Women Health Flashcards
(55 cards)
1
Q
Function of the female reproductive system
A
– complex process, consists internal/external undergo hormonal changes.
2
Q
Function of Ovulation?
A
(periodic discharge of mature ovum, occurs 2 wks b/4 period)
3
Q
Function of Menstruation?
A
refers to the shedding of the endometrial lining each month while a woman is fertile.
4
Q
function of Menstrual cycle
A
involves reproductive and endocrine systems(unfertilzed ovum, endometrium becomes thick/hemorrhage begins, consists of old blood/mucus/endometrial tissue)
5
Q
Function of Menarche?
A
is characterized by the first episode of menstrual bleeding.
6
Q
Significant hormones and hormonal changes ?
A
Estrogens, progesterone , androgens, Follicke-stimulating hormone, Luteinizing hormone and Perimenopause/ Menopause
7
Q
Function of Estrogen?
A
Produced in the ovaries,
Assist in development/maintaining female reproductive organs and breast/monthly changes in the uterus.
8
Q
Function of Progesterone?
A
- produces in the ovaries, secreted in corpus luteum.
- Important in endometrium, high in pregnancy
- Function of placenta to maintain normal pregnancy
- Estrogen prepares breast for breast milk
9
Q
Function of Androgens?
A
Produced in ovaries/adrenal glands, assist in female development, libido, oiliness of the skin/hair &hair growth
10
Q
Function of Follicle-stimulating hormone (FSH) ?
A
stimulating ovaries to secrete estrogen .
11
Q
Function of luteinizing hormone (LH)?
A
stimulating progesterone production
12
Q
Function of perimenopause/menopause?
A
Perimenopause (begins age 35) menopause (end of women reproductive capacity, B/T 45 to 55 years)
13
Q
What does health history consist of?
A
-Menstrual history and history of pregnancies
-History of exposure to medications
-Pain with menses (Dysmenorrhea) or intercourse (Dyspareunia)
-Vaginal discharge, odor, or itching (Vaginitis)
-Urinary (frequency/Urgency/incontinence)and bowel function
-Sexual history, including sexual or physical abuse (Intimate partner violence)
-History of STDs, surgeries, or procedures (genital mutilation/circumcision)
-Chronic illness or disabilities that affect health and self-care
-Family and genetic history
Table 64.1 Female Reproductive History (study).
14
Q
What is included in a sexual assessment?
A
-subjective and objective data
-Purpose is to obtain information to picture a woman’s sexuality and sexual practices to promote sexual health
-May move from less sensitive areas of general health history or assessment to more sensitive areas
-Ask for permission to discuss these issues
Do not assume sexual preferences
- Asking the patient to label herself as married, single, and so on may be interpreted as inappropriate; asking about current meaningful relationships may be less offensive.
- Use PLISST model
Table 64.1 Female Reproductive History (study).
15
Q
What is the PLISST model?
A
Use PLISST model (Permission, Limited Information, Specific Suggestion, intensive Therapy) E.g. “May I have permission to ask you some questions about your sexual activity”
16
Q
Female genital mutilation or cutting (FMG)?
A
- Involves partial/complete removal of external female genitalia
- Causing injury/infertility/childbirth complications/bladder and urinary function
- Care must be non-judgmental/respectful of culture/practices/beliefs
17
Q
Intimate Partner violence (IPV)-?(what to consider)
A
- Public health issue,
- Involves Physical, sexual, stalking, psychological aggression
- Care is to ensure a safe environment
- Ask about family violence, abuse, neglect, rape/assault, assess fear/anxiety
18
Q
Incest and childhood sexual abuse –?(what to consider)
A
-Assess depression in traumatized victims
-prost-traumatic stress disorder
-H/A, GI problems, may be obese,
Pelvic issues, anxiety about —pelvic exam, removal of clothing
19
Q
Health issues in women with disabilities –?
A
- Experience less preventive healthcare screening due to stereo-typing
- increased abuse
- mal-treatment
- neglect
20
Q
Lesbians, bisexual, and transgender women (LGBT) –
what to consider?
A
- Care providers are ill-equipped
- LGBT have concerns have discrimination
- Experience physical/mental abuse
21
Q
Gerontologic considerations ?
A
- High/low functioning,
- ill, risk for DM, HTN, thyroid disease, dyslipidemia
- Encourage health screening/promotions (heart disease, cognitive/physical functions, falls, gynecological/breast concerns)
22
Q
Physical assessment for women ?
