Title: Women
1Womens Health
- Fibrocystic Breasts
- Endometriosis
- Polycystic Ovary Syndrome
- Vaginal Infections
- Uterine Tumors/Fibroids
- Gynecological Cancers
- Breast Cancer
- Pelvic Relaxation/Hysterectomy
- Female Circumcision
2Fibrocystic 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
3Fibrocystic Breasts
- Symptoms increase approaching menopause and
decrease after menopause - Pain, tenderness, swelling before menses, lumpy
feel to breasts - May have serosanguineous discharge
4Fibrocystic Breasts
- Diagnostic studies
- Mammography, sonography, palpation
- Fine needle aspiration
- Biopsy
5Fibrocystic Breasts
- Treatment
- Restrict sodium intake
- Limit caffeine
- Mild diuretic
- Mild analgesic
- Hormone inhibitor danazol
- Oral contraceptives
- Antiestrogen tamoxifen
- Oil of evening primrose
6Endometriosis
- 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
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8Endometriosis
- 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
9Endometriosis 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
10Polycystic 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
11Polycystic 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
12Polycystic Ovary Syndrome
- Less common features
- Male-pattern baldness
- Skin tags in armpits or neck
- High total cholesterol, low HDL chol.
- High blood pressure
- Diabetes
13Polycystic Ovary Syndrome
- Diagnosis
- Pelvic ultrasound, hormone levels
- Treatment
- Oral contraceptives
- Exercise
- Low calorie diet
- Electrolysis, hair removal creams
- Medicate to cause ovulation in infertility
14Vaginal 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)
15Vaginal Infections
- Candidiasis monilial yeast infection
- Vaginal cottage cheese discharge, itching,
dysuria, dyspareunia - Treatment - Clotrimazole
16Sexually Transmitted Infections (STIs)
- Trichomoniasis
- Protozoal infection
- Toilet seats, wet bathing suits, wet towels
- Yellow-green frothy odorous discharge
- Treatment
- Metronidazole (Flagyl)
- Treat both partners
17STI
- Chlamydia
- Bacterial infection
- Treatment
- Azithromycin, doxycycline
18STI
- Gonorrhea
- Treatment
- Ciprofloxacin with doxycycline
19STI
- Herpes
- Treatment
- Acyclovir
20STI
- Syphilis
- Can be transmitted transplacentally
- Treatment
- Penicillin G
21STI
- Human Papilloma Virus (HPV)
- Venereal warts
- Soft, grayish-pink, cauliflower-like lesions
- Treatment
- Cryotherapy, laser surgery
- Linked to cervical cancer
22STI
23Abnormal 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
24Ovarian 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
25Ovarian Masses
26Ovarian 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
27Uterine 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
28Uterine Fibroids
29Uterine 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
30Endometrial 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
31Endometrial Cancer
32Endometrial 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
33Breast 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
34Manifestations 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
35Diagnostic Tests for Breast Cancer
- Breast examination
- Mammogram
- Needle biopsy
- Excisional biopsy
- Ductal lavage and nipple aspiration
36Treatment for Breast Cancer
- Mastectomy
- Lumpectomy
- Simple
- Modified radical
- Radiation therapy
- Chemotherapy
- Breast Reconstruction
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38Pelvic Relaxation
- Cystocele
- Relaxation of anterior vaginal wall with prolapse
of bladder
39Pelvic Relaxation
- Rectocele
- Relaxation of posterior vaginal wall with
prolapse of rectum
40Pelvic Relaxation
- Uterine Prolapse
- Downward displacement of uterus
41Pessaries
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.
42Hysterectomy
- Surgical removal of uterus
- TAH or TVH w/ BSO
- TAH preferred for cancer, large fibroids,
endometriosis - TVH preferred for small fibroids, abnormal
uterine bleeding
43Female 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
44Female 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
45NCLEX 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.
46NCLEX 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
47NCLEX 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
48NICU 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.
49NICU 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.
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