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Women

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The DONUT pessary provides support for a third-degree uterine prolapse as well as cystocele and rectocele. RING pessaries, with or without support, ... – PowerPoint PPT presentation

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Title: Women


1
Womens Health
  • Fibrocystic Breasts
  • Endometriosis
  • Polycystic Ovary Syndrome
  • Vaginal Infections
  • Uterine Tumors/Fibroids
  • Gynecological Cancers
  • Breast Cancer
  • Pelvic Relaxation/Hysterectomy
  • Female Circumcision

2
Fibrocystic Breasts
  • Thickening of breast tissue due to imbalance in
    estrogen and progesterone
  • Cyst formation is a late change in breasts
  • Most common benign breast disorder
  • Ages 30 50 years
  • May or may not increase risk of breast cancer
    depends on type of cellular changes

3
Fibrocystic Breasts
  • Symptoms increase approaching menopause and
    decrease after menopause
  • Pain, tenderness, swelling before menses, lumpy
    feel to breasts
  • May have serosanguineous discharge

4
Fibrocystic Breasts
  • Diagnostic studies
  • Mammography, sonography, palpation
  • Fine needle aspiration
  • Biopsy

5
Fibrocystic Breasts
  • Treatment
  • Restrict sodium intake
  • Limit caffeine
  • Mild diuretic
  • Mild analgesic
  • Hormone inhibitor danazol
  • Oral contraceptives
  • Antiestrogen tamoxifen
  • Oil of evening primrose

6
Endometriosis
  • Endometrial tissue outside the endometrial cavity
  • Endometrial tissue bleeds cyclically like a
    menstrual period
  • Causes inflammation, scarring, adhesions
  • Occurs between 20 and 45 years of age

7
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8
Endometriosis
  • Pelvic pain - related to menstrual cycle
  • Dyspareunia - painful intercourse
  • Abnormal uterine bleeding
  • Bimanual examination
  • Fixed, tender, retroverted uterus
  • Palpable nodules in cul-de-sac
  • Diagnosis confirmed by laparoscopy

9
Endometriosis Treatment
  • Surgical removal of visible endometrial tissue
  • Excision, endocoagulation, electrocautery, or
    laser vaporization
  • Surgery is effective in relieving pain
  • Surgical removal of uterus, ovaries, tubes
  • Hormonal therapy, OCs
  • Women with minimal symptoms - observation,
    analgesics, nonsteroidal anti-inflammatory drugs

10
Polycystic Ovary Syndrome
  • Imbalance of hormones
  • Higher levels of androgens
  • Enlarged ovaries with many fluid-filled cysts
  • Egg-containing cysts in ovaries grow but do not
    release the egg
  • Not cancerous
  • Runs in families

11
Polycystic Ovary Syndrome
  • Irregular, decreased or no periods
  • Less frequent ovulation
  • Excess growth of hair on face, chest, abdomen,
    back, pubic area
  • Acne or oily skin
  • Weight gain, esp. waist area
  • Patches of thickened, dark colored skin

12
Polycystic Ovary Syndrome
  • Less common features
  • Male-pattern baldness
  • Skin tags in armpits or neck
  • High total cholesterol, low HDL chol.
  • High blood pressure
  • Diabetes

13
Polycystic Ovary Syndrome
  • Diagnosis
  • Pelvic ultrasound, hormone levels
  • Treatment
  • Oral contraceptives
  • Exercise
  • Low calorie diet
  • Electrolysis, hair removal creams
  • Medicate to cause ovulation in infertility

14
Vaginal Infections
  • Bacterial Vaginosis
  • Alteration of vaginal pH allowing bacteria to
    grow (Gardnerella, mycoplasmas)
  • Not an STI
  • Thin, watery white or gray discharge with fishy
    smell
  • Treat with metronidazole (Flagyl)

15
Vaginal Infections
  • Candidiasis monilial yeast infection
  • Vaginal cottage cheese discharge, itching,
    dysuria, dyspareunia
  • Treatment - Clotrimazole

16
Sexually Transmitted Infections (STIs)
  • Trichomoniasis
  • Protozoal infection
  • Toilet seats, wet bathing suits, wet towels
  • Yellow-green frothy odorous discharge
  • Treatment
  • Metronidazole (Flagyl)
  • Treat both partners

17
STI
  • Chlamydia
  • Bacterial infection
  • Treatment
  • Azithromycin, doxycycline

18
STI
  • Gonorrhea
  • Treatment
  • Ciprofloxacin with doxycycline

19
STI
  • Herpes
  • Treatment
  • Acyclovir

20
STI
  • Syphilis
  • Can be transmitted transplacentally
  • Treatment
  • Penicillin G

21
STI
  • Human Papilloma Virus (HPV)
  • Venereal warts
  • Soft, grayish-pink, cauliflower-like lesions
  • Treatment
  • Cryotherapy, laser surgery
  • Linked to cervical cancer

22
STI
  • Pediculosis Pubis

23
Abnormal Pap Smear Results
  • Detects variety of abnormalities
  • Greatest impact on detection of cervical cancer
  • Bethesda system most widely used Pap Smear
    reporting system Early detection allows changes
    to be treated before precancerous or cancerous
    cells develop
  • Deliver results in a caring way

24
Ovarian Masses
  • May be palpated during a pelvic exam
  • Between 70 and 80 of ovarian masses are benign
  • More than 50 are functional cysts
  • Occurs most commonly in women 20 to 40 years of
    age
  • May be asymptomatic or symptomatic
  • Symptoms Cramping, dyspareunia, irregular
    bleeding, delayed menses