A
- Annual breast and pelvic examinations:
- All women 21 years of age or older
- Who are sexually active, regardless of age
- Alleviate feelings of anxiety with explanations and education
- Patient is asked to empty her bladder and to provide a urine specimen if urine tests are part of the total assessment
- Diagnostic studies include imaging and surgical procedures to assess the female reproductive systems.
- Include mammography, ultrasound, MRI, colposcopy, laparoscopy, hysteroscopy, dilation and curettage, and endometrial biopsy. Table 64.3
- Laboratory assessment includes the Pap smear, wet preparations (wet preps), and cultures.
- Serum blood tests looking at hormone levels of FSH, LH, total estrogen, progesterone, and testosterone are important to determine normal functioning.
23
Q
Diagnostic Examinations and Tests?
A
Pelvic examination ,Pap smear, colposcopy, cryotherapy, cone biopsy and loop electrosurgical excision (LEEP)
24
Q
Pelvic examination –
A
use of speculum
25
Pap smear
– used to detect cervical cancer
26
Colposcopy (cervical cytology screening) and cervical biopsy
- Used to evaluate mucosa of the cervix and/or vagina.
- Often used after there has been an abnormal Pap smear that revealed an underlying lesion or precancerous cells.
- Provides direct visualization/magnification of mucosal layer of vagina/cervix with a colposcope, a low-power binocular microscope.
27
Cryotherapy (freezing cervical tissue with nitrous oxide) and laser therapy –
done output. Excessive bleeding, pain, fever should be reported
28
Cone biopsy and loop electrosurgical excision (LEEP)-
Avoid intercourse after procedure
29
Endometrial biopsy -
obtaining endometrial tissue due to irregular bleeding during/after menopause or taking hormone therapy/tamoxifen, contraindicated during pregnancy
30
Dilation and curettage –
ID irregular bleeding, obtain endometrial, cervical tissue for exam, therapeutic for incomplete abortion
31
Laparoscopy (pelvic peritoneoscopy)/hysteroscopy –
- visualize pelvis for diagnosis, treatment, facilitate surgical procedures
- An invasive procedure allows direct visualization of female anatomy using a fiber-optic scope inserted through a small incision on the abdominal wall.
- Abdomen is distended with CO2 to increase visualization
32
Pathophysiology of Vulvovaginal infections -
- Disorders of the female reproductive system may be minor or major problems leading to anxiety, distressing feeling, self-limiting, or life threatening requiring immediate actions/treatment
- Common problem
- Vagina is normally protected by acid pH maintained (3.5-4.5) in part by Lactobacillus acidophilus
- Vaginal epithelium is responsive to estrogen, which induces glycogen formation, which breaks down into lactic acid; therefore, decreased estrogen decreases lactic acid production
- With perimenopause, and menopause, decreased estrogen is related to vaginal and labial atrophy, and tissue is more susceptible to infection
33
Vulvovaginal Candidiasis ?
– fungal yeast infection caused strains candida. E.g. antibiotics alter natural flora of the vagina.
- 75% of women experience infection once in their lifetime
- Accounts for 95% of cases
- Use of antibiotic agents decreases bacteria, altering the natural protective organisms usually present in the vagina.
- Infections can occur at any time, occur more commonly:
- Pregnancy
- Diabetes or obese patients
- Human immune deficiency virus (HIV) infection
- Patients taking medications such as corticosteroids or oral contraceptive agents
34
Clinical manifestations of Vulvovaginal Candidiasis?
- Vaginal discharge that causes pruritus (itching) with subsequent irritation.
- Discharge may be watery or thick but usually has a white, cottage cheese–like appearance.
- Symptoms usually more severe just before menstruation.
- May be less responsive to treatment during pregnancy.
- Diagnostic testing made by microscopic identification of spores and hyphae (long branching filamentous structures) on glass slide prepared from a discharge specimen is mixed with potassium hydroxide.
- With candidiasis, pH is 4.5 or less
35
How is Vulvovaginal Candidiasis?
Antifungal agents:
- Miconazole (Monistat)
- Nystatin (Mycostatin)
- Clotrimazole (Gyne-Lotrimin
- Terconazole (Terazol) cream
- Agents are inserted into the vagina with an applicator at bedtime (1-night, 3-night, and 7-night treatment courses)
- Oral medication fluconazole [Diflucan] one-pill dose.
- Relief should be noted within 3 days.
36
Genital Viral Infections-Epidemiology of Genital Herpes?
- Genital herpes is a common, chronic STI caused by herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2).
- National estimates reveal that the prevalence of HSV-1 is 47.8%
- HSV-2 is 11.9% among individuals aged 14 to 49, with a total adolescent and adult population ratio of 1 to 5.
