Women's Health 2023 with complete solution questions and answers

Which hormone controls the menstrual cycle? Estrogen Which hormone controls pregnancy? Progesterone Menstrual abnormalities: Amenorrhea = No menses Caused by: Pregnancy, Excessive exercise, Psychological stress, Menopause, Anorexia nervosa, Interventions: treat the cause Menstrual abnormalities: Menorrhagia = Excessive prolonged menses Caused by: IUD, Fibroids/tumors/endometriosis, Assessment: Pads (amount of bleeding), Hgb/Hct, Treatment: D&C (dilation and curettage) (Fibroid is not cancerous, Tumor is cancerous) Post-Op D&C Assess: Bleeding, voiding Treatment/teaching: No strenuous activity (4-6 weeks), No douche/intercourse 'til check up, Drainage goes from pink to dark red to brown, Call MD if: bleeding, ↑ temp, ↑ pain Menstrual abnormalities: Menometrorrhagia Irregular, more frequent bleeding Is a symptom of something else... Can lead to anemia Hormonal treatment Treat the cause Causes of menometrorrhagia Uterine fibroids, endometriosis, uterine cancer, ectopic pregnancy (form outside of the uterus the baby typically in the fallopian tubes), birth control can not be quite right cause it can imbalance hormone levels Dysmenorrhea painful menses PMS Causes unknown PMS affects 2-5% of women Signs/Symptoms: begin 5 days prior to menstruation Fluid retention HA Swelling Depression Anger Confusion Anxiety Patient education PMS Educate patient about a diet with low salt, whole grains, fruits and vegetables, SSRI's can be used as an antidepressant or anxiety medication, Xanex can be used for anxiety, diuretic can help with the fluid retention Menopause caused by ↓ estrogen Assessment: 1. hot flashes 2. menstrual irregularities 3. vaginitis 4. osteoporosis (Estrogen inhibits bone reabsorption) Depression, irritability, mood changes vaginal dryness which can lead to other conditions urinary incontinence anytime a patient c/o bleeding 1 year or more after menses the cause MUST be investigated Hormone Therapy (HRT) Combination of estrogen and progesterone Benefits: Prevent hot flashes, Reduce osteoporotic fractures, May reduce CV diseases, colorectal cancer Increased risks: Endometrial cancer, ovarian cancer, breast cancer, Heart attack, Stroke, Thromboembolism do what to strengthen bone take calcium and vitamin D for strengthening of the bone & weight bearing exercises s/s of pulmonary embolism Shortness or breath, chest pain s/s DVT tenderness and redness of the leg, swelling PID (Pelvic Inflammatory Disease) etiology, progression, assessment May cause irreversible sterility Etiology: usually bacterial: gonococcus (STD), staph, strep or e-coli (also fungal, viral, parasitic) Progression: Inflammation from vagina "uterus " fallopian tubes "ovaries and pelvis/Abdominal cavity (causing abscess) Assessment: Could be asymptomatic Discharge or bleeding Fever, Pain: lower abdominal pain Generalized infectious response PID (Pelvic Inflammatory Disease) teaching, interventions Teaching: abstinence, condoms don't prevent STDs, STDs have no cure, Can cause scared uterus fallopian tubes and close it to lead to sterility (PID) Interventions: antibiotics, semi fowlers position, education on prevention Vaginitis risk and assessment Risk factors/causes: pH more alkaline with ↓ estrogen ∆ normal flora infectious agents: candida (fungus), bacteria, trichomonas (protozoa) STD (chlamydia and gonorrhea) Suppression of immune system Assessment: "smelly" discharge, Pruritis Dx: C&S Vaginitis prevention and interventions Prevention: wipe front to back, no tight underwear and clothing Interventions: medications, antifungal, estrogen cream to build vaginal wall, antibacterial, to strengthen natural flora acidofolis (to build up immune system), Trichomoniasis usually sexually transmitted Caused