Unit I

• routine postop care
• bowel sounds
• bleeding - check pad/inscision q 4 hrs
• foley/encourage voiding when removed
• leg exercises/TEDs
• coughing/deep breathing
• avoid tub baths until bleeding sos
• avoid heavy lifting, douching, tampons, intercourse 4-6 weeks

• absense of a period
• pregnancy, menopause, lactation, hormonal imbalance, anorexia

painful menstruation (cramps)

• excessive menstruation
• endocrine/reproductive disorders, anticoagulants
• excessive blood loss, fatigue, anemia, hemorrhage, sexual dysfunction

• bleeding between periods
• s/s of cervical/uterine cancer

• S/S of hormomal imbalance (estrogen/progesterone)
• pituitary gland effects fluid levels causing bloating & weight gain
• 10 days before/3 days after menses

• irritibility/mood swings
• depression
• breast tenderness
• abd distention
• acne

• made by exclusion
• blood work for hormonal imbalances

• duiretics
• anti-depressants
• analgesics
• anti-anxieties
• diet: low sodium/caffeine, B vitamins, calcium/mag

• no menses for one year
• age 45-55
• ovaries cease to function, atrophy
• uterus returns to prepubescent size
• vagina dries/thins
• breast tissue & body hair decreases

• hot flashes
• night sweats
• vaginal dryness
• emotional changes

symptoms, age, blood work

• hormone replacement therapy - s/e edema, weight gain, phlebitis
• selective estrogen receptor modulators (SERMs)
• aromatherapy
• herbs
• meditation
• vitamins D, E
• soy protein

• inability to achieve an erection
• spinal cord injury, radial prostatectomy, diabetes, COPD, anti-hypertensives, MS

• treat underlying cause
• erectile dysfunction meds: facilitate blood flow in the corpus caverosum
• Viagra, Cialis, Levitra
• can drop B/P w/nitrates

• inability to conceive a child
• inadequate egg production, blockage of fallopian tube, hormonal imbalance, low sperm count/motility, STDs

• disturbance of normal flora of vagina
• vaginitis is most common (caused by e-coli or yeast)
• r/t antibiotics, birth control, improper hygiene, sexual intercourse, poor handwashing, douching
• tx - vaginal suppositories

• chronic infection of the cervix, uterus, fallopian tubes, ovaries
• r/t gonorrhea/chlamydia, sex w/infected partners, abortion, irrigation, infection during pregnancy
• scar tissue causes infertility
• can spread to other organs

• pelvic pain
• fever
• malaise
• vomiting
• discharge
• dysuria

• C&S
• increased WBC
• ultrasound
• laparoscopy

• antibiotics
• analgesics
• IV fluids
• surgery - adhesions, TAH-BSO
• treat partner at same time

• pt teaching - inform sexual partners, hygiene, abstain during treatment
• monitor VS (temp)
• monitor vaginal drainage

• staph or strep infection
• r/t tampon use, diaphragm, cervical sponge
• change tampon at least every 8 hours

• high fever
• N&V, abd pain, diarrhea
• muscle pain
• sore throat
• HA
• dizziness, low BP
• red rash
• conjunctivitis
• peeling skin on palms/soles
• altered mental status

• antibiotics
• IV fluids to correct eletrolyte imbalance/hypotension
• corticosteroids

• benign uterine tissue grows outside uterus
• cause unknown
• women in 20s, 30s, no pregnancies

• pain
• menorrhagia/metrorrhagia
• painful intercourse
• HA
• backache
• painful defecation
• infertility

• ultrasound
• laparoscopy

• hormones to stop ovarian function (BCP)
• Danzol: causes pseudomenopause
• surgery - removal of endometrial tissue, TAH-BSO

• post-op surgical care
• pain management
• patient teaching - med side effects
• anemia

• uterine prolapse: uterus moves down through vagina
• rectocele: front wall of rectum moves into vagina
• cystocele: bladder falls into vagina

treated surgically - preop kegels

• benign tumors of the uterus
• 20-30% of women over 30, AA, premenopausal

• menorrhagia/metrorrhagia
• increased pelvic pressure
• constipation
• urinary retention
• weight gain
• enlarged abd
• infertility
• painful intercourse

adb/transvaginal ultrasound

• HRT
• uterine artery embolectomy - occludes blood supply to fibroid
• myomectomy - removal of fibroids
• hysterectomy (abd or vaginal)
• endometrial ablation - cauterization of lining of uterus

