1
Nr 602 final topics
NR 602 Final Topic, Final Exam Study Guide
NR 602 -Primary Care of the Childbearing and Childrearing
Family
Chamberlain College of Nursing
, 2
Nr 602 final topics
Week 8:
ACOG guidelines regarding well women exams
ACOG Pap smear guidelines
Start @ 21, every 3
Age 30+ PAP & HPV repeat every 5 if negative (co-test) or 3 yr no co-test
@65 may stop if (-) hx for 10 yrs or hysterectomy w/o hx of cancer
Amenorrhea (Primary and Secondary)
Primary and Secondary Amenorrhea
Primary amenorrhea: No menarche by the age of 15 years (with or without development of secondary sexual
characteristics). Half of cases are caused by chromosomal disorders (50%) such as Turner syndrome.
Puberty is delayed if there is no breast development by age 13 years, absence of pubic
hair at age 14 years, and no menarche by age 15 years.
Secondary amenorrhea: No menses for three cycles, or 6 months if previously had menses. Most
common cause is ).
Secondary Amenorrhea Associated With Exercise and Underweight
Excessive exercise and/or sports participation have a higher incidence of amenorrhea (and infertility) due to relative
caloric deficiency
"Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis
Labs
Pregnancy test (serum human chorionic gonadotropin [hCG])
Serum prolactin level (rule out prolactinoma-induced amenorrhea)
Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing hormone (LH; rule out
premature ovarian failure)
If amenorrhea for more than 6 months, measure bone density
Treatment Plan
Educate about increasing caloric intake and decreasing exercise
Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin E 400 IU daily
Complications
Osteopenia/osteoporosis (stress fractures)
Myocardial atrophy, arrhythmia (sudden death), bradycardia, hypotension
Hypoglycemia, dehydration, electrolytes
Lanugo (fine downy hair), telogen effluvium (hair loss), xerosis (dry skin), infertility
Low body mass index (BMI), cachexia, anemia, respiratory failure
American Cancer Society recommendations
Breast cancer recommendations: Baseline mammogram: Start at age 50 years and repeat every 2 years until the age
of 74 years
Age 75 years or older: Insufficient evidence for routine mammogram
Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial breast cancer, history chest
radiation at a young age or previously diagnosed with high-risk breast lesion who may benefit from starting
screening in their 40s
NOTE: Age 40 to 49 years (individualize based on risk factors, if done). The American Cancer Society
recommends starting routine screening at age 40 years. *U.S. Preventive Services Task Force (USPSTF)
Recommendation Statement (January 2016).
Cervical Cancer Screening
Age Group. Recommendations for Pap/Liquid Cytology
, 3
Nr 602 final topics
Age 20 years or younger Do not screen (even if sexually active with multiple partners). Cervical cancer is rare
before age 21 years.
Age 21 to 65 years Baseline at age 21 years. Screen every 3 years.
Age 30 to 65 years Another option starting at age 30 years is to screen with combination of cytology plus
human papillomavirus (HPV) testing every 5 years.
Had hysterectomy with removal of cervix If hysterectomy with cervical removal was not due to cervical
intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening.
Women older than 65 years who had adequate prior screening Do not screen if history of adequate prior
screening and is otherwise not at high risk for cervical cancer.
Source: USPSTF (2012).
Notes*
These recommendations do not apply to women who are immunocompromised (i.e., Hiv infection), had in
utero exposure to diethylstilbestrol (DES), or have a diagnosis of high-grade precancerous cervical lesion or
cervical cancer.
*USPSTF Screening Recommendations for Cervical Cancer (July 2015).
Ovarian cancer- ACS RECOMMENDATIONS - The typical patient is a middle-aged or older woman with vague
symptoms of abdominal bloating and discomfort, low-back pain, pelvic pain, and changes in bowel habits. Look for
family history of having two or more first- or second-degree relatives with a history of ovarian cancer or a
combination of ovarian cancer, especially women of Ashkenazi Jewish ethnicity with a first-degree relative (or
second-degree relatives on the same side of the family) with breast or ovarian cancer (American Cancer Society,
U.S. Preventive Services Task Force [USPSTF], 2012). Very-high-risk women with suspected BRCA 1/BRCA
2 mutations should be referred for genetic counseling pre- and posttest. The screening starts at age 30 years (or 5 to
10 years before the earliest age of first diagnosis of ovarian cancer in a family member).
Androgen insensitivity/resistance syndrome
description/features
Inability of body to respond properly to male sex hormone, produced during pregnancy
Sx-
genetic make up is male but physical traits of woman
Vagina but no cervix, inguinal hernia w/ testes, normal female breasts, testes in abd or other place of body
ASCUS/HSIL results from Paper Test Report
(atypical squamous cell undetermined significance) from CDC---
For non-pregnant women between 25 and 65 years of age with ASCUS cytology who have not had HPV co-testing
already, HPV testing is the preferred next step (high-risk HPV testing only). With a negative HPV test (either on co-
test or after cytology), repeat co-testing every three years is recommended.
Normal Pap and Negative HPV Rescreen in 5 years.
Normal Pap and Positive HPV Repeat co-test in one year or do HPV DNA typing now (see ASCCP guidelines above).
ASCUS Pap, No HPV Test Repeat cytology in one year or do HPV test now (see ASCCP guidelines above).
ASCUS Pap and Negative HPV Repeat Pap and co-test at interval as per ASCCP guidelines.
