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Module 6 > UNIT 3- WOMENS HEALTH > Flashcards

UNIT 3- WOMENS HEALTH Flashcards

1
Q

What are some leading causes of death amoung women?

A

Heart disease, cancer, stroke, unintentional injuries (FALLS)

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2
Q

What is the number 1 killer of women?

A

Dan… jk
Cardiac disease

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3
Q

Why is cardiac disease the number 1 killer in women?

A

Women typically present with atypical symptoms

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4
Q

What are some atypical symptoms of cardiac disease?

A
  1. Pain, pressure in the chest, discomfort in arm,neck and jaw
  2. Pain in the upper back and or stomach
  3. Unusual fatigue
  4. n/v
  5. Loss of appetite
  6. Lightheadedness, dizziness, palpitations
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5
Q

How do nurses assist women with cardiac disease?

A

Nurses help women identify risk factors and teach women the non classic symptoms of cardiac disease

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6
Q

What are warning signs of a stroke?

A

Sudden onset of
1.numbness/weakness of the face/arm and or legs
2.Trouble seeing out of one or both eyes
3.Trouble walking, dizziness, loss of balance or coordination
4.Severe headache with no known cause

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7
Q

What is the golden hour?

A

It is 1 hour from onset of stroke symptoms to administer tPA (tissue plasminogen activator)

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8
Q

What patient education should we provide about strokes?

A
  1. Call 911 immediately. Dont wait to see if it will go away
  2. Teach family and patient to recognize s.s of stroke
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9
Q

What preventative counseling can we provide patients?

A
  1. Healthy weight-reduce health problems
  2. Balanced diet-calcium & vitamin D (dairy, green leafy veggies and sunlight)
  3. Physical activity- 30 min/day, weight-bearing 3-4/week
  4. Avoid smoking & second-hand smoke
  5. Immunization
  6. Limit alcohol- 1st drink/day
  7. Accident & injury (rugs)
  8. Safe sex
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10
Q

What screening procedures should you have done annually esp if there are risk factors?

A
  1. Pap smear according to ACS (every 3 years unless abnormal)
  2. Dental (2 cleanings)
  3. STI
  4. Fecal occult blood
  5. UA
  6. Thyroid annually if signs of dysfunction
  7. Genetic testing (signs of hibitual aborter)
  8. Transvaginal ultrasound
  9. TB
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11
Q

When should you have a bone density exam?

A

65 y/o q 2 years
over 45 is starting to be seen more

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12
Q

When should you start having labs to check cholesterol?

A

20 or if risk factors

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13
Q

When should women have a colonscopy done?

A

50 y/o q 10 years unless its abnormal

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14
Q

When should women have there eyes checked?

A

40 y/o q 2-4
65 y/o 1-2 years or annually

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15
Q

When should women be tested for there fasting glucose level?

A

45 y/o q 3 years

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16
Q

When should women start having their hearing checked?

A

q 10 years until 50 then every 3 years

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17
Q

When should women start getting mammos done?

A

40 y/o q 1-2 yrs

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18
Q

When should a women be checked for rubella immunity?

A

Childbearing age

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19
Q

When should women start doing monthly self breast exams?

A

After onset of putbery and period starts

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20
Q

What changes in our monthly self breast exam should we report to our PCP?

A

Lumps, change in skin color or texture, nipple changes (inverted), leaking clear or bloody fluid

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21
Q

How often should a ACS-clinical breast exam happen?

MUST KNOW

A

3 years-19-39y/o
Annually- >40 y/o

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22
Q

When should we teach women to there monthly self breast exam?

A

After period about a week after.. during your period your breast tend to have lumps due to hormonal changes

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23
Q

What is a mammogram?

A

Low dose x-ray during mechanical compression of the breast

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24
Q

What are some inidcations of mammogram?

A
  1. Screening- every 1-2 years after 40
  2. Diagnostic- abnormal finding- require further testing
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25
Q

What education should we provide patients about mammograms?

A
  1. Pre-procedure- avoid underarm deodrants, lotions, and powders
  2. Post-procedure- Anticipated time of resuts, mammogram follow-up, and self-breast exams
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26
Q

When should women do a monthly vulvar exam?

A

All women 18 y/o or younger if sexually active

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27
Q

How is a vuvlar self exam done?

A

Systematic manner
1. Inspect & palpate- signs of precancerous conditions or infections
2. Mons,clitoris,labia minor, labia majora, perineum, and anus

Report any abnormalities for follow up- discharge, infection, sores, warts

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28
Q

When does the American cancer Society recommend cervical paps?

A

No longer recommends annual cervical pap smears.. ACS- cervical screening recommendations:
1. 21-29y/o- every 3 years
2. 30-65 y/o every 5 years
3. >65-stop pap- no previous pre cancerious pap in 20 years

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29
Q

Pelvic exam includes what

A
  1. External organs exam
  2. Speculum exam
  3. Bimanual exam
  4. Cervical cystoloty or pap smear
  5. Rectal examination
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30
Q

What should we educate patients on regarding pelvic ecams and papsmears?

A
  1. Scheduled 5 days after menstrual period
  2. Nothing inserted vaginally 48 hours prior to the exam
  3. Have patient empty their bladder
  4. Eduction regarding procedure
  5. Provide a hand to hold or mirror so patient can observe
  6. Pace in lithotomy position & drape approppriately
    • consider semi-fowlers, side lying, with or without stirrups for females unable to lie in lithotomy
  7. Special considerations- female genital mutilation-female circumcision- usually done to keep them from being sexually active… can ask if they have had any surgery on genital or infections
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31
Q

What is a colposcopy and what are the clinical indications for having one done?

