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Aspects of nursing care for medical interruption of pregnancy
- -scientifically based information
- -risks
- -alternatives, non-judgmental attitude
- -support
- -monitoring verbal clues
- -monitoring physical clues
- -importance of post-abortion care
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Papanicolaou smear (pap smear)
screen for cellular abnormalities of cervix and endometrial canal.
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when to start getting pap smears?
at age 18 or once sexually active; once a year
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- frequency of pelvic examination
- what does the examination consist of?
- - yearly at the time of pap smear
- - vulva, vaginal and cervical ispection, bimanual
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gynecologic screenings
- breast examination
- clinical breast examination
- mammography
- pap smear
- pelvic exam
- rectal examinations
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should have vaginal rest for how long with pap smear
24 hrs
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nursing considerations with pelvic exam
- doctor will need?
- privacy and comfort
- - speculum, gloves, lubricant, pap slide, light source, cultures
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nursing care for pap smear
- - assessment of risks, early screening and recommendations, diagnostic procedures
- - bethesda system of reporting results
- - squamnocolumnar junction rises with age
- - anxiety, preparation
- - do not give abnormal reassurance
- - give pre surgery counseling
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diagnostic procedures following an abnormal pap smear
repeat pap, colposcopy, endocervical biopsy, cryotherapy, laster, coinzation, alrge loop excisions of t-zone
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at risk for abnormal pap smear
early first coitus, multiple partners, STD exposure, smoking, long term oral contaceptive use, immunosuppressive therapy, DES exposure in utera, and 98% of the time it is HPV
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-Cystocele
-treatment
- - bladder displacement down into vaginal wall. weakness of fascia. urinary stress incontinence, vaginal fullness, sitting on a ball.
- - kegel's mildly helpful; pessaries until surgery
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rectocele
lower posterior vaginal wall prolapse
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enterocele
upper posterior vaginal wall prolapse usually contains loops of bowel
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uterine prolapse
varying degrees depends on how far prolapse extends
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nursing care: pelvic relaxation
- - instruction of kegel exercises to restore tone. involves contracting and relaxing pubococcygeal muscles
- - before and after childbirth
- - pessaries: urethral plug: surgery
- - urinary incontinence 10% women ages 15-64
- - eliminate caffeine, alcohol, artificial sweetner
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fibrocystic breast disease
most common benign disorder in women 20-50. rare in postmenopausal women not taking HRT. only atypical hyperplastic changes are risk of cancer.
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intraductal papillomas
tumors in terminal portion of duct of breast. unilateral mass and or nipple discharge (usually bloody) benign by may become malignant
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fibroadenoma
benign tumor in teens and 20's. freely movable, solid tumor, sharply delineated, rubbery texture, asymptomatic and non-tender
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galactorrhea
nipple discharge. physiologic, drug induced, idiopathic, pathologic
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duct ectasia
comedomastitis, inflammation of duct behind nipple. occurs around menopause. thick sticky nipple discharge of various colors. may have nipple retraction.
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nursing care for breast disease
- assess risk, discharge, pain, timing, knowledge deficit, anxiety;
- will be extremly anxious;
- give treatment options
- clarify misconceptions
- screenings
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how many in US have malignant breast disease
one in eight
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breast cancer has a higher mortality rate than any other cancer except
lung
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risk factors for breast cancer
- -over 40
- -history of previous cancer
- - family history of 1st degree relative with bilateral pre-menopausal breast CA
- - overweight or obese after menopause
- - alcohol consumption
- - no pregnancy history
- - never breastfed
- - longer reporductive phase
- -physical inactivity
- - geographic location
- -US
- -europe
- -north urban areas
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low risk geographical areas for breast cancer
rural south, asia and africa
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symptoms of breast cancer
- -mass
- -change in size or shape
- -nodularity
- -dimpling
- -retraction
- -erosion or ulceration
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endometriosis
endometrial tissue outside uterine cavity
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