Nr 602 final topics
NR 602 Final Topic, Final Exam Study Guide
NR 602 -Primary Care of the Childbearing and Childrearing
Family
Chamberlain College of Nursing
, 2
Nr 602 final topics
Week 8:
ACOG guidelines regarding well women exams
ACOG Pap smear guidelines
Start @ 21, every 3
Age 30+ PAP & HPV repeat every 5 if negative (co-test) or 3 yr no co-test
@65 may stop if (-) hx for 10 yrs or hysterectomy w/o hx of cancer
Amenorrhea (Primary and Secondary)
Primary and Secondary Amenorrhea
Primary amenorrhea: No menarche by the age of 15 years (with or without development of secondary sexual
characteristics). Half of cases are caused by chromosomal disorders (50%) such as Turner syndrome.
Puberty is delayed if there is no breast development by age 13 years, absence of pubic
hair at age 14 years, and no menarche by age 15 years.
Secondary amenorrhea: No menses for three cycles, or 6 months if previously had menses. Most
common cause is ).
Secondary Amenorrhea Associated With Exercise and Underweight
Excessive exercise and/or sports participation have a higher incidence of amenorrhea (and infertility) due to relative
caloric deficiency
"Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis
Labs
Pregnancy test (serum human chorionic gonadotropin [hCG])
Serum prolactin level (rule out prolactinoma-induced amenorrhea)
Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing hormone (LH; rule out
premature ovarian failure)
If amenorrhea for more than 6 months, measure bone density
Treatment Plan
Educate about increasing caloric intake and decreasing exercise
Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin E 400 IU daily
Complications
Osteopenia/osteoporosis (stress fractures)
Myocardial atrophy, arrhythmia (sudden death), bradycardia, hypotension
Hypoglycemia, dehydration, electrolytes
Lanugo (fine downy hair), telogen effluvium (hair loss), xerosis (dry skin), infertility
Low body mass index (BMI), cachexia, anemia, respiratory failure
American Cancer Society recommendations
Breast cancer recommendations: Baseline mammogram: Start at age 50 years and repeat every 2 years until the age
of 74 years
Age 75 years or older: Insufficient evidence for routine mammogram
Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial breast cancer, history chest
radiation at a young age or previously diagnosed with high-risk breast lesion who may benefit from starting
screening in their 40s
NOTE: Age 40 to 49 years (individualize based on risk factors, if done). The American Cancer Society
recommends starting routine screening at age 40 years. *U.S. Preventive Services Task Force (USPSTF)
Recommendation Statement (January 2016).
Cervical Cancer Screening
Age Group. Recommendations for Pap/Liquid Cytology
, 3
Nr 602 final topics
Age 20 years or younger Do not screen (even if sexually active with multiple partners). Cervical cancer is rare
before age 21 years.
Age 21 to 65 years Baseline at age 21 years. Screen every 3 years.
Age 30 to 65 years Another option starting at age 30 years is to screen with combination of cytology plus
human papillomavirus (HPV) testing every 5 years.
Had hysterectomy with removal of cervix If hysterectomy with cervical removal was not due to cervical
intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening.
Women older than 65 years who had adequate prior screening Do not screen if history of adequate prior
screening and is otherwise not at high risk for cervical cancer.
Source: USPSTF (2012).
Notes*
These recommendations do not apply to women who are immunocompromised (i.e., Hiv infection), had in
utero exposure to diethylstilbestrol (DES), or have a diagnosis of high-grade precancerous cervical lesion or
cervical cancer.
*USPSTF Screening Recommendations for Cervical Cancer (July 2015).
Ovarian cancer- ACS RECOMMENDATIONS - The typical patient is a middle-aged or older woman with vague
symptoms of abdominal bloating and discomfort, low-back pain, pelvic pain, and changes in bowel habits. Look for
family history of having two or more first- or second-degree relatives with a history of ovarian cancer or a
combination of ovarian cancer, especially women of Ashkenazi Jewish ethnicity with a first-degree relative (or
second-degree relatives on the same side of the family) with breast or ovarian cancer (American Cancer Society,
U.S. Preventive Services Task Force [USPSTF], 2012). Very-high-risk women with suspected BRCA 1/BRCA
2 mutations should be referred for genetic counseling pre- and posttest. The screening starts at age 30 years (or 5 to
10 years before the earliest age of first diagnosis of ovarian cancer in a family member).
Androgen insensitivity/resistance syndrome
description/features
Inability of body to respond properly to male sex hormone, produced during pregnancy
Sx-
genetic make up is male but physical traits of woman
Vagina but no cervix, inguinal hernia w/ testes, normal female breasts, testes in abd or other place of body
ASCUS/HSIL results from Paper Test Report
(atypical squamous cell undetermined significance) from CDC---
For non-pregnant women between 25 and 65 years of age with ASCUS cytology who have not had HPV co-testing
already, HPV testing is the preferred next step (high-risk HPV testing only). With a negative HPV test (either on co-
test or after cytology), repeat co-testing every three years is recommended.
Normal Pap and Negative HPV Rescreen in 5 years.
Normal Pap and Positive HPV Repeat co-test in one year or do HPV DNA typing now (see ASCCP guidelines above).
ASCUS Pap, No HPV Test Repeat cytology in one year or do HPV test now (see ASCCP guidelines above).
ASCUS Pap and Negative HPV Repeat Pap and co-test at interval as per ASCCP guidelines.