A

Microscopic exam of vaginal & cervical tissue usually done if a women has an abnormal pap or to treat condyloma

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32
Q

What is a cervical biopsy and what are the clinical indications for having one done?

A

Extensive surgical biopsy usually done if a women has an abnormal pap-atypical or abnormal cells it is performed early phase of the menstrual cycles and tissue is excised and sent for pthological exam

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33
Q

What is an endometrial biopsy and what are the clinical indications for having one done?

A

Endometrial tissue aspirated from the uterus usually done if a women has abnormal or postmenopausal bleeding

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34
Q

What is a hysterosalpingography and what are the clinical indications for having this done?

A

Cervix, uterus, and fallopian tubes are visulized by x-ray after injecting contrast dye usually done to evulate for fibriods tumors, fisturlas or infertility

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35
Q

What are our nursing considerations for procedures regarding womens health?

Pre procedure, intra and post procedure

A

Pre-procedure
1. obtain menstrual hx-LMP and allergies
2. Administer analgesia prior to the procedure (advil or motrin before they come to help with cramping)
3. Education regarding procedure, discomfort and relaxation
4. Empty bladder, place in lithotomy poisition and drape appropriately

Intra-procedure- offer patient support and assist provider

Post-procedure
1. Provide perineal tissue/pad
2. Education patient regarding s/s to report
- allergies, infection and when to expect results

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36
Q

What is a dilation & curettage and what are the diagnnostic and therapeutic reasons it might be done?

A

Dilate cervix & scrape endometrial tissue (D&C)
Diagnotistc- malignancy,fertility, dysfunctional uterine bleeding
Therapeutic- heavy uterine bleeding, incomplete abortion

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37
Q

What is a endometrial ablation?

A

Removal of endometrial tissue with laser

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38
Q

What is laparscopy and what are the diagnostic and therapeutic reasoning for this exam?

A

Laparoscope insterted for visualization & surgery
Diagnostic- fertility,ectopic, adhesions, cysts, endometriosis or PID
Therapeutic- tubal ligation, IUD, or adhesion removal or egg retrieval

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39
Q

What is a hysterectomy?

A

Surgical removal of the uterus there are different types and which type a women gets depends on reason, age and health

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40
Q

What is a total hysterectomy?

MUST KNOW

A

Removal of cervix, uterus up to the fundus. Ovaries and fallopian tubes are left

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41
Q

What is a subtotal or supracervical hysterectomy?

MUST KNOW

A

Take out above the cervix but leave the cervix

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42
Q

what is a hysterectomy with salpingo-oophorectomy?

MUST KNOW

A

Cervix up to the fundus in addition to the fallopian tubes and ovaries

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43
Q

What is a radical hysterectomy?

A

Take everything and part of the vagina and lymph nodes usually done in cancer that has mets

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44
Q

What are clinical indications for a hysterectomy?

MUST KNOW

A

Cancer-cervical, endometrial, ovarian
Noncancerous- fibroids tumors, endometriosis, gentral prolapse, PID

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45
Q

What are different surgical techniques of performing a hyst

A
  1. Abdominal-transverse (Psfannenstiel)/vertical (low-midline)
  2. Vaginal-lithotomy position
  3. Larparoscopic assisted vagainal hyst (LAVH)
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46
Q

What are risk related to a hyst surgery?

A
  1. anesthesia complications
  2. uterine, bladder, or bowel injuries
  3. hemorrhage
  4. infection
  5. DVT-
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47
Q

What is our pre-op nursing care for hysts

A

1.Admission assessment- no anticoagulants, ASA, NSAIDS
2.Pre-op checklist
- H&P
- informed concent
- Labs- cbc, type and cross, UA, Pregnancy
- Remove jewlrey, glassess, contacts
- NPO 8 hours prior to surgery
- EKG- perform and verify
3. Start IV
4. Void, insert cath
5. Pre-op education, anwser questions
6. Emotional suport

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48
Q

What is our post op nursing care for a hyst procedure?

A
  1. Assess v/s, blood loss, LOC, I&O, lung & bowel sounds
  2. IV therapy
  3. Pain managment- meds, positioning, pain pump possible
  4. Administer medication- antibiotics, hormone replacement
  5. Assist with ambulation
  6. DC- IV, catheter 24-48 hours
  7. Progress diet
  8. Education
  9. Emotional support
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49
Q

What is fibrocystic breast changes?

A

Thickening of reast tissue with the formation of cysts

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50
Q

When is fibrocystic breast changes seen?

A

Occurs before menopause

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51
Q

What are symptoms of fibrocystic breast?

A

Pain & tenderness are often bilateral occurs around the menstrual cycle

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52
Q

what are diagnostic exams that detect fibrocystic breasts?

A
  1. mammograms
  2. ultrasound
  3. fine needle aspiration/or core needle biospy
  4. Excision of the mass
  5. open or surgical biospy
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53
Q

What is a key assessment question to ask if you are trying to figure out if a lump found in the breast is fibrocystic breasts or potenitally cancer related?

A

When was your last menstrual period… if they are currently menstrating tell them to do a self breast exam in 7-10 days if the lump remains call again

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54
Q

What is the treatment for fibrocystic breasts?& what’s med might be used

A

No specific tx proven beneficial. Supportive bra recommended, avoid caffeine, and danazol an androgenic medication which suppresses estrogen

DANZOL is important

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55
Q

What is amenorrhea?

A

Absence of menses

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56
Q

What are nursing considerations for benign breast disorders?

A

Acknowledge a breast mass evokes feeling of fear and anxiety and educate regarding how and when results will be communicated

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57
Q

What is the number 1 cause of amenorrhea?

A

Pregnancy

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58
Q

What is primary amenorrhea?

MUST KNOW

A

Delayed- no secondary sex characteristics by age 14 OR no menses with secondary sex characteristics by age 16
May be genetic or inherited

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59
Q

What is secondary amenorrhea?

A

Cessation of menstruation– no menses 3-6 months following normal cycles or there is an underlying cause like pregnancy

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60
Q

What is the patho of amenorrhea?

A
  1. Endocrine/pituitary function- lack or hormone production
  2. Heredity/congenital- emotional support may be needed
  3. PCOS- causes women not to ovulate correctly which causes abnormal periods
  4. Nutritional/uncontrolled diabetes- anorexia- body doesnt allow period
  5. Heavy athletic activity- people who are training for sports everyday for 8-10hours have no body fat and there body shurts down and it doesnt let them have periods
  6. Emotional distress
  7. 90% no identifiable cause
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61
Q

How do we managage amenorrhea?

A

Identify and treat the underlying condition

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62
Q

What are nursing considerations for amenorrhea?

A
  1. Emotional support- young teen may feel left out
  2. menstration is unique funciton of women
  3. Absence can create concerns about feminity and having children
  4. Adolescent is the time when being diff that you peers is painful
  5. Education concerning diet, nutrition and exercise
  6. sometimes a change in diet will do the trick
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63
Q

What is menorrhagia?

A

Prolonged or heavy menstrual bleeding

Think MANNNNYYY pads for MANNNNY bleeding

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63
Q

What is metrorrhagia?

A

Irregular bleeding which often occurs between period or after menopause

Metro- think metro train in new york and you get on it and off

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64
Q

What is menometrorrhagia?

A

Prolonged or excessive bleeding that occurs irregular and mroe frequent

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65
Q

What is the patho of abnormal uterine bleeding (menorrhagia, metrorrhagia, menometrorrhagia)

A
  1. Pregnancy complication- spontaneous abortions
  2. Lesions- begnign or malignant of the vagina, cervix, or uterus
  3. Drug induced bleeding- hormonal contracepties (may not have correct dosage)
  4. systemic disorders- diabetes, hypothyroidism, uterine fibroids
  5. Failure to ovulate
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66
Q

How is abnormal uterine bleeding (menorrhagia, metrorrhagia, menometrorrhagia) managed?

A
  1. pregnancy test- may be a sign of a missed abortion
  2. Hormone levels- determine if ovulation is occuring
  3. Lab- CBC, Coagulation studies, liver function
  4. Endometrial biopsy
  5. Ultrasound or hysteroscopy- assess the uterine linign
  6. Oral contraceptive-progestin-estrogen combination- sometimes getting them regulated will help
  7. Surgical- D&C, endometrial ablation, hyst
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67
Q

What is nursing considerations for abnormal bleeding (menorrhagia, metrorrhagia, menometrorrhagia)?

A
  1. Encourage women to seek immediate medical attention
  2. encourage women to record bleeding episodes and amount of loss
  3. Importance of nutrition and stress reduction
  4. Education about diagnostic procedures
  5. Emotions support for women who fear cancer
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68
Q

What is premenstrual syndrome (PMS)

A

Physical and emotional changes related to menstrual cycle

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69
Q

What are some syptoms a women may experience with PMS?

A
  1. Musculoskeltal- back pain, join pain
  2. Neuro- clumspy, crazy, vertigo
  3. GI/GU- bloating weight gain, n/v/d, cravings
  4. Mental or emotional
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70
Q

What is the patho of PMS?

A

unknown cause but associated with
Hormonal changes- estrogen-progesterone imblance
chemical changes in the brain

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71
Q

What kind of impact does PMS have?

A

Impacts family- strain on relationships-family conflict, disrupted communication which can lead to the loss of control- child battery, self inflicted injuries and accidents

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72
Q

What are our nursing considerations for PMS?

A
  1. Encourage exam and correct dx
  2. Education about lifestyle changes-diet, exercise, relaxation, sleep, herbal remedies
  3. Education about mediations- ibuprofen, antidepressants, diuretics, oral contraceptives
  4. Education and support to the family- family needs to udnerstand this is an actual condition
  5. Education concerning planning for feeling of loss of control- whats her plan for the day that kids are misbehaving so that her children dont get hurt
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73
Q

What is menopause?

A

Perment cessation of menstrual cycles

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74
Q

When is the onset of menopause usually?

A

35-58y/o average age is 51 y/o

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75
Q

What are the 3 stages of menopause?

A
  1. Perimenopause- 1st year before last menses typically periods start getting further and further apart, hot flashes, mood swings, decline in estrogin and progestrin
  2. Menopause- one year after last menses
  3. Post menopause- after menopause
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76
Q

What is the patho of menopause

A

Ovaries stop producing eggs and a decline in estrogen and progesterone production

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77
Q

What are the s/s of menopause changes

A
  1. Vasomotor- irregular periods/hot flashes/night sweat (1st symptoms typically)
  2. GI-Incontinence/vaginal changes- increase pH/dryness/painful sex
  3. Psychoslogical- mood swings/sleep changes/ decrease in sleep/fatigue
  4. Skeletal- decrease bone density
  5. Cardio- irregular heartbeat palpitations decrease in HDL and increase in LDL
  6. Dermatologic- decrease skin elasticity/hair loss
  7. Reporductive- breast changes, decrease interest in sex
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78
Q

What are womens psychological response to menopause?

A
  1. Excited- no longer worry about childbearing
  2. Grieve-loss of fertility
  3. comes to term with aging
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79
Q

What are therapies used for menopause managment?

