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Pap Smears:
Purpose?
System?
Ages performed?
- The most useful procedure for detecting precancerous and cancerous cells shed by the cervix.
- Bethesda system: reports three elements
- Initial exam should be done first year after sex or by age 21. Then annually afterwards
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What is the primary hormone responsible for cramping (Dysmenorrhea or painful periods) during menses? What are secondary reasons? What can be taken for symptom relief?
- Prostaglandin: released during menstruation d/t destruction of endo cells.
- Secondary: Polyps, fibroids, Endometriosis
- Meds: NSAIDS, Oral contraceptives (can help with pain and shorten menstrual periods)
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List ways to relieve symptoms of PMS, including diet tips and meds
- Increase exercise and stress management
- Diet: reduce caffeine, simple sugars, salt, alcohol (depression); drink fluids and six small meals
- Meds: with PMDD (premenstrual dysphoric disorder or severe sx) - Sarafem (Prozac)
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What is vulvovaginal candidiasis? s/s? diagnostics? tx?
- Vulvovaginal candidiasis: yeast infection, affects vulva and vagina
- s/s: intense itching, erythema, dysuria (painful urination), and thick curd like discharge (cottage cheese)
- diagnostic: presenting c/o, KOH wet mount (psuedo hyphae (pH <4.5)
- tx: antifungal Azoles - vaginal inserts done at night
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What are three causes of vaginitis?
- 1. vulvovaginal candidiasis: yeast infection
- 2. Bacterial Vaginosis: caused by gardnerella vaginalis
- 3. Trichomoniasis: protozoon thriving in an alkaline environment
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What are s/s of bacterial vaginosis? diagnostic? tx? risk for pregnancy?
- s/s: fishy odor (especially after sex), thin grayish discharge
- diagnosis: clue cells on wet mount, pH >4.5 + whiff test, shows up on pap smear
- tx: Metrogel (flagyl), clinamycin
- risk: can cause preterm labor
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What is trichomoniasis? s/s? tx? teaching?
- A bacteria that thrives in an alkaline environment
- s/s: purulent vaginal discharge (thin, frothy, malodorous, and yellow-green; itching, edema, redness
- tx: Metronidazole (Flagyl) or Tinidazole (Tindamax)
- teaching: sex should be refrained until cured; reinfection can result if both partners are not treated.
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What is PID and its manifestations? What are two major causes? tx?
- Infection from STD or a lower genital tract infection. Some women are asymptomatic, others: pelvic pain, fever, purulent discharge, nausea, anorexia, irregular vaginal bleeding.
- two major causes: GC and gonorrhea
- tx: Regimen of abx, pain meds, possible surgery
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What is Endometriosis? What are two major s/s? diagnostic? tx?
- It is when endometrial tissue is present outside the uterus, which can respond to stimulation from estrogen and progesterone, which will then grow and proliferate during phases of menstruation. This can cause pain and cyclic bleeding into the pelvic cavity
- two major symptoms: cyclic pain and infertility
- dx: Laparoscopy
- tx: NSAIDS, progesterone, and Danazol therapy for those who desire fertility. surgery
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What are s/s of Gonorrhea / Chlamydia? tx? if left untreated?
- s/s: yellow vaginal discharge and painful urination
- tx: Zithromax / Rocephin and treat partner as well, use condoms until cure is confirmed
- - come back in 2 weeks after tx to see if culture shows clear
- If left untreated -> PID
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What is HPV? Which type # causes 70% of cervical cancer? vaccine? diagnostics?
What does the CDC recommend of when to vaccinate children?
- HPV: also known as genital warts, associated with cervical cancer.
- Type: #16 and 18 causes 70% of cervical cancer.
- Vaccine: a bivalent vaccine (Cervarix) against 16 and 18. another vaccine is Gardasil against types 6, 11, 16 and 18 to protect against genital warts.
- Diagnostics: colposcopy done to evaluate abnormal tissue and detect HPV. Pap tests done more freuently.
- When to vaccinate: immunize males and females age 9-26 using a total of 3 doses (first dose, then in 2 months, then in 4 months)
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Meds to decrease viral load of HSV?
- Acyclovir, famciclovir and valacyclovir: redure or suppress symptoms, shedding, and recurrent episodes
- *If @36 weeks gestation, will put on lower dose to prevent outbreak during labor (otherwise c-sec)
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s/s of each and their tx:
Syphilis
Bacterial Vaginosis
Trichomoniasis
- Syphilis: painless chancre on oral lips, genetalia or anus. Tx: PCN
- Bacterial vaginosis: thin grayish vaginal discharge, fishy odor, pH elevated. Tx: Metronidazole, Clindamycin
- Trichomoniasis: purulent, gray/yellow discharge. Tx: tindamax, metronidazole
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What is the action of an oral contraception?
What are other benefits? s/e? How long should a women abstain or use a condom when first taking the pill?
What does the danger sign, ACHES stand for?
- Inhibits ovulation by suppressing FSH and LH from pituitary, causing endometrium to be less hospitable for implantation to occur.
- Others: Improves acne, PMS symptoms with some forms, dysmenorrhea, endometriosis, DUB (DYSFUNCTIONAL Ureteral bleeding)
- s/e: n/v, breast tenderness, breakthrough bleeding, water retention, mood changes
- Should wait two weeks for unprotected sex with partner
- A (abdominal pain), C (chest pain or SOB), H (headache severe), E (eye problems), S (severe leg or arm pain or numbness)
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List contraindications for BCP
Contraindications: women >35 y/o, smokes or have the following conditions (CVA, MI, clots, unexplained vaginal bleeding)
- Others: known or suspected cancer, suspected pregnancy
- caution with: HTN, migranes, gallbladder dz, diabetes, epilepsy, sickle cell, liver dz
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List properties of IUD. How long does it last?s/e? How often for string check?
- Inserted into uterus to provide continuous preg prevention by releasing progestin, thickening cervical mucus, inhibits sperm motility, and ovulation. also makes endometrium hostile to implantation
- ParaGard for 10 years, Mirena for 5 years
- s/e: cramping and bleeding with insertion, menorrhagia and dysmenorrhea
- String check q1month
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What are advantages and disadvantages of taking Progesterone only contraceptive?
- Pro: good for women who are bf, dx w/ HTN, unable to tolerate estrogen, and who aren't good pill takers (IM inj q12weeks)
- Con: using for 2 or more years can cause irreversible bone loss (teens should be cautious about using this) and is important for teens to get enough calcium and vitamin D when on Depo-provera
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List tx for infertility, including Provera challenge
- 3 month trial in office after 1 year of trying
- Provera challenge: give for 10 days to produce period, then CD 1 to wake up ovaries and produce egg (Clomid)
- CD 10-16: have intercourse
- CD 32-35: will have menses, if not check UPT if pregnant
- - if menses: may repeat cycle 2 more times
- - refer to specialist after 2 more times and no pregnancy
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At what age to start a mammogram? When should a woman self check in regards to her period? How often should she self check? clinical exams?
List risk factors for breast ca
- age 40 q1-2years, earlier if family hx (<35)
- Menses: a few days after your period to self check if breasts aren't sore.
- Self check qmonth starting at age 20
- Clinical exams: q3years age 20-40, yearly after 40
- Risk: mencarge <12 or >55 yo, excessive alcohol, smoking, nulliparity, first born after age 30, no BF, oral contraceptive, prolonged PMP HRT (hormone replacement therapy)
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List nonmodifiable risk factors and modifiable RF of breast cancer
- Nonmodifiable: advanced age, race (older white women), fam hx, menarch before age 12 and menopause after 55.
- Modifiable: excessive alcohol
- cigarette smoking
- nulliparity
- first born after age 30
- no breast-feeding
- oral contraceptive use
- prolonged PMP HRT
- obesity
- sedentary lifestyle
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List post-op nursing care of Mastectomy
- Position in semi-fowlers with arm elevated
- Wound care: JP suction, bleeding, temp, swelling
- CSM
- avoid BP of on affected side
- TCDB/pain
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List Patient teaching of Post-op Mastectomy
- Encourage arm exercies
- Emotional support
- Reconstruction options
- avoid constrictive clothing
- How to report s/s of edema, redness, breakdown, mass/lump on other breast
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List cancer risks of uterine cancer
- Obesity
- never been pregnant, infertility/drugs, or 1st child AFTER 30
- DM
- ERT
- Menses <12yo and late menopause >55yo
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What is mixed incontinence and overflow incontinence?
- Mixed: s/s of both stress incontinence and Urge incontinence
- - Stress: sudden loss of urine from intra-abd pressure (sneezing, coughing, etc)
- - Urge: loss of urine with strong desire to void as bladder contracts. Strain to empty bladder, but emptying is incomplete.