25
Ovarian Masses
26
Ovarian Masses (contd)
  • Treatment Oral contraceptives, surgery
    considered for large masses
  • Most ovarian cysts resolve on their own
  • Ovarian cancer is the most fatal of all cancers
    in women
  • Difficult to diagnose
  • Often spread throughout the pelvis before it is
    detected

27
Uterine Masses
  • Fibroid tumors/leiomyomas
  • Most common benign disease entities in women
  • Most common reason for gynecologic surgery
  • Between 20 and 50 of women develop leiomyomas
    by age 40
  • Common in women of African heritage

28
Uterine Fibroids
29
Uterine Masses (contd)
  • Frequently asymptomatic
  • Symptoms include Lower abdominal pain, fullness
    or pressure, menorrhagia, dysmenorrhea
  • Diagnosis Ultrasonography revealing masses or
    nodules
  • Masses or nodules involving the uterus palpated
    on pelvic examination
  • Treatment None, embolization (plug artery
    supplying blood), U/S, or surgery

30
Endometrial Cancer
  • Most common disease of postmenopausal women
  • High rate of cure if detected early
  • Hallmark sign is vaginal bleeding in
    postmenopausal women not treated with hormone
    replacement therapy
  • Diagnosis Endometrial biopsy, transvaginal
    ultrasound, posthysterectomy pathology of uterus

31
Endometrial Cancer
32
Endometrial Cancer (contd)
  • Treatment Total abdominal hysterectomy (TAH) and
    bilateral salpingo-oophorectomy (BSO)
  • Radiation therapy may also be indicated
  • Nursing management
  • Reinforce knowledge of etiology, symptoms, and
    treatment options
  • Schedule follow-up appointments
  • Provide emotional support and counseling

33
Breast Cancer
  • Unregulated growth of abnormal cells in breast
    tissue
  • Most common cancer in women
  • Second leading cause of death in women
  • Can metastasize to bone, brain, lung, liver,
    skin, lymph nodes
  • Staging 0, I, II, III, IV

34
Manifestations of Breast Cancer
  • Breast mass or thickening
  • Unusual lump in underarm or above the collarbone
  • Persistent skin rash near the nipple area
  • Flaking or eruption near the nipple
  • Dimpling, pulling, or retraction in an area of
    the breast
  • Nipple discharge
  • Change in nipple position
  • Burning, stinging, or pricking sensation

35
Diagnostic Tests for Breast Cancer
  • Breast examination
  • Mammogram
  • Needle biopsy
  • Excisional biopsy
  • Ductal lavage and nipple aspiration

36
Treatment for Breast Cancer
  • Mastectomy
  • Lumpectomy
  • Simple
  • Modified radical
  • Radiation therapy
  • Chemotherapy
  • Breast Reconstruction

37
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38
Pelvic Relaxation
  • Cystocele
  • Relaxation of anterior vaginal wall with prolapse
    of bladder

39
Pelvic Relaxation
  • Rectocele
  • Relaxation of posterior vaginal wall with
    prolapse of rectum

40
Pelvic Relaxation
  • Uterine Prolapse
  • Downward displacement of uterus

41
Pessaries
The GELLHORN pessary provides support for a
second to third degree uterine prolapse or
procidentia.
The DONUT pessary provides support for a
third-degree uterine prolapse as well as
cystocele and rectocele.
RING pessaries, with or without support, provide
relief for first and second-degree uterine
prolapse or cystocele.
42
Hysterectomy
  • Surgical removal of uterus
  • TAH or TVH w/ BSO
  • TAH preferred for cancer, large fibroids,
    endometriosis
  • TVH preferred for small fibroids, abnormal
    uterine bleeding

43
Female Circumcision
  • Female genital mutilation performed on 2 million
    girls/year in African and Asia countries
  • Cultural practice of womanhood
  • Sunna excision of clitoris
  • Excision removal of entire clitoris and part or
    all of labia
  • Infibulation excision of clitoris, labia minora
    and scraping out labia majora

44
Female Circumcision
  • Provide privacy
  • Create environment of trust where patient can
    talk openly
  • Use warmed pediatric speculum for exams
  • Provide health education about reproductive care
    and pregnancy care
  • Develop birth plan to meet cultural needs

45
NCLEX Question
  • The nurse is planning to teach couples factors
    that influence fertility. What should not be
    included in the teaching plan?
  • Sexual intercourse should occur 4 times a week.
  • Wait one hour to urinate after intercourse.
  • Do not douch.
  • Use stress reduction techniques.

46
NCLEX Question
  • A menopausal woman tells the nurse that she
    experiences discomfort from vaginal dryness
    during sexual intercourse, and asks, What should
    I use as a lubricant? What should the nurse
    recommend?
  • Petroleum jelly
  • Water-soluble lubricant
  • Body cream or lotion
  • Less-frequent intercourse

47
NCLEX Question
  • A nursing tech is assisting with nursing care of
    a postmastectomy client. What information does
    the nurse reinforce with the nursing tech?
  • Maintain strict Intake and Output
  • No BP on the mastectomy side
  • Begin arm exercises immediately
  • Elevate proximal joint higher than distal joint

48
NICU Nurses Prayer
  • Help me to remember to care for the littlest of
    children with tenderness and compassion.
  • Keep me ever mindful that babies cant tell me of
    their needs, so I must use every one of my senses
    in taking care of them.
  • Walk with me in every task of my day so that I
    will stay alert to any changes that need my
    attention.

49
NICU Nurses Prayer
  • Let me encourage the parents as they learn how to
    care for their babies.
  • Give me the grace to teach them with patience and
    show them unconditional love.
  • Help us to care for each other when the shift is
    long and the work is stressful. Remind us to be
    thankful and to celebrate this healing ministry.

50
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