by: protozoa (parasite), inflammation in vagina, urethra, cervix Assessment: Yellow-green discharge, Itching, burning sensation Dx: C&S Interventions: Flagyl, Condom use for prevention, Infection via water (pool/bath) is unlikely Endometriosis cause, risk, patho Cause unknown (hormonal effect) Risk factors: genetics, no children Pathophysiology: Abnormal growth of endometrial tissues to myometrium, ovaries, abdomen, kidney etc., Abnormal endometrial tissues respond to hormone ∆ and causes bleeding, Bleeding causes adhesions/infertility Endometriosis assessment, dx, interventions Assessment of S/S: Pain: chronic pelvic pain, dysmenorrhea, Infertility, Chocolate cyst (from old blood) of ovary Dx: confirmation by laparoscopy (commonly used: ultrasound, MRI) Interventions: Symptomatic for pain (NSAIDS) Oral contraceptives (progesterone) CO2 via laser to vaporize Hysterectomy (for uncontrolled bleeding or pain) Uterine Prolapse (vaginal) uterus falls down into vagina (painless) & may protrude outside the body - Vaginal floor muscle exercise - hysterectomy Cystocele (anterior): bladder pushes on weakened vaginal wall Assessment: frequency/urgency, UTI's, incontinence Rectocele (posterior) rectum protrudes into vaginal wall Something is "falling down" sensation within pelvis Breast Cancer (1:8 women) Causes: Mutation in genes: BRCA-1, BRCA-2, p53 High fat diet (contributing factor) Estrogen only HRT (Estrogen only will lead to breast and other cancers) Risk factors: No breast feeding, smoking, stress Dx of breast cancer SBE: most lumps found by self Mammogram Biopsy Ultrasound Elevated level of CEA (cancer recurrence) - CEA should only be used when a diagnosis of cancer has already been made Breast Cancer Interventions (multimodality) Radiation: internal or external Chemo and hormonal tx Surgery Lumpectomy Mastectomy (simple, radical) Sentinel node bx Complications Infection Lymphedema: By sentinel node removal (blockage of lymph drainage of arm) Focus on education (textbook readings) Reconstructive surgery: TRAM, LD, DIEP flaps TRAM Flap, DIEP, LD flap Surgery Post op Assessment Flap check for circulation: edema, well-approximated wound edges, signs of infection, color, warmth, cap refill, doppler readings → Poor circulation requires prompt surgical intervention to save the graft HOB 30 degrees to decrease tension on incision ROM of affected UE Cervical Cancer Risk Factors HPV (human papillomavirus): causes more than 90% cervical cancer Partner uncircumcised Multiple partners Stress Smoking Dx of cervical cancer PAP (With early detection: 100% curable) Colposcopy cobas® HPV test Cervical Cancer: Assessment and Intervention Assessment: Vaginal bleed/discharge is LATE Interventions for precancerous stage: Laser (vaporize) Cryosurgery (freeze) Conization (LEEP biopsy) Interventions for Cancerous stage: Hysterectomy Uterine Cancer (Endometrial) Inappropriate estrogen replacement without progesterone is #1 risk factor Assessment: Vaginal bleed Dx: Endometrial biopsy Treatment: TAH-BSO, Radiation Ovarian Cancer Leading cause of death for reproductive CA Risk factors: Estrogen only HRT "Whispering disease" GI: bloating, ∆ bowel patterns Fatigue/backache dysparunia Dx and Tx for ovarian cancer Dx: Early: CA-125 tumor marker is ↑ 90% Late: mass (ultrasound) Tx: TAH-BSO Radiation Chemo TAH-BSO total abdominal hysterectomy with a bilateral salpingo-oophorectomy remove the uterus and cervix TAH-BSO Post-Op Assessment, Nursing Implications, Teaching Look for: bleeding and voiding; edema side is close to the bladder, pain and gas Nursing implications: s/sx of post op complications, fever, elevated temp, pain, excessive bleeding, Teaching: main teaching is no longer can have children; normal intercourse after healing, need hormone replacement therapy