NR602 MIDTERM EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE

NR602 MIDTERM EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED LATEST UPDATE Terms in this set (81) Amenorrhea absent menses ovarian cycle graph Dysmenorrhea painful menstruation (prevents or interferes w/normal activity and requires medication) Primary dysmenorrhea cyclical menstrual pain w/no identifiable pelvic disease Risk factors for primary dysmenorrhea age 30 BMI 20 Smoking Early menarche Hx of sexual abuse Premenstrual emotional Sx Hx of pelvic surgery Depression *controversial risk factors: longer menses, higher BMI, nulliparity, alcohol Primary dysmenorrhea: HPI/Physical Exam -cyclical pain that precedes or begins w/ menstrual flow and lasts for a few hours to a few days. -Pain--crampy or a dull ache usually in the midline of the lower abdomen which may radiate down the thighs/lower back. -Associated Sx may include N/V/D, HA, fatigue -Physical exam should include a pelvic exam to check for infection, uterine or ovarian enlargement, abdominal masses. -exam is usually normal Primary dysmenorrhea: Treatment NSAIDS; Vitamin E? COCs--suppress ovulation/endometrial tissue proliferation, minimizes prostaglandin release and decreases menstrual flow Secondary dysmenorrhea cyclical menstrual pain that results from underlying pelvic pathology (PID, ***endometriosis, uterine fibroids, adenomyosis, etc.) ***most common Secondary dysmenorrhea HPI/PE pain begins a few days or several hours before menses starts. often relieved by menstrual flow, dull, continuous, diffuse pain over the lower abdomen. can also radiate down the thighs and to the lower back. pain occurs during the first few cycles after menarche or starts after the age 25 as well as if there is no improvement with the use of NSAIDs or oral contraceptives. considered in the presence of infertility or if a pelvic abnormality exists. Secondary Dysmenorrhea Physical Exam The physical exam should always include an abdominal, pelvic and rectal examination to palpate for masses. The provider should also make note of the size, shape, consistency and position of the uterus, the appearance of the cervix and the size of the ovaries. Keep in mind that the absence of a palpable mass should not rule out pelvic pathology, since a mass may not be palpable until it is very large. Secondary Dysmenorrhea diagnosis r/o pregnancy, STI Transvaginal ultrasound Definitive Dx: laparoscopic biopsy and histology Secondary Dysmenorrhea Tx pain relief and cycle regulation (NSAIDS, hormonal birth control Conservative surgical management may be tried in women who do not respond to medication treatment which may include excision or destruction of the lesion(s) with laser or heat and lysis of adhesions if indicated. Hysterectomy is reserved for women who have not responded to drug treatment or conservative surgery and who were not planning on becoming pregnant in the future. Endometriosis growth or multiple growths (polyps) of endometrial tissue found outside of the uterine cavity; respond to cyclic hormones of menstrual cycle--bleeding/pain can also adhere to adjacent organs (ovaries, bowel, bladder, peritoneum) Endometriosis symptoms -Scar tissue, or adhesions, commonly develop and are a common source of chronic pelvic pain. -Depending upon its location, it can be associated with painful intercourse (dyspareunia), rectal pain with defecation and urgent micturition. -When dysmenorrhea is associated with any of these symptoms, endometriosis should be considered as highly likely. Risk factors for endometriosis Increasing age heredity caucasian race early menarche high association of autoimmune conditions Uterine Fibroids (leiomyomas & myomas) Uterine fibroids are benign tumors of the uterine myometrium, the smooth muscle of the uterus. Fibroids can range in size from microscopic to very large. Single or multiple fibroids are possible. Like endometriosis, fibroids can be associated with menorrhagia, infertility and bowel and bladder complaints. Uterine fibroids are the most common indication for hysterectomy in the United States. Risk factors include heredity, obesity, african american ancestry and a primiparous status (giving birth to only 1 child). Adenomyosis Adenomyosis is the growth of endometrial tissue into the uterine myometrium. The myometrium is the middle layer of the uterine wall which is made up of involuntary smooth muscle and is responsible for contraction of the uterus. Adenomyosis, in addition to dysmenorrhea, can also cause menorrhagia (heavy periods) as well as a diffusely enlarged, boggy and tender uterus Menorrhagia heavy menses Menometrorrhagia abnormal and heavy menses Metrorrhagia abnormal or irregular menses Premenstrual Syndrome (PMS) Occurs during luteal phase Common, majority of premenopausal women Premenstrual Dysphoric Disorder (PMDD) Occurs during luteal phase Less common Mores severe form of PMS, Sx significantly disrupt daily functioning PMS/PMDD: Affective Symptoms anxiety irritability angry outbursts depression mood swings social withdrawal confusion