-
menopause
- 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
-
breast examination
- palaption is the most important technique
- monthly BSE recommended
- perform BSE 1 week aftger menses
-
breast exam recommendations
- 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
-
reproductive health in aging women
- 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
-
is the bladder full or empty for a pelvic examination
empty
-
insufflation
pain in neck, shoulders and upper back after CO2 pumped into body during endoscopy of abdomen or pelvis
-
gynecomastia
- presence of breast tissue in men
- indicates excess femal hormones
-
varicocele
- vericose veins in the spermatic cord
- feels like a bag of worms
-
position of patient during a DRE (digital rectal exam)
knee-chest position
-
DRE (digital rectal exam)
- recommended for all men over 40
- prostate palpated by inserting a gloved, lubricated finger into the rectum
-
TSE (testicular self exam)
- done monthly
- best done after a warm shower or bath
- examine testicles for lumps or hard spots
-
cystourethroscopy
foley catheter inserted and a dye is injected into the bladder
-
cyclic breast discomfort
- swelling, tenderness and sometimes pain associated with hormonal changes
- oral contraceptives and NSAIDs helps alleviate symptoms
-
fibrocystic breast disease
- 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
-
diagnosis and treatment of fibrocystic breast disease
- identified by palpation
- no treatment needed
- limit dietary fat and caffein
- addition of oral contraceptives may help control hormonal changes that result in discomfort
-
mastitis
- breast infection with inflammation
- abscess may form
- breast feels...
- swollen
- hot
- red
- painful
-
treatment and care of pt with mastitis
- NSAIDs
- warm packs
- ice packs
- antibiotic
- breast supports
- breast feedingis ok; infant usually already colonized
-
factors that increase risk of breast cancer
- 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
-
s/sx of breast cancer
- lump or thickening of breast tissue
- change in contour of breast
- clear or bloody nipple discharge
- swelling, discoloration or tenderness of breast
-
prevention of breast cancer
- moderation in fat and alcohol consumption
- methods for nonhormonal birth control and menopause symptoms
- breastfeeding
-
lumpectomy
removal of tumor from breast
-
mastectomy
- partial: remove tumor and margin
- simple: remove breast tissue from one or both breasts
- radical: remove entire breast tissue, underlying muscle and lymph nodes
-
therapeutic measures for breast cancer
- targeted therapy
- hormone therapy
- chemotherapy
- radiation therapy
- surgery
-
hormone therapy as a breast cancer treatment
- drugs reduce amount of circulating estrogen in the body
- drugs block use of estrogen by cancer cells
-
amenorrhea
menses absent for more than 6 months or 3 of previous cycles
-
the aging reproductive system in men
- less testosterone
- less spermatogenesis
- enlarged prostate (BPH)
-
menorrhagia
passing more than 80 ml of blood per menses
-
whatcan cause menstrual disorders
- stress
- pregnancy
- hormonal imbalances
- metabolic imbalances
- tumors
- infection
- organ disease
- foreign bodies in the uterus (ex. iud)
-
Best way to estimate menstrual flow of a pt
weigh the pads
-
treatment of menstrual disorders
- hormone therapy
- dilation and curretage
- laser ablation of endometrial tissue
- hysterectomy
-
dysmenorrhea
- painful menstration
- caused by prostaglandins
- treated with aspirin and NSAIDS; prostaglandin synthesis is supressed
-
PMS
- 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
-
endometriosis
- fuctioning endometrial tissue is located outside the uterus
- causes bleeding into abdominal structures
- treated by reducing estrogen and preventing ovulation
-
s/sx of endometriosis
- pain
- swelling
- damage to abdominal organs
- scar tissue development
- infertility
-
perimenopause
- period of gradual decline in hormone production
- lasts from months to years
- erratic menses
- less lubrication
- more alkaline PH
- hot flashes
- night sweats
-
menopause treatment
- hormone replacement therapy
- phytoestrogens: soy, tofu, flax seeds, black cohosh and dong quai
-
administering meds for a pt with vaginal inflammation or infection
- 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
-
toxic shock syndrome
- 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
-
perevention of toxic shock syndrome
- 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
-
what causes displacement disorders in women
- pregnancies that produce large babies or are rapid/traumatic
- scarring from STDs
- aging and lower estrogen levels
- chronic constipation
- obesity
- lack of exercise
-
therapeutic measures for female displacem disorders
-
pessary
- supportive device to support pelvic organs
- placed at proximal end of vagina
- expect increased clear vaginal discharge
-
cystocele
- bladder sags into vaginal space
- kegels or pessary help
-
rectocele
- rectum sags into vagina
- kegels and high fiber diet may help
- s/sx:
- pelvic pressure
- fecal incontinence
- constipation
- hemorrhoids
-
uterine prolapse
- uterus sags into vagina
- causes:
- gravity
- poor pelvic support
- excessive lifting or straining
-
s/sx of uterine prolapse
- painful intercourse
- pelvic pain
- back pain
- urinary incontinence
- constipation
- hemorrhoids
-
vasovagal reflex
- stimulation of vagal nerve
- caused when cervix, larynx or trachea manipulated
- hypotension
- decreased cardiac output and rate
-
advantage of oral contraceptives
- improved dysmenorrhea
- increased regularity of menses
- decrease in menstrual flow
- improvement of endometriosis
-
disadavantage of oral contraceptives
- higher rates of blood clot formation
- strokes
- high b/p
- heart attacks
- worsening of diabetes
-
use of hormonal contraceptives increases the risk of which vitamin deficiency
vitamin b
-
most effective form of birth control if a pt had a medical reason for not wanting to get pregnant
depo provera; intramuscular shot lasts 3 months
-
implanted birth control
- implanon and uniplant
- not effective for first 2 weeks
- fertility may not return for several months to a year
- gain 5 to 10 pounds
-
contraceptive ring
- left in place for 3 weeks
- removed for 1 week
- use estorgen-progesterone
-
transdermal contraceptive patch
- ortho evra
- on for 3 weeks
- off for 1 week
- place on abdomen, buttock or upper arm
-
IUD
- 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
-
abortion methods for early pregnancy
- 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
-
fibroid tumors
- 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
-
treatment of fibroid tumors
- hormone suppression
- hysterectomy; removal of uterus
- myomectomy; removal of fibroid tumor only
-
polyps
- 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
-
polycystic ovary syndrome
- endocrine imbalance
- excessive insulin stimulates androgen secretion
- linked to family history of too much or too little hair, severe acne, infertility and irregular menses
-
s/sx of polycystic ovary syndrome
- infertility
- obesity
- menstrual disturbances
- masculanization
- elevated b/p
- coronary artery disease
- endometrial cancer
-
tx for polycystic ovary syndrome
- bp meds
- lipid control meds
- oral hypoglycemics
- diet
- oral contraceptives
- antiandrogen meds (aldactone)
-
dermoid cysts
- cells in ovary become foreign tissue (ex. skin, teeth, etc)
- surgically removed
- biopsy done to confirm non-malignancy
- hormone therapy if needed
-
vulvar cancer
- 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
-
cervical cancer
- associated with hsv 2 and hpv
- may experience slight spottingor serosanguineous discharge
- usually asymptomatic
-
diagnostic tests for cervical cancer
- pap smear
- schillers test done after abnormal pap smear
-
gardasil
- hpv vaccination
- for women 9 to 26
- given regardless of sexual activity or hpv exposure
-
endometrial cancer
- most common uterine cancer
- develop from estrogen excess
-
ovarian cancer
- 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
-
prostatitis
- inflammation of prostate
- prostate swells resulting in pain when standing
- prostate is warm, irregular and swollen during DRE
-
s/sx of prostatitis
- urgency
- frequency
- hesitancy
- dysuria
- low back pain
- perineal pain
- postejaculation pain
-
tx of prostatitis
- bactrim for 30 days
- anti-inflammatory agents
- warm sitz baths
- sit on a pillow
- prostatic massage
- stool softeners
- decrease spicy foods and alcohol
-
bph
- enlargement of prostate
- doesn't increase risk of cancer
- narrows urethra
- increases PSA, serum creatinine, BUN levels
-
s/sx of bph
- 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
-
complications of bph
- hydronephrosis
- renal insufficiency
- urosepsis
- damage to bladder walls
- recurrent uti
- calculi
- inability to urinate
-
tx of bph
- catheterization
- fluids and antibiotics for uti
- proscar and avodart to reduce prostate size
- flomax relaxes smooth muscles; monitor for hypotension
-
transurethral resection of the prostate (turp)
- 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
-
post surgical care of turp pt
- 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
-
retrograde ejacualation
- common side effect of prostate surgery
- semen falls back itno bladder
- semen is urniated out
-
prostate cancer
- 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
-
s/sx of prostate cancer
- urinary obstruction
- hematuria
- urinary retention
- hip or back pain during metastic stage
- complications: difficulty urinating, bladder or kidney infection, erectile dysfunction
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