitis
345
obesity, diabetes, smoking, and anytime of impairment to the skin(nipple piercings).
Cellulitis Risk factors:
346
Can be underdiagnosed and can spread very quickly.
Cellulitis
347
Incision and drainage-abscess development.
Cellulitis
348
Antibiotics are the first line treatment for abcess or no abcess.
Cellulitis
349
to report immediately to get antibiotic(priority) tx. If painful can take NSAIDs
Cellulitis Education
350
how are we managing and detecting them.
Benign Conditions of the Breast Care Management-
351
90% of lumps are discovered by the pt by utilizing
Breast Self Exam.
352
Perform 5-7 days after menses.
Breast Self Exam.
353
Best time for hormones in the system(releasing more hormones at the time)
Breast Self Exam.
354
Client History and Physical Examination-
women's 20’s- breast exam done by HC provider and early 40’s a mammogram- for early detection.
355
1. inform pts when screening should take place and how to do BSE (Do the same pattern and position) arm up. Inner to outer or clockwise-do same way each time.
Benign Conditions of the Breast Nursing Actions: based on education
356
2.Provide written information
Benign Conditions of the Breast Nursing Actions: based on education
357
3.offer therapeutic communication-be sensitive to concerns and fears even if benign
Benign Conditions of the Breast Nursing Actions: based on education
358
Malignant Conditions of the Breast Etiology
Gender, age, time of menarche, menopause and time of first live birth
Personal History
Geographic differences
First pregnancy after 40
359
Gender, age, time of menarche, menopause and time of first live birth
Nonmodifiable
360
Personal History
Increases risk for second malignancy
361
Geographic differences
Woman from japan- lowest rates
Western counties- equalizes of that of the native population
362
First pregnancy after
40
363
Malignant Conditions of the Breast
Genetic component Considerations:
85% risk of developing breast cancer if pt has both BRCA1 and BRCA2
364
If present Woman receives biannual breast exams with imaging
BRCA1 and BRCA2
365
Malignant Conditions of the Breast
Chemoprevention:
drugs used to prevent breast cancer.
Taken prophylactically.
To decrease occurrence.
They are toxic and have unpleasant side effects
366
2nd leading cause of death in women
Breast Cancer
367
1 in 8 will be diagnosed with ___
Breast Cancer
368
Breast Cancer Surviaval rate-
83% chance of survival and had increased in the last 10-15 years.
Early detection has played a huge role.
369
Exact cause is unknown
Breast Cancer Etiology
370
Discussing differences in the breasts look for
lumps or dimples and note any unilateral change=bad(more significant than anything else)
371
early menarchy=<13 yrs
Breast Cancer Risk factors:
372
family history of malignancy
Breast Cancer Risk factors:
373
White women >50yrs old
Breast Cancer Risk factors:
374
African American women in 30s are at increased risk bc it is often missed bc it occurs so early,
Breast Cancer Risk factors:
375
Nulliparity- never been pregnant
Breast Cancer Risk factors:
376
If occurring on one side why?
Breast Cancer
377
Longevity(years after diagnosed)- 80% range survival rate. an have increased chance of getting it again.
Breast Cancer
378
Preventative health care and education and better tx options.
Breast Cancer
379
___ of cases are male breast cancer
1%
380
Invasive tumors can travel elsewhere in the body
Malignant Conditions of the Breast: Pathophysiology
381
All tumors behave and act differently
Malignant Conditions of the Breast: Pathophysiology
382
Most common type of breast cancer is ductal carcinoma
Malignant Conditions of the Breast: Pathophysiology
383
Rate of breast cancer growth depends on the effects of:
1. estrogen
2. progesterone
3. other subtypes hormones and receptors
384
Types of tumors
Ductal carcinoma, Lobular carcinoma, Nipple carcinoma
385
Ductal carcinoma-
found in ducts of the breast. Invades surround breast tissue. Tumor is Solid, nonmobile and non tender
386
Lobular carcinoma
found in lobules in the breast and not palpable.
Diagnosing is specific and can only be done with imaging
387
Nipple carcinoma
occurs with ductal carcinoma and at the site we would see draining, bleeding and crusting around the nipple
388
Inflammatory breast cancer-
appears as a reddish discolored rash and often misdiagnosed for mastitis.
Extremely aggressive- presents as stage 2 cancer
389
Breast cancer can Metastasize-
spread to the bones, blood, lungs, brain and the liver.
Cancer cells enters the blood and traveling to the other areas.
390
Other cancers Can be secondary to the breast cancer.
Origination is important
391
Breast cancer screening guidelines
Mammography, MRI, Biopsy
392
Mammography
gold standard. used for early detection but our gold standard is till ont 100% at detecting breast cancer. Tumor or lesion detection
393
MRI
used in combination with a mammogram or ultrasound. Combination imaging beneficial for pts that have silicone breast implants and increased risk for breast caner bc its giving multiple modalities to view tissues or personal history of cancer
394
Biopsy
Confirm the diagnosis. Core needle biopsy to diagnose BC. Put in the tumor-punch hole effect
395
Breast Cancer Prognosis
Nodal involvement and (large) tumor size are the most significant prognostic criteria for long-term survival.
396
Fibrocystic should still receive
mammogram
397
Breast Cancer Care Management
Surgery, Mastectomy, Breast reduction, Radiation therapy, Adjuvant Systemic Therapy
398
Surgery-
common type is a lumpectomy- removal of the tumor and small margin if healthy tissue bc could be residual cancer cells and to not be too close to it so it does not puncture and spread more.
399
Mastectomy-
One sided or bilateral- take one breast or bother breasts, determined by risk factors or nodal.
Involvement and size of tumor.
Nsg considerations: cannot obtain bp of extremity on affected side.
Iv or blood sample.
Most invasive-removing entire breast including nipple and areola.
400
Breast Reconstruction-
typically performed at the time of the mastectomy.
401
Radiation Therapy-
the most conservative approach when utilized when a lumpectomy.
Ensure all cancer cells have been removed to decrease reoccurrence.
402
Radiation-unpleasant s/e-
skin irritation, heaviness in breast and fatigue.
403
Adjuvant Chemotherapy-
chemotherapy combination with surgery
404
Done with tamoxifen(oral antiestrogen).
Hormonal Therapy-
405
Tamoxifen(oral antiestrogen). Unwanted s/e:
Need annual pap smear, frequent eye exams, bone density screen every 3 years. Liver Function Tests (LFTs) need to be evaluated every 6 months.
406
Correlate with s/e:
can cause cataracts, endometrial cancer, impact activation of vitamin d to absorb calcium at risk for osteoporosis, increase risk for weight gain stroke, hot flashes, DVTs, mood changes
407
Chemotherapy
Most common therapy for node-positive and node-negative tumors
High-dose therapy
408
<40 years old make up 12% of population diagnosed with breast cancer.
409
Use same standard of treatments and recognize sexual activities and childbearing capabilities that can be impacted by tx
410
Women 65 and over:
The occurrence of breast cancer is declining, but the likelihood of diagnosis increases with age.
Preventative measure in place but even with age the risk will always increase.
411
Survivorship issues- related to anti-estrogen therapy- osteoporosis and chemotherapy, cardiotoxicity, neuropathy
Vasomotor symptoms
Sexual dysfunction
Osteoporosis
Weight gain
Cognitive changes
Cancer-related Fatigue
Cardiotoxicity
Neuropathies
412
A woman presents to a health care clinic complaining of a lump in her breast. Which finding is highly suggestive of breast cancer?
Newly retracted right nipple (New, should not be retracted) unilaterally