A
  1. Hormone replacement therapy (HRT)-estrogen-progesterone (UTERUS IN)
    • both hormones in this therapy work together and it decreases the chance of cancer because you dont have a complete overload of estrogen with uterus but there is an increased risk for breast and uterine cancer
  2. Estrogen replacement therpay (ERT)- estrogen (NO UTERUS)
    • risks and benefits must be considered
    • may help with symptoms but increases risk of cancer
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80
Q

What is our menopause education?

A
  1. life style changes- diet and exercise
  2. Hot flashes- avoid alcohol, caffeine, hot drinks, spicy food, smoking; layer clothing
  3. Night sweats- cool shower before bed, cotton nightwear, cool room
  4. Sleep distrubances- regular bedtime, 8hrs sleep, dark, quiet, cool room
  5. Vaginal dryness & sexual discomfort- vaginal lubercants or estrogen cream
  6. Complementary/alternative therapy
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81
Q

What are the s/s cyclic pelvic pain?

A
  1. Pelvic pain which occurs midway between menstrual periods at the time of ovulation
  2. Sharp pain felt in the lower right or left pelvic area
  3. last for a few hours up to 2 days
  4. slight vaginal bleeding after the discomfort
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81
Q

What is primary dysmenorrhea?

MUST KNOW

A

Painful, cramping 12-24 hours before menses, that last about 12-24 hours– consistent usually with every period

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82
Q

What is the patho of primary dymenorrhea?

must know

A

Excessive endometrial producation of prostaglandin (protaglandin tells your body its time to have menses)

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83
Q

What is seocndary dysmenorrhea?

must know

A

Painful menses with known anatomic factors/pelvic pathology

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84
Q

What is the patho of secondary dysmenorrhea?

must know

A

Endometriosis, adhesions, cervical senosis,fibroids

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85
Q

What is the managment of dysmenorrhea?

A
  1. Identify and tx underlying conditions
  2. Prostaglandin inhibitors- ibuprofen
    • For primary- ibuprofen inhibits the production of prostaglandin and it wont be as painful
  3. Pain managment- analgesia, heat, warm bath
  4. oral contraceptives
  5. diet-low fat
  6. excersice, relaxation, biofeedback, acupuncture
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86
Q

What is endometrosis?

A

The presence of endometrial tissue outside the uterus

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87
Q

What is the patho of endometriosis?

A
  1. Retrograde menstration- uterus should be lined up with vaginal opening but sometimes a women may have a retrograde and the uterus kind of lies lower allowing the menstral cycle to flow back towards the pelvic cavity. The endometrial tissue sticks to structures outside of the uterus and so when its time to have mentral cycle these area will bleed along with
  2. Predisposition, immunological changes, hormonal influences
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88
Q

What is happening during endometriosis?

A
  1. Tissue repsonds-progesterone & estrogen of the menstrual cycle
  2. Thickens and bleeds during cycle
  3. Inflammation in surrounding tissues
  4. Scarring, adhesion & fibroids on the reproductvie and structures occurs
89
Q

What are s/s of endometriosis?

A
  1. Cyclic pelvic, low back pain, dymenorrhea
  2. Infertility-main reason women seek tx
  3. Dyspareunia- painful intercourse r/t tissue inflammation
  4. Diarrhea, constipation, pain with defacation r/t endometrial tissue can be adhered to the bowel
  5. Fixed or retroverted uterus- scarred down in that position and not flexable
  6. Enlarged & tender ovaries- endomentrial tissue that as attached to ovaries
90
Q

How is endometriosis managed?

A
  1. pain managment- NSAIDs, analgesia- ibuprofen to help with release of progtaglandins
  2. Hormone therapy- birth control, assisted reporduction
  3. endometrial biopsy- prior to pregnancy they will scrap off endometrial tissue to help support pregnancy
  4. surgical tx
91
Q

What are our nursing actions for endometriosis?

A
  1. Education-endometriosis and pain managment
  2. Emotional support esp. if they are suffering from infertility
92
Q

What is PCOS?

A

Polycysitc ovary syndrome- endocrine disorder, a genetic component causing incorrect/absent ovulation

93
Q

What is the patho of PCOS?

A
  1. Increase in estrogen, testosterone, LH and decrease in FSH
  2. Multiple cysts on ovaries produce escessive estrogen
94
Q

What are the risks of PCOS?

A
  1. Diabetes, metabolic syndrome
  2. dyslipidemia, hypertension
  3. cardiac
  4. cancer
  5. infertility
  6. sleep apnea

If we can identify this they may be able to make changes to prevent some of the risk that heppen later in life. Can be as simple as lifestyle changes

95
Q

What are s/s of PCOS?

A
  1. Menstrual disorders
  2. Infertility
  3. Pelvic pain- cysts
  4. Ovarian cysts
  5. obesity
  6. oily skin
  7. acne
  8. hirsutism
  9. male pattern baldness
96
Q

What is the medical managment of PCOS?

A
  1. Lifestyle medication-diet/exercise
  2. Hormone therapy- low-dose contraceptives
  3. fertility therapy
  4. diabetic medication METFORMIN
97
Q

What our are nursing actions for PCOS

A

1.Education-risk factors for PCOS and weight reduction
2.Treatment- hirsutism, acne, oily skin
3.Emotional support, ifertility & psychological effects

98
Q

What are ovarian cysts?

A

Soild or fluid filled cycts that develope on the ovaries

99
Q

What are the two types of ovarian cysts?

