repro

• absence of  menses for 12 months
• occurs between 45 and 55
• estrogen secretion decreases and ovulation and menstrual cycles  become irregular and finally cease
• increased risk of heart disease
• osteoporosis

• palaption is the most important technique
• monthly BSE recommended
• perform BSE 1 week aftger menses

• yearly mammograms at age 40
• clinical breast esam every 3 years during the 20s and 30s, yearly at 40
• optional BSE starting in the 20s
• MRI and mammogram for women at high risk

• increased bone loss due to lower estrogen levels
• dietary calcium and vitamin D required unless on hormone replacement
• elevated choloesterol levels
• dry vagina
• women over age 65 should have bone density tests
• women over 50 should be assessed for bone loss

empty

pain in neck, shoulders and upper back after CO2 pumped into body during endoscopy of abdomen or pelvis

• presence of breast tissue in men
• indicates excess femal hormones

• vericose veins in the spermatic cord
• feels like a bag of worms

knee-chest position

• recommended for all men over 40
• prostate palpated by inserting a gloved, lubricated finger into the rectum

• done monthly
• best done after a warm shower or bath
• examine testicles for lumps or hard spots

foley catheter inserted and a dye is injected into the bladder

• swelling, tenderness and sometimes pain associated with hormonal changes
• oral contraceptives and NSAIDs helps alleviate symptoms

• common in women between 30 and 50
• overresponsiveness to in breast cells to hormonal stimulation
• normal tissue replaced with fibrous tissue and cysts may form
• breasts feel hard and lumpy
• subside with menopause
• non-cancerous

• identified by palpation
• no treatment needed
• limit dietary fat and caffein
• addition of oral contraceptives may help control hormonal changes that result in discomfort

• breast infection with inflammation
• abscess may form
• breast feels...
• swollen
• hot
• red
• painful

• NSAIDs
• warm packs
• ice packs
• antibiotic
• breast supports
• breast feedingis ok; infant usually already colonized

• family history of breast, ovarian or prostate cancer
• didn't breast feed
• smoking
• high-fat diet
• high alcohol diet
• treament with estrogens
• earl menarche
• late menopause
• first pregnancy after 25

• lump or thickening of breast tissue
• change in contour of breast
• clear or bloody nipple discharge
• swelling, discoloration or tenderness of breast

• moderation in fat and alcohol consumption
• methods for nonhormonal birth control and menopause symptoms
• breastfeeding

removal of tumor from breast

• partial: remove tumor and margin
• simple: remove breast tissue from one or both breasts
• radical: remove entire breast tissue, underlying muscle and lymph nodes

• targeted therapy
• hormone therapy
• chemotherapy
• radiation therapy
• surgery

• drugs reduce amount of circulating estrogen in the body
• drugs block use of estrogen by cancer cells

menses absent for more than 6 months or 3 of previous cycles

• less testosterone
• less spermatogenesis
• enlarged prostate (BPH)

passing more than 80 ml of blood per menses

• stress
• pregnancy
• hormonal imbalances
• metabolic imbalances 
• tumors
• infection
• organ disease
• foreign bodies in the uterus (ex. iud)

weigh the pads

• hormone therapy 
• dilation and curretage
• laser ablation of endometrial tissue
• hysterectomy

• painful menstration
• caused by prostaglandins
• treated with aspirin and NSAIDS; prostaglandin synthesis is supressed

• symptoms: water retention, headaches, discomfort of joints muscles and breasts, changes in affect and concentration, sensory changes
• treatment: nsaids, aspirin, antidepressants, diuretics, calcium, magnesium, vitamin e, vithamin b12
• restrict alcohol, caffeine, nicotine, salt and simple sugars

• fuctioning endometrial tissue is located outside the uterus
• causes bleeding into abdominal structures
• treated by reducing estrogen and preventing ovulation

• pain 
• swelling
• damage to abdominal organs
• scar tissue development
• infertility

• period of gradual decline in hormone production
• lasts from months to years
• erratic menses
• less lubrication
• more alkaline PH
• hot flashes
• night sweats

• hormone replacement therapy
• phytoestrogens: soy, tofu, flax seeds, black cohosh and dong quai

• pt should wear absorbent pad to prevent staining
• best to apply meds when pt is lying down and ready to sleep
• administer medicated douches to hospitalized pt sitting in a bed pan in semi fowlers
• pt may self admin while on toilet

• associated with use of super absorbent tampons or nasa packings
• s/sx:
• redness of palms and soles of feet
• sudden high fever with sore throat
• headache
• dizziness
• rash
• blisters
• petechiae
• peeling of the skin
• confusion

• use sanitary napkins instead of tampons at night
• change tampons every 4 hours
• wash hands before inserting anything into vagina
• don't leave female barrier contraceptives in longer than needed
• not using female barrier contraceptives in teh first 12 weeks after birth

• pregnancies that produce large babies or are rapid/traumatic
• scarring from STDs
• aging and lower estrogen levels
• chronic constipation
• obesity
• lack of exercise

• pessary
• kegels

• supportive device to support pelvic organs
• placed at proximal end of vagina
• expect increased clear vaginal discharge

• bladder sags into vaginal space
• kegels or pessary help

• rectum sags into vagina
• kegels and high fiber diet may help
• s/sx:
• pelvic pressure
• fecal incontinence
• constipation
• hemorrhoids