- Majority of genital herpes is caused by HSV-2.
- Globally, prevalence of HSV-2–related genital herpes present in persons aged 15 to 49 is 417 million.
- Estimates reach over a billion within the same age range when including the cases of genital herpes caused by either HSV-1 or HSV-2.
37
Genital viral infections -Herpes type 2 infection (herpes genitalis)
- Herpes type 1 (cold sores lips).
- A recurrent lifelong viral infection with herpetic blisters on external genitalis.
- An STD that also may be transmitted by contact and may be transmitted when the carrier is symptomatic.
- Causes painful itching and 2-3 burning herpetic lesions/blisters to heal.
- Recurrence less painful, risk include stress, sunburn, dental work, poor rest/hygiene.
- Is a chronic condition that may affect quality of life.
- Psychosocially, genital herpes may have implications that can lead to depression, withdrawal from relationships, poor coping skills/self-confidence, shame, guilt, and perceived poor body image
38
Nine types of herpes viruses belonging to three different groups of infection in humans?
- Herpes simplex type 1 (HSV-1)= cold sores of the lips
- Herpes simplex type 2 (HSV-2)= genital herpes
- Varicella zoster or shingles
- Epstein–Barr virus
- Cytomegalovirus
- Human B-lymphotropic virus
- Transmitted by direct skin-to-skin contact during the prodromal stage of infection (onset of the infection
39
How can herpes viruses be aquires?
-Acquire infection through close human contact of the mouth, oropharynx, mucosal surface, vagina/cervix, skin lacerations and conjunctivae.
-Infection can occur through oral-to-oral, oral-to-genital, genital-to-genital, or anal contact.
-Virus killed at room temperature by drying.
Replication diminishes, virus ascends peripheral sensory nerves and remains inactive in the nerve ganglia.
-Stress can cause another outbreak.
-Triggers of onset of outbreaks can be due to physical factors (immunosuppression, ultraviolet radiation, fatigue, menses) and psychological factors (emotional and psychological stress).
-Pregnant women with active herpes, infants delivered vaginally may become infected with the virus.
-Risk of fetal morbidity and mortality if this occurs, cesarean delivery if virus recurs near the time of delivery.
40
Risk factors for genital herpes:
-Risk factors for genital herpes are similar to those for other STIs.
-History of other STIs.
-Early age of sexual intercourse.
-Multiple partners.
-Low socioeconomic status.
Immune-compromised individuals.
-Herpes simplex virus 2 is more commonly diagnosed in females than males because the female genitalia are more susceptible to skin breaks.
-Genital herpes is more easily transmitted from males to females than from females to males.
41
Clinical manifestations for genital herpes? pt1
- Itching and pain occur as infected site becomes red and edematous.
- Infection begins with macules/papules = vesicles and ulcers. Vesicles appears blister, later coalesces, ulcerates, and encrusts.
- In women = labia usual primary site, cervix, vagina, and perianal skin may be affected, buttocks
- Females tend to have more severe symptoms than males.
- In men = glans penis, foreskin, or penile shaft typically affected.
- Influenza like symptoms occur 3 or 4 days after lesions appear.
- Primary or initial outbreak presents as one or several clear vesicles, or blisters, that erupt in the genital area.
- Vesicle then ruptures and forms a painful ulcer several days later. The ulcer may last up to 2 to 4 weeks if untreated.
- Table 67.3 displays common symptoms observed in males and females.
42
Clinical manifestations for genital herpes? pt 2
- Inguinal lymphadenopathy (enlarged lymph nodes in the groin), minor temperature elevation, malaise, headache, myalgia (aching muscles), and dysuria (pain on urination)
- Pain evident first week and then decreases.
- Lesions last 2 to 12 days before crusting over
- Complications arise from extra-genital spread (buttocks, upper thighs, or eyes due to touching lesions and then touching other areas.
- Patients teaching to wash hands after contact with lesions.
- Other potential problems:
- Aseptic meningitis
- Neonatal transmission
- Severe emotional stress related to the diagnosis
43
Clinical management for genital herpes?
Currently, no cure for genital herpes infection
- Treatment aimed at relieving/lessen the severity/duration of symptoms.
* Management goals:
- Prevent spread of infection
- Make patients comfortable
- Decrease potential health risks
- Initiate counseling and education program.
- Educate the patient on prevention, manifestations, transmission of STIs, reducing the number of partners, and barrier methods.
44
RN teaching for genital herpes?
- Educate the patient on prevention, manifestations, transmission of STIs, reducing the number of partners, and barrier methods.
* Safe sex can help decrease the transmission and occurrence of genital herpes.