A
  1. Folicular- mature follicle fails to rupture (asymptomatic)
  2. Luteal- corpus luteum becomes cystic and fails to reabosrb
    • Acute pain, delays next menstrual cycle, may rupture
100
Q

What are the tx for ovairan cysts?

know

A

Depends on the type of cyst
1. wait and examine after next menstrual cycle
2. Oral contraceptives
3. surgical removal

101
Q

What is vaginal wall prolapse?

pelvic floor dysfuntion

A

Loss of support to the pelvic organs- uterus, bladder, rectum

102
Q

What are the risk factors of vaginal wall prolapse?

A
  1. Multiparity
  2. Pelvic tearing or trauma during childbirth
  3. Obesity
  4. Vaginal muscle weakness associated with aging/menopause
103
Q

How is vaginal wall prolapse prevented?

A
  1. Postpartum-kegal excercies
  2. Spaced pregnancy
  3. Weight control
104
Q

What is a cystolcele?

Pelvic floor dysfunciton

A

Relaxation of anterior vaginal wall with prolapse of the bladder

105
Q

What are the s/s of a cystocele?

A
  1. Urinary retention
  2. Bladder infection
  3. Incontinence
  4. Stress incontinence- leaking urine with increased intrabdominal pressure

UTI education important

106
Q

What is a rectocele?

Pelvic floor dysfunction

A

Relaxation of the posterior vaginal wall with prolapse of the rectum

107
Q

What are s/s of rectocele

A
  1. constipation
  2. Hemorrhoids
  3. Uncontrolled flatus
  4. Sense of pressure or need to deficate

constipation prevnetion important

108
Q

What is uterine prolapse?

A
  1. Downward displacement of the uterus into the vagina?
109
Q

What are the symptoms of a uterine prolapse?

A
  1. Fatigue
  2. Low backache
  3. dymenorrhea
  4. pressure, protrusions
  5. dyspareunia- painful intercourse
  6. Pulling and dragging sensations in pelvis and back
  7. symptoms may be worse after prolonged standing or deep penile protrusion
110
Q

What are nonsurgical interventions for pelvic flood dysfunction?

A
  1. Kegal exercises
  2. Vaginal pessary- hold uterus, clean with soap and water when you take it out (like a plug)
  3. Hormone therapy-intravaginal estrogen
111
Q

What are surgical interventions for pelvic floor dysfunciton?

A
  1. Hysterectomy and anterior & posterior repair
112
Q

What are some nursing considerations for pelvic floor dysfunction?

A
  1. Pessary inesertion, removal, cleaning
  2. Prevention of constipation
  3. Pre & post op care
113
Q

What is a gential fistula?

A

An abnormal connection between the vagina and the bladder, urethra or rectum– may cause them to poo out of the wrong hole

114
Q

What are the risk factors of genital fistulas?

A

trauma, childbirth sexual violence

115
Q

What is our assessment of of a gential fistual consist of?

A
  1. urine or fecal leakage from the vagina, foul vaginal odor
116
Q

What are the medical managmement of gential fistulas

A
  1. pelvic exam to determine to detmine loctaion and severity
  2. small fistulas- resolve on its own
  3. larger fistulas- require surgical repair
117
Q

What are nursing considerations for gential fistulas?

A

education-care of minor fistulaand pre and post op care

118
Q

What is a leiomyomas, fibroids, myomas, fibromyomas or fibromas?

A

Benign tumors arising from the muscle tissue of the uterus this is more common in nuligravidas and black women with the most common sign being abnormal uterine bleeding and it often disappears after menopause

119
Q

What is the treatment of leiomyomas, fibroids, myomas?

A
  1. Cryosurgery
  2. Myomectomy or hyst
  3. GnRH hormone regimens to shring the tumor
  4. Uterine artery embolization of the blood vessel supplying the fibroid tumor

Uterine scar c-section likely depending on where scar is may need records requested

120
Q

What are nursing interventions for leiomyomas, fibriods, myomas, fibromyomas, fibromas?

A
  1. GnRH- if discontinued expect regrowth of tumors, amenorrhea may occur
  2. Preop education-no alcohol, asprin or anticoagulants 24 hours prior to surgery
  3. Expect cramping during procedure as polyvinyl alcohol pellets are injected
  4. Post op care for cyrosurgery, myomectomy, hysterectomy, uterine artery embolism
  5. discharge instructions
    • medication as directed
    • Report- bleeding, pain, swelling at puncture site, fever, urinary retnention, abonormal vaginal discharge no tampons intercourse or douching for 4 weeks
121
Q

What are s/s of cervical cancer?

A

Early
1. vaginal discharge, abnormal vaginal bleeding, might be spotting with intercourse

Late
1. Weight loss, fatigue, pelvic pain, vaginal leakage of feces/urine

122
Q

What are risk factors of cervical cancer?

A
  1. History of an STI (HPV)
  2. Early onset sexual activity
  3. Multiple sex partners
  4. Inadequate cervical screenings
123
Q

How is cervical cancer diagnosed?

A
  1. Pap smear- detects dysplasia the precursor to cervical cancer
124
Q

What are the 3 stages of cervical cancer?

A
  1. Early dyplasia
  2. Early carcinoma
  3. Late carcinoma
125
Q

How is cervical cancer treated?

A

Treatment depends on the stage and future pregnancy plans
1. Dysplasia- cryosurgery, loop electrocautery excision procedure (LEEP), laser, conization, hyst
2. Early carcinoma- Hysterectomy, intracavity radiation
3. Late carcinoma- External beam radiation with hyst (radical), antineoplastic chemo, pelvic exentreration

126
Q

What are s/s of endometerial cancer?

A
  1. Postmenopausal or abnormal premenopausal bleeding
  2. abnormal vaginal discharge
  3. difficult or painful urination
  4. pelvic pain or pain with intercourse
127
Q

What are risk factors of endometrial cancer?