• uterus sags into vagina
• causes:
• gravity
• poor pelvic support
• excessive lifting or straining

• painful intercourse
• pelvic pain
• back pain
• urinary incontinence
• constipation
• hemorrhoids

• stimulation of vagal nerve
• caused when cervix, larynx or trachea manipulated
• hypotension
• decreased cardiac output and rate

• improved dysmenorrhea
• increased regularity of menses
• decrease in menstrual flow
• improvement of endometriosis

• higher rates of blood clot formation
• strokes
• high b/p
• heart attacks
• worsening of diabetes

vitamin b

depo provera; intramuscular shot lasts 3 months

• implanon and uniplant
• not effective for first 2 weeks
• fertility may not return for several months to a year
• gain 5 to 10 pounds

• left in place for 3 weeks
• removed for 1 week
• use estorgen-progesterone

• ortho evra
• on for 3 weeks
• off for 1 week
• place on abdomen, buttock or upper arm

• made of copper or plastic
• paragard (copper wire) lasts for 10 years
• mirena (plastic with progestin) lasts for 5 years
• may cause pelvic inflammatory disease
• inserted during first 7 days of menstrual cycle
• insertion has risk of vasovagal reflex

• menstrual extraction: suction away endometrial lining within 7 weeks
• vacuum aspiration: suction of uterus within 13 weeks
• DandC: cervix dilated and uterine contents scooped out wthin 13 weeks

• benign tumors implanted in walls of the uterus
• cause pain or menstural disorders
• exert pressure on bladder or bowel
• affect fertility
• cause necrosis by cutting off blood supply

• hormone suppression
• hysterectomy; removal of uterus
• myomectomy; removal of fibroid tumor only

• benign growths that grow inside uterus or on cervix
• may bleed after intercourse or between menstrual cycle
• usually develop after 42 
• removed vaginally or transcervically

• endocrine imbalance
• excessive insulin stimulates androgen secretion 
• linked to family history of too much or too little hair, severe acne, infertility and irregular menses

• infertility
• obesity
• menstrual disturbances
• masculanization
• elevated b/p
• coronary artery disease
• endometrial cancer

• bp meds
• lipid control meds
• oral hypoglycemics
• diet
• oral contraceptives
• antiandrogen meds (aldactone)

• cells in ovary become foreign tissue (ex. skin, teeth, etc)
• surgically removed
• biopsy done to confirm non-malignancy
• hormone therapy if needed

• persistent itching of vulva
• appearance of white or red patches, rough areas, skin ulcers or wartlike growths
• risk factors:
• stds
• precancerous or cancerous changes of anus or genitalia
• immune system depression
• smoking

• associated with hsv 2 and hpv
• may experience slight spottingor serosanguineous discharge
• usually asymptomatic

• pap smear
• schillers test done after abnormal pap smear

• hpv vaccination
• for women 9 to 26
• given regardless of sexual activity or hpv exposure

• most common uterine cancer
• develop from estrogen excess

• usually asymptomatic until cancer is adavanced
• treatment involves surgery and radiation therapy
• risk factors:
• low fertility
• low number of children
• late menopause
• family history of colon cancer
• diet rich in animal fats

• inflammation of prostate
• prostate swells resulting in pain when standing
• prostate is warm, irregular and swollen during DRE

• urgency
• frequency
• hesitancy
• dysuria
• low back pain
• perineal pain
• postejaculation pain

• bactrim for 30 days
• anti-inflammatory agents
• warm sitz baths
• sit on a pillow
• prostatic massage
• stool softeners
• decrease spicy foods and alcohol

• enlargement of prostate
• doesn't increase risk of cancer
• narrows urethra 
• increases PSA, serum creatinine, BUN levels

• obstruction or problems related to riirtation
• difficulty in startin a stream
• dribbling after urination is complete
• urinarty retention
• feeling that the bladder is not empty
• overflow incontinence
• nocturia
• dysuria
• urgency

• hydronephrosis
• renal insufficiency
• urosepsis
• damage to bladder walls
• recurrent uti
• calculi
• inability to urinate

• catheterization
• fluids and antibiotics for uti
• proscar and avodart to reduce prostate size
• flomax relaxes smooth muscles; monitor for hypotension

• rectoscope inserted into urethra and prostate is "chipped"
• away
• foley catheter filled with 30 - 60 cc of water to stop the bleeding
• continuous bladder irrigation for 24 - 48 hrs to maintain patency

• monitor amount and color of urinary output for first 24 - 48 hrs
• bloody urine is normal
• sent home with light pink to clear urine
• encourage pt to drink up to 2500 ml of fluids
• avoid constipation and heavy lifting
• avoid aspirin and nsaids
• belladonna and opium suppositories for bladder spasms
• no driving
• no sex for 6 weeks
• stool softeners for 6 - 8 weeks

• common side effect of prostate surgery
• semen falls back itno bladder
• semen is urniated out

• most common cancer in men
• grow slowly, not a major threat
• spreads to bladder, seminal vesicles, peritoneum or lymph
• often in men over 65
• during DRE hard lump or hardened lobe found
• elevated PSA or PAP

• urinary obstruction
• hematuria
• urinary retention
• hip or back pain during metastic stage
• complications: difficulty urinating, bladder or kidney infection, erectile dysfunction