• benign tumors of the ovaries
• Dx: palpation, ultrasound
• Tx: laparoscopic removal

• HPV
• early sexual experience
• multiple partners
• HIV
• unprotected sex
• smoking
• poor diet

• asymptomatic in beginning
• spotting between periods/after sex
• dark foul discharge
• leukorrhea - white discharge
• leg pain/swelling
• flank pain/pelvic pain
• weight loss
• hematuria
• rectal bleeding

• abnormal pap x2 --> colpopscopy/biopsy
• MRI
• HPV test

• preinvasive - conization (removal of cone shaped section of cervix)
• no metastasis - hysterectomy/intracavity radiation
• metastasis - radical hysterectomy (removal of ovaries, tubes, lymph nodes)

• supine position/legs extended
• Lovenox/antibiotics prophylactically
• pain management
• nurse must wear doximeter badge/lead apron
• no pregnant women/children under 16
• visitors remain 6 feet away
• if discharged, handle with forceps and place in lead container

• age (50-70 yrs)
• family history
• diabetes
• obesity
• uterine polyps
• late menopause
• smoking

moderate to large amounts of abnormal bleeding after menopause (usually painless)

• endometrial biospy
• liver & bone scans
• IVP (renal involvement)
• barium enema (rectal involvement)

• surgery - TAH-BSO, lymph nodes
• chemo
• radiation

• leading cause of death among female cancers
• usually Dx after symptomatic/metastasized (stage 3 or 4)
• less than 20% survival

• older age
• early menarche
• late menopause
• infertility
• Clomid tratment
• family Hx of breast/ovarian cancer

• asymptomatic in beginning
• abd pain/swelling
• indigestion/GI symptoms
• abd mass
• 30% have abnormal pap

• biospy
• elevated CA-125
• CAT scan

surgery - TAH-BSO

• emotional support
• post op care
• pt teaching
• hospice

• benign tumors of the breast due to increased estrogen
• ages 30-50
• increased risk for breast cancer

• palpation
• mammogram
• ultrasound
• biopsy

• reduce caffeine intake
• vitamins C, E, B-complex
• oral contraceptives to suppress estrogen

• most common dx malignancy in women (1 in 8)
• 2nd leading cause of cancer deaths
• survival - 97% if localized, 79% if lymph, 23% if other organs

• white females over 50
• family Hx (mom, sister)
• endometrial cancer, fibrocystic breast changes
• early menarche/late menopause
• late births (after 30)
• multiple CXRs
• 2+ alcoholic drinks daily
• obesity
• smoking
• breast trauma

• 80% of all breast cancers
• originates in mammary ducts
• upper outer quadrant of breast
• 5-9 years of growth before can be palpated
• high cure rate if non-invasive (still in duct)
• most found after invasive (infiltrated other tissues/palpable)
• causes dimpling of breast

• phyical exam (mass > 1cm can be palpated)
• mammogram (mass > 0.5cm)
• ultrasound to distinguish between benign (fluid) vs cancerous (solid)
• biopsy to confirm
• MRI/PET scan

• palpable mass that is small, irregularly shaped, firm, non-tender, non-mobile
• discoloration of the nipple
• breast/axilla tenderness

• T: tumor size
• N: lymph involvement
• M: metastasis
• G1-4: grade of tumor cells

removal of the breast

removal of the breast, chest muscles, lymph nodes

removal of the breast, lymph nodes (chest muscles intact)

removal of the tumor/small margin of surrounding tissue

• wound care
• emotional support
• CSM of affected arm
• no BP/blood work affected arm
• arm exercises - wall climbs, over head pulley, rope turns, arm swings
• patient teaching
• risk for infection
• pain management

• infection of the epididymis (contracts during orgasm/moves sperm)
• Hx of STDs, UTIs

• pain
• scrotal swelling
• fever
• malaise

• urinalysis
• CBC
• exam
• symptoms
• semen specimen

• antibiotics
• ice packs
• scrotal support

• bed rest
• patient teaching - antibiotics
• complication - abscess

• age 15-35
• non-aggressive cancer

• scrotal pain
• edema
• palpable lump in scrotum

• ultrasound
• elevated serum alpha fetoprotein (AFP) and HCG
• CXR/CAT scan (metastasis)

• orchiectomy
• chemo
• radiation

• roll testes between thumb and fingers
• after bath/shower, use soap
• monthly exam

• infections transmitted though vaginal or oral intercourse, mother to fetus
• causes infertility, cancer, chronic infection, death

• patient education
• support groups