A
  1. hormone replacement therapy (HRT)
  2. Menopause after the age of 52
  3. Nuliparity r/t more exposure to estrogen
  4. Diabetes, obesity, PCOS r/t irregular period and more exposure to estrogen
128
Q

How is endometrial cancer diagnosed and managed

A
  1. Endometrial biopsy dx
    managment- based on size, stage, tumor grade, estrogen effect
  2. Radical hyst
  3. Chemo
  4. Radiation
  5. hormone
129
Q

What are the s/s of ovarian cancer?

A
  1. Asymptomatic or vague symptoms make it diffiuclt to diagnose early
130
Q

What are advanced clinical symptoms of ovarian cancer?

A
  1. Pelivc or abominal discomfort
  2. low back and leg pain
  3. weight changes
  4. increased abdominal girth
  5. n/v
  6. constipation
  7. urinary sympotoms- urgency and frequency
  8. difficulty eating or feeling full quickly
131
Q

What are risk factors of ovarian cancer?

A
  1. Menses started earlier than 12 y/o
  2. nuliparity or 1st child after age of 30
  3. Late menopause
  4. infertility, infertility drugs
  5. Family hx- ovairan, breast, or colorectal ca
  6. Personal hx of breast ca
132
Q

How is ovarian cancer dx

A

laparotomy is primary tool for diagnosis and staging the disease

133
Q

how is ovarian cancer managed?

A

managment depends on the stage
1. total abdominal hyst
2. biopsy lymph nodes, pelvic and abdominal tissues
3. chemo

134
Q

Reproductive tract infection disorders increase the risk of…

A

Chronic pain, cancer, systemic infection and infertility

135
Q

Why are older women more susceptiable to UTIs

A

Supressed immune system, weaker bladder not able to completely empty, decrease estrogen alters normal vaginal flora, e.coli and they dont wipe good

136
Q

In older women what indicates a serious UTI that warrents immediate treatment

A

Fever

137
Q

What are s/s of a UTI in an older women?

A
  1. Agitation
  2. confusion, delirum, hallucinations
  3. Poor motor skills or dizziness, falling
  4. Fever-immediate tx is indicated
138
Q

What is PID?

A

Acute inflammation of UPPER female genital tract

139
Q

What is the patho of PID?

A
  1. Bacteria- chlamydia trachomatis, neisseria gonorrhoeae
  2. Caused by a variety of aerobic and anaerobic organisms that ascend the vagina, cervix, uterus, fallopian tuves, ovaries and peritoneum
140
Q

What are the consequenses of PID?

A

Ectopic pregnancy
chronic pelvic pain
infertility

141
Q

What are the symptoms of PID

A
  1. Asymptomatic
  2. Vague symptoms
  3. severe abdominal, uterine, ovarian pain or tenderness
  4. dyspareunia-painful intercourse
  5. Purulent vaginal discharge, foul odor
  6. Nausea, anorexia
  7. Irregular vaginal bleeding
  8. Fever 100.4
142
Q

How is PID managed?

A
  1. Test & treat STI- ORAL ANTIBIOTIC partner will also need to be treated
  2. Analgesia
  3. Hospitalization/Iv antibiotic
143
Q

What are our nursing considerations for PID

A
  1. medication education-antibiotic complience
  2. s/s & consequences
  3. risk reduction
144
Q

What is toxic shock syndrome?

A

Rare but potentially fatal- caused by toxin-producing strain of staphyloccous aureus

145
Q

What increases your risk for TSS

A

Tampon, diahragm or cervical cap use

146
Q

What are the s/s of TSS

A
  1. flu-like, headache, sore throat, v/d
  2. Hypotension
  3. generalized rash
  4. skin feeping from palms and soles of feet
147
Q

How is TSS treated?

A
  1. Stabilize hypotension- fluid replacement, vasopressors
  2. antimicrobial therapy
148
Q

What are our nursing considerations for TSS

A
  1. Safe tampon, diaphragm and cervical cap usage
  2. Changing tampon every 4 hours
  3. avoid superaborbent tampons- allow bacteria proliferates
  4. use pad at night
  5. avoid use of diaphragm and cervical cap during menses
  6. removed diaphragm & cervical cap within 24 hours
149
Q

What is vaginits?

A

Vaginal inflammation-discharge, burining, itching, irritation

150
Q

What is the patho of vaginitis?

A

Vaginal flora is disrupted by an overgrowth of yeast or bacteria
1. candida
2. vaginitis bacterial
3. trichomoniasis

151
Q

What are factors affecting the vaginal flora

A
  1. Hormonal changes
  2. depressed cell-mediated immunity
  3. antibiotic use
152
Q

What is candidiasis vaginitis?

A
  1. Vaginal ecosystem is distrubed by a GRAM positive fungus
    • candida albicans (yeast)
    • Most common form of vaginitis
153
Q

What is the patho of candidiasis vaginitis?

A
  1. Hormonal changes- increased estrogen during pregnancy
  2. increases candida vaginites before and after mensis
  3. antibiotic
154
Q

What are the risk factors for candidiasis vaginits?

A
  1. Antibotics
  2. suppressed immune system
  3. diabetes
  4. pregnancy
  5. menopause
155
Q

What are s/s of candidiasis vaginitis?

A

itching & irritation of the vulvar
White, cheesy vaginal discahrge
burning on urination

156
Q

What is the medical managment of candidiasis vaginitis?

A
  1. Diagnosis- wet mount & WIFF TEST
  2. Medications- OTC, prescriptions

must know wiff

157
Q

What are the nursing considerations for candidiasis vaginitis?

A
  1. cotton underwear to decrease risk
  2. call provider- recurrent symptoms or bloody discharge, abdominal pain or fever
158
Q

What is bacterial vaginosis?

A

Disruption of the normal vaginal flora there is an overgrowth of gardnerella vaginalis and a decrease in lactobacilli acidophilus

159
Q

What are contribution risk factos for bacterial vaginosis

A
  1. Multiple sex partners
  2. New sexual partner
  3. Lesbians-sharing sex toys
  4. douching
  5. antibiotic therapy
160
Q

What are s/s of bacterial vaginosis?

MUST KNOW

A
  1. Thin white, gray milky discharge
  2. Malodorus (fishy) vaginal discharge
161
Q

What are risks of having bacterial vaginosis?

A

Chorioamnionitis
Premature rupture of membranes
premature labor & delivery

162
Q

How is bacterial vaginosis dx

A
  1. Speculum exam to assess vagina and cervix
  2. dx WET mount and whiff test

Must know 2

163
Q
A
163
Q

What medication may be prescribed to tx bacterial vaginosis?

A
  1. Metronidazole, clindamycin
164
Q

What is our nursing management for bacterial vaginosis?

A
  1. Medication- Metronidazole- with means and NO ALCOHOL
  2. teach risk factors
  3. avoid tight fiting clothes
  4. cotton underwear
165
Q

What are womens risk from untreated STI

A
  1. cervical cancer
  2. chronic pelvic pain & PID
  3. blocked fallopian tubes- infertility, ectopic pregnancy
  4. premature birth
166
Q

What causes chlamydia?

A

Bacteria: chlamydia trachomatis

167
Q

what are the s/s of chlamydia in females

A

1.”silent” disease- asymptomatic in 70-75%
2.Fever
3.lower abodminal pain
4.uterine or adnexal tenderness
5.dysuria
6.dyspareunia- painful intercourse
7.Mucopurulent vaginal/cervical discharge

168
Q

What should we know about males and chlamydia

A

Males are leading cause of nongonococcal urethritis

169
Q

How is chlamydia dx

A

Genital culture or enzyme-linked immunosorbant assay (ELISA)

170
Q

How is chlamydia treated

MUST KNOW

A
  1. Azithromycin 1gm orally
  2. Doxycyline/Erthromycin
    3.Retested in 3 weeks
    4.Partner treated to decrease risk of reinfection
171
Q

What risks does chlamydia have?

KNOW

A

PID, infertility, ectopic pregnancies, premature birth
NEWBORNS: opthalmia neonatorum- erythromycin eye prophylaxis

172
Q

What causes gonorrhea?

A

Bacteria-Neisseria gonorrhoeae

173
Q

What symptoms to females have with gonorrhea?

A
  1. Asymptomatic-majority
  2. spotting
  3. low backache
  4. dypareunia-painful intercourse
  5. anal itching
174
Q

What symptoms do males have with gonorrhea

KNOW

A

Dysuria, urinary frequency
Purulent yellow-green ureteral discharge

175
Q

How is gonorrhea dx

A

genital or cervical culture

176
Q

How is gonorrhea tx

KNOW

A
  1. ceftriaxone 250mgs im
  2. Azithromycin 1gm oral
  3. Retest in 3 months
  4. Partners need to be treated to decrease risk of infeciton
177
Q

What risks does gonorrhea have for adults and newborn

KNOW

A

PID, Infertility ectopic pregnancy
NEWBORN: opthalmaia neonatorum, sepsis-erythromicin eye prophylaxis

178
Q

What causes trichomonas

A

PROTOZOAN- trichomonas vaginalis

179
Q

What are the s/s of trichomonas in a female

A
  1. profuse forthy green-yellow or brownish gray discharge
  2. Foul smelling odor
  3. dyspareunia-painful intercourse
  4. erythema, edma, pruritis of external genital
  5. Small red ulceration of vagina or cervix “strawberry spots”

KNOW 1

180
Q

What symptoms do males present with when they have trichomonas?

A
  1. Asymptomatic
181
Q

How is trichomonas diagnosed?

KNOW

A

Wet mount & wiff test (postive)

182
Q

What is the treatment of trichomonas

know

A
  1. Metronidazole 2gm oral single dose
  2. NO alcohol for 25 hours- flusing, n/v, headache and abdominal cramping
  3. partner must be treated
183
Q

What risks does trichomonas have and adults and newborns?

A
  1. PID, infertility, premature rupture of membranes and L&D
  2. NEWBORNS: Low birth weight
184
Q

What causes genital herpes?

A

Herpes simplex virus type 1 or 2

185
Q

What are the symptoms of a primary herpes infection?

A
  1. Systemic symptoms-flu-like, malaise, muscle aches, headache
  2. Painful genitla lesion-itching, burining
  3. Most severe outbreak & last 2-4 weeks
186
Q

What are recurrent symptoms of genital herpes?

A

outbreak lasting 5-10 days

generally shorter

187
Q

how is genital herpes dx

A

history and exam

188
Q

How is genital herpes treated?

A

NO CURE
1. Antiviral-acyclovir, valacyclovir, famiciclovir
2. comfort measures-viscous lidocaine to lesions
3. Partner: condom to prevent spread

189
Q

What are the risks of genital herpes?

A
  1. C-section to prevent nenatal herpes
  2. Newborn: Primary exposure- 50-60% nenonatal mortality
  3. Sepsis or neuological complication
190
Q

What cause HPV?

A

Human papillomavirus

191
Q

What are the symptoms of HPV?