- Overflow: involuntary
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List tx and meds for urinary incontinence
- tx: kegel's, biofeedback, pelvic stimulation, urodynamics
- (biofeedback involves measurement of BP, HR, temp, sweat, etc. to alert pts instantly early signs of tension so they can commence relaxation techniques)
- (pelvic stimulation causes muscles to tighten or contract, strengthening them)
- Meds: estrogen vaginal creams, anticholinergics, bladder neck sling, TVT
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List the types of Pelvic Organ Prolapses
- Cystocele: bladder drops into vagina
- Rectocele: rectum bulges into vagina
- Enterocele: small intestine bulges into vag.
- Uterine Prolapse: uterine drops into vagina
- Vagina vault prolapse: uterus removed and walls of vagina fall into themselves
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List nonsurgical and surgical tx of Pelvic organ prolapses
- Nonsurgical:
- - wearing a pessary ring to support organ
- - kegal exercises to strengthen pelvic muscle (contract your pelvic floor muscle as if to stop the urine stream for 10x twice a day.)
- Surgical:
- - Cystocele: anterior repair (sutures)
- - Rectocele and Enterocele: posterior repair (sutures)
- - Uterine Prolapse: Hysterectomy
- - Vaginal vault prolapse: suspension
- (Cystocele: bladder drops into vagina
- Rectocele: rectum bulges into vagina
- Enterocele: small intestine bulges into vag.
- Uterine Prolapse: uterine drops into vagina
- Vagina vault prolapse: uterus removed and walls of vagina fall into themselves)
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List characteristics of Estrogen and Progesterone
- Estrogen: secreted by ovaries
- - protects against heart disease, CVA, osteoperosis, dementia
- - improves thickness and elasticity of skin, vaginal and bladder walls
- - improves brain fxn, body balance
- Progesterone: secreted by ovaries
- - prepares uterus for pregnancy
- - protects against uterine, breast ca, osteoperosis, fibrocystic breast dz and ovarian cysts
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List characteristics of Testosterone and Thyroid
- Testosterone: secreted by testes, ovaries, and adrenal gland
- - affects energy level, muscle mass, strength, endurance, fat development, exercise tolerance and mood
- Protects against MI, CVA, HTN, obesity, and arthritis
- Thyroid: secreted by thyroid gland
- - regulates circulation, temp, metabolism and brain fxn
- - protects against MI, CVA, brain metabolism [improved] and memory problems
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What is and list s/s of Perimenopause.
What can be done?
- Perimenopause includes premenopause, menopause, and at least 1 year AFTER menopause)
- s/s can last 7-10 years:
- - hot flashes, night sweats
- - vaginal dryness, mood swings
- - forgetfullness, HA
- - urinary problems, decreased libido
- What to do:
- - soy-rich diet
- - ERT/HRT (estrogen alone can be used for women don't have a uterus, HRT (estrogen and progesterone) is needed if women has a uturus)
- - vaginal creams for dryness
- - vitamin D and calcium (estrogen deficiency can lead to bone loss or type 1 osteoperosis)
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What are type 1 and 2 osteoperosis?
What is type 3?
- Type 1: characterized by increased bone resorption d/t osteoclastic activity r/t estrogen deficiency
- - continues 15-20 years after menopause
- - pts. c/o back pain
- - vertebral crush fx, and distal radius fx main complications
- Type 2: results from normal aging and associated with 1-2% loss of bone mass yearly (starting at age 35-40)
- Type 3: secondary to another illness or use of meds
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What is the dexa scan and what do the scores mean? (scores not tested)
- A non-invasive test that measures bone density in the hip and spine
- T-score of <-1.0 = normal
- -1.0 to -2.5 is osteopenia (low bone density but not yet osteoperosis)
- <-2.5 = osteoperosis
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How can these drugs help with osteoperosis?
Bisphosphonates
Estrogen
SERMs
Calcitonin
Teriparatide
- Bisphosphonate: inhibits osteoclasts (cells that break down bone). Drugs like Alendronate (fosamax) are used to prevent and treat postmenopausal osteoperosis.
- Estrogen: low estrogen is associated with Type 2 osteoperosis
- SERM: Raloxifine (Evista) is a selective estrogen receptor modulator or SERM, which binds to estrogen receptors to reduce bone loss
- Calcitonin: a calcium regulator usually prescribed as a daily nasal spray. produces modest increases in bone mass because it slows the rate at which osteoclasts absorb bone
- Teriparatide: an injectable parathyroid hormone for postmenopausal women, which stimulates new bone formation.
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List prevention methods for heart dz in women
- Healthy diet
- Increase soluble fiber
- Limit cholesterol and total fat (saturated and trans)
- Get fasting lipid panel q5years
- colonoscopy by age 50
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