- Instruct the patient to report any history of infection to sexual partners.
- Partner may be at risk and/or may need to be treated.
- Important to understand genital herpes transmission is possible even when symptoms are not evident.
* Start treatment as soon as prodromal symptoms occur.
- Prompt treatment may decrease severity and duration of an outbreak.
- Importance of abstinence during symptomatic episodes
- Abstinence during an acute outbreak can help reduce transmission to sexual partners.
- Educate patient on means to help alleviate symptoms.
- Warm salt baths prn
- Assist with drying up the lesions and ease physical discomfort of pain/itching from the vesicles or ulcers
- Ice to the affected area
- May aid in relieving discomfort
- Loose-fitting clothing
- Increased airflow may help ease discomfort and promote healing.
45
Clinical management for genital herpes?
- Three oral antiviral agents:
- Suppress symptoms and shorten the course of the infection
- Oral agents effective in reducing duration of lesions and prevent recurrences
- Acyclovir (Zovirax),
- Valacyclovir (Valtrex),
- Famciclovir (Famvir)
- Analgesics and saline compress provide additional relief of symptoms. Resistance and long-term side effects not major problems.
- Recurrent episodes often milder than the initial episode.
- Prophylactic vaccine and topical gel development for genital herpes continues to be investigated in clinical trials
46
Chlamydia and Gonorrhea most common causes of ?
endocervicitis
47
Chlamydia and Gonorrhea
Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly reported infectious diseases in the United States.
Coinfection with C. trachomatis often occurs in patients infected with N. gonorrhoeae.
The greatest risk of C. trachomatis infection occurs in young women between 15 and 24
48
Chlamydia Trachomatis ?
- Causes about 2.86 million infections every year in the United States
- Globally, WHO reports more than 131 million cases annually
- Frequency/morbidity of Chlamydia infections reported to be greater in females
- Commonly found= in young people 25 years or younger; low socioeconomic status; multiple sexual partners; history of STIs; unmarried status; immature cervix; and diagnosis of mucopurulent inflammation of the cervix transmitted through sexual contact
49
three groups at high risk for Chlamydia Trachomatis ?
-Sexually active females under age of 25
Persons over age 25 who -frequently engage in sexual intercourse with a new partner
-Mem having sex with men (MSM).
-CDC recommends that these groups be screened annually.
50
In females, untreated chlamydia -
infections spread to fallopian tubes/uterus leading to serious complications PID, ↑ risk of ectopic pregnancy, tubal abscesses, ectopic pregnancy, chronic pelvic pain, and Fitz-Hugh-Curtis syndrome (perihepatitis, or inflammation of the peritoneal covering of the liver) and infertility.
51
In males, if the Chlamydia infection spreads
it may travel to the epididymis, causing epididymitis (inflammation of the epididymis), a rare condition, or prostate gland infection.
52
complications for Chlamydia Trachomatis-
- Other complications include conjunctivitis, pharyngitis, pneumonia, Reiter’s syndrome, also known as reactive arthritis. This is a rare autoimmune arthritic condition that causes urethritis, or inflammation in the urinary genital tract, conjunctivitis, and inflammation of mucous membranes lining the eyes.
- Chlamydial infections of the cervix presents no symptoms, but cervical discharge, dyspareunia, dysuria, and bleeding may occur
53
Gonorrhea?
- Second reported STI
- Estimated 820,000 new cases each year
- Inflamed cervix from infected woman more vulnerable to HIV transmission from an infected partner.
- Gonorrhea is often asymptomatic and a major cause of PID, tubal infertility, ectopic pregnancy, and chronic pelvic pain
- Diagnosis confirmed by urine culture or using swab to obtain a sample of cervical or penile discharge from the patient’s partner
54
Clinical manifestations of Gonorrhea in women:
- Both C. trachomatis and N. gonorrhoeae infections frequently do not cause symptoms in women.
- When symptoms are present, mucopurulent cervicitis with exudates in the endocervical canal is the most frequent finding.
- Women with gonorrhea infections present symptoms of urinary tract infection or vaginitis.
55
Clinical manifestations of Gonorrhea in men:
- Men are more likely than women to have symptoms when infected
- Infected men with N. gonorrhoeae or C. trachomatis can be asymptomatic.
- Symptoms may include burning during urination and penile discharge.
- Patients with N. gonorrhoeae infection may also report painful, swollen testicles.
* Dysuria in both males and females is a clinical manifestation of chlamydia/gonorrhea.
* Rectal pain common clinical manifestation of gonorrhea in both males and females.
- Table 67.4 Manifestations of Male/Famale Chlamydia