A
  1. Painless genital warts-vagina, vulva, perineum, anus
  2. Abnormal cervical changes
192
Q

How is HPV dx

A

history,exam, and pap smear

193
Q

How is HPV treated

KNOW

A
  1. Podophyllin-topical application by patient
  2. Provider- Trichloroacetic acid application or surgical removal usuing laser or cryotherapy
194
Q

What partner education should we provide for a patient with HPV

A
  1. Abstain from sex until lesions are healed
  2. wear condom to prevent spread
195
Q

What are the risk of HPV?

A

Cervical or penile cancer
NEWBORN: resp papillomatosis

196
Q

What causes HIV/AIDS

A
  1. Human immunodeficiency virus
197
Q

What are the symptoms of HIV/AIDS (early and late)

A
  1. Asymptomatic
  2. Early-fever,fatigue,sore throat, rhinitis, rash,lymphadenopathy
  3. Late- fever, night sweats, weight loss, dry cough, leukopenia, throbocytopenia
    • women- candidasis, BV, PID, menstural changes
198
Q

What are the risks of HIV/AIDs

A
  1. placental transfusion
199
Q

How is HIV/AIDS dx

A

Antibody, antigen/antibody & neucleic acid test

200
Q

What is the tx for HIV/AID

A

NO CURE
1. HAART(highly active antiviral therapy)
2. Maintain health of HIV postive women
3. Reduce perinatal transmission
4. Partner; test and condoms
5. Pregnancy: placental transmission, deliver prior to ROM
6. Newborn: AVOID breastfeeding, antiretroviral prophylaxis

201
Q

What causes syphilis?

A
  1. Treponema pallidum (BACTERIA)
202
Q

What are the primary, secondary and Tertiary symptoms of syphillis?

A

Primary (up to 90 days post exposure)
1. Single painless chancre, fever, weight loss, malaise

Secondary (6weeks to 6 months post exposure)
1. fever, fatigue, sore throat, muscle aches, weight loss
2. Rash to hands & feet

Tertiary (10-30 years post exposure)
1. Cardiac, and neurological destruction
2. CNS & multi-organ damage

203
Q

How is syphillis diagnosed?

A

RPR or VDRL

204
Q

What is the tx of syphillis?

KNOW

A

Pen G regimen
partner tested & treated

205
Q

What are the risks of syphillis?

A
  1. PID, infertility, ectopic pregnancy
  2. NEWBORN- congenital syphillis, premature birth, neuo complications, stillbirth
206
Q

IPV in pregnancy correlates with maternal, fetal and infant health issues like…

A
  1. uterine rupture
  2. Placental abruption
  3. Preterm births, low birth weight infants
  4. Maternal & neonatal deaths
207
Q

What are characteristics of an abuser?

A
  1. Witness abuse of a mother as a child
  2. COntrolling, possessive, jealous, poor impulse control
  3. Denies responsibilities for violence and blames the women
208
Q

What are the components of the cycle of violence theory?

A
  1. Tension-buliding phase
  2. Acute battering incident
  3. Tranquil phase (honey moon phase)
209
Q

What are some psychological/emotional acts of violence in IPV

A
  1. Humilation, intimindation, threats
  2. Isolation, control
  3. Uses others-children
  4. Blame, minimize
  5. Male privilege, economic abuse
210
Q

What are some physical acts of violence that might be seen in IPV

A
  1. Pushing,shoving, slapping
  2. Kicking, punching, beating
  3. chocking
  4. shaking, burning
  5. use/threat of weapon- gun, knife
211
Q

What are some sexual acts of violence that might be seen in IPV

A
  1. Forced to engage in sexual activity aginst her will
  2. foced use of objects
  3. foced to have sex with someone else
  4. forced to trade sex for food, money & drugs (sex trafficking)
212
Q

What is sexual assult?

A

Sexual contact, touch or penetration without consent

213
Q

What are different types of rape?

A
  1. Power, sadistic, stranger, acquaintace, gang, drug facilitated
214
Q

What are characteristics of perpetrators

A
  1. All ethinic, racial, religious, socioeconomic & educational
  2. Attitudes toward women, male entiltement
  3. Impulsive, antisocial, emotionally unsupportive family
215
Q

What is trauma informed care?

A
  1. SANE/SAFE- special trained officers, physicians, sexual assult nurses or forensic examiner
  2. Forensic medical exam-primary purpose- restore dignitiy and then collect evidence
    • obtain a history, perform a head to toe and genital exam looking for trauma
    • offer STI, HIV & pregnancy prophalaxis medications
    • Make referrals for advocasy, couseling, shelters, legal assistance
    • Document findings for legal court testimony
216
Q

What do we want to avoid doing to a vitcim of rape

A

Secondary victimization-2nd rape- by law enforcement, physican and staff

know about rape trauma syndrome- PTSD- varing degrees of intensity, difficult to treat

217
Q

What challanges do we face when caring for victims of violence?

A
  1. Victim is physically/psychologically controlled, often loyal to perpetrator
  2. experienced many traumas, drugged, intoxicated or in pain
218
Q

What are some ques that may hint at a patient being a victim of violence?

A
  1. Serious untreated injuries-delayed care
  2. Injury not consistent with story, various stages of healing
  3. Injuries to head,neck, face, abdomen and breast if pregnant- always look under the clothes
  4. Overly protective partner or anxiety when parner is present
219
Q

What are the ABCDES of IPV

A
  1. Alone-universal screening question
  2. Believe- reassure it is not thier fault
  3. Confidentilality- know the reporting requirements for your state
  4. Document- facilitates communication between providers
  5. E-education- advocasy, counseling, legal assistence, shelters
  6. S-Safety- assess support system- help create a safety plan
220
Q

Risk for homocide is the greatest when

A

attempted seperation

221
Q
A

Module 6 (19 decks)

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