FINAL: OB Reproductive Health

What is perinatal loss?

Nonvoluntary end of pregnancy from conception through 28 days of life

What are some causes of uterine prolapse?

Pelvic relaxation - child birth, reproductive surgery, radiation

What are the 3 stages in the Cycle of Violence

Phase 1: Tension-building Phase 2: Acute battering Phase 3: Honeymoon

Treatment for Premenstrual Dysphoric Disorder (PMDD)

Same as PMS plus calcium supplement

Substance abuse in pregnant females will likely result in....

low birth weight infants

Treatment for Intraductal papilloma

once malignancy is ruled out then a surgical excision is performed

dyspareunia

painful intercourse

What is a short term fix for uterine prolapse?

pessary

What is the leading cause of anovulation and most common endocrine problem in premenopausal women?

polycystic ovary syndrome

Cystocele

protrusion of bladder into the vagina, difficulty emptying of bladder

Modified radical mastectomy

removal of breast and lymph nodes

Radical Mastectomy

removal of breast, axillary nodes, pectoral muscle

Lumpectomy

removal of tumor

Partial mastectomy

removal of tumor and varying amount of tissue around tumor

Hypomenorrhea

scanty bleeding

What causes hot flashes and night sweats?

vasospasm instability

Ovarian Cyst (malignant)

-Slow growing "silent killers" -Early diagnosis uncommon -Recurrence common -Stage I-IV (85% stage III & IV) -Treatment (Surgery, chemo, radioactive implant, radiation) ***5th cancer killer of women!

S/S Breast Cancer

-Unilateral, upper outer quadrant -Nipple discharge, usually bloody -Painless, lump, usually not well defined -Invades surrounding tissue with "crab-like" tenticles -Fibrosis results in puckering (orange skin) appearance

Treatment for Premenstrual Syndrome (PMS)

-address the symptoms -lifestyle changes -decrease/stop alcohol and/ or smoking -vitamins, antidepressants, diuretics, NSAIDs

Nipple Discharge

-common occurrence in females -bilateral serous discharge expressed during nipple stimulation can be considered a normal finding -must be evaluated because a small % could be r/t a serious endocrine disorder or malignancy

Fibroadenoma

-benign breast condition -can occur from puberty through menopause -Discrete, solid, non-tender, solitary lumps typically found in upper outer quadrant -Definitive diagnosis is needed to rule out carcinoma via a Mammography, ultrasound, or MRI

What are some treatments for preinvasive cervical cancer?

-cryosurgery -laser -electrosurgical excision LEEP

What is the treatment for fibrocystic changes in the breast?

-diuretics -decrease caffeine -NSAIDs

Benign Neoplasms

-Ovarian cysts (hormonal influences) -Polycystic ovarian syndrome -Uterine polyps (cervix and endometrium) -Leiomyomas (tumors in the muscle of uterus)

What are some treatments for invasive cervical cancer?

-Radical hysterectomy (uterus, BSO, 1/3 of vagina, ligaments, node dissection) -Radiation therapy -Pelvic Exenteration

Premenstrual Dysphoric Disorder (PMDD)

-Severe variant of PMS - 3-8% -Mood disorder: depression, anxiety, tension, anger -Week before and few days after onset of menstruation

Total Mastectomy

(simple) removal of all breast tissue = breast, nipple, areola

Menopause

-1 year without a menstrual period -End of reproduction (fertility) -No follicle = decrease in estrogen and progesterone = amenorrhea

Normal sperm characteristics

-20 million/ml or > 40 million per ejaculate; (vol1.5 to 5 ml) -motile > 50% -normal shape > 30% -viscosity > 3 (0-4) sperm agglutination less than < 2 (0-3)

What are some s/s of POCS?

-Acanthosis nigricans (indicates insulin resistance) -Menstrual cycle disturbances (amenorrhea, anovulation & infertility) -Obesity (central, android, apple) -Hyperandrogenism (hirsutism)

Pathophysiology of Breast Cancer

-Alterations (mutations) in breast cells -Invasive - infiltrating -Noninvasive - in situ -Most frequent - Invasive ductal carcinoma

Risk factors for breast malignancy

-Caucasian, high socioeconomic -Genetics - 5% -Environmental risks -Menarche before 12, menopause after 55 -Nulliparity, estrogen replacement -Obesity, high-fat diet -US (highest rate of breast cancer): 1 in 8

Cervical Cancer (malignant)

-Cell change (dysplasia) -Carcinoma in situ -Gradual onset -detection via pap smear -Invasive carcinoma (cells penetrate into uterus)

What are risk factors for cervical cancer?

-Early age for sexual intercourse -Multiple partners/ partner with multiple

Types of perinatal loss

-Ectopic pregnancy -Miscarriage (loss before 20 weeks) -Stillbirth (loss after 20 weeks) -Neonatal/ Newborn death (live birth followed by death in 28 days)

What is Endometriosis?

-Endometrial tissue is located outside the uterus: attaches to ovaries, fallopian tubes, outer side of uterus, bowels, pelvic wall and rectovaginal septum -All endometrial tissue responds to hormones regardless of location

Management of menopause

-Hormone therapy (HRT) = risks vs. benefits -Weight bearing exercises, supplements -Annual breast exam and mammogram -Estrogen cream -Herbal treatments

Menopause symptoms (result of decreased estrogen)

-Hot flashes, disturbed sleep, mood changes -Lower HDL, increased CVD -Decrease bone density, osteoporosis -Vaginal dryness, cystitis, stress incontinence -Skin dry and thin -More abdominal fat

Treatment for POCS

-Oral Contraceptive (regulate bleeding/hyperandrogenism) -anti-androgens (spironolactone) -insulin lowering medications -lifestyle (diet,exercise,behavioral support/counseling)

Factors that can alter sperm counts

-heat, desk job with less ambulation, hot tubs, saunas chronic infection: TB, sinusitis ( temp), cryptorchidism (undescended testes); -sons of DES mothers (Diethylstilbesterol exposure>abnormal sperm)

vaginismus

-involuntary vaginal contraction -cannot insert anything in (tampon etc)

Endometrial Cancer (malignant)

-most common -50-65 yrs -slow growing -good prognosis -Screening not routine -Metastasis through lymphatic system

Fibrocystic changes in breast tissue

-most common benign breast problem -Palpable thickening, with or without pain and tenderness -Fluctuates with menstrual cycle -70% non-proliferative -25% proliferative (2X risk for breast cancer)

Infertility

-no pregnancy after 1 yr unprotected sex -if female > age 30, consult after 6 months

Intraductal papilloma

-rare, benign condition that develops in the terminal nipple ducts -too small for palpations -clinical presentation with sign of serous, serosanguineous, or bloody nipple discharge (unilateral and spontaneous)

Mastitis

-sore red area on breast -fever, flu-like symptoms -Tx: antibiotic therapy

The nurse in a maternity unit is providing emotional support to a client and her husband who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement made by the client indicates a component of the normal grieving process? A. "We want to attend a support group." B. "We never want to try to have a baby again." C. "We are going to try to adopt a child immediately." D. "We are okay, and we are going to try to have another baby immediately."

A. "We want to attend a support group." Rationale: A support group can help the parents work through their pain by nonjudgmental sharing of feelings. The correct option identifies a statement that would indicate positive, normal grieving. Although the other options may indicate reactions of the client and significant other, they are not specifically a part of the normal grieving process.

A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the family remained together, holding and touching the baby. Which statement by the nurse would further assist the family in their initial period of grief? A. "What can I do for you?" B. "Now you have an angel in heaven." C. "Don't worry, there is nothing you could have done to prevent this from happening." D. "We will see to it that you have an early discharge so that you don't have to be reminded of this experience."

A. "What can I do for you?"

Which virus is highly linked to cervical cancer?

HPV

Premenstrual Syndrome (PMS)

Variety of symptoms occurring in the luteal phase of the menstrual cycle, resolves with the onset of menstruation

When is a good time to do a BSE?

after menses and 1x/month

Primary symptoms of endometriosis

as tissue swells and bleeds in response to cycle hormones (estrogen) damage to organs and adhesions develop, infertility can result *painful

What are late signs of cervical cancer?

back pain and rectal bleeding

Metrorrhagia

bleeding at other times

What is a primary intervention for IPV?

breaking the abuse cycle through community initiatives

What is fibrocystic changes in the breast associated with?

caffeine, ETOH, smoking

What is a secondary intervention for IPV?

dealing with victims and abusers in early stages to prevent progression of abuse

Premenopause

decrease in immature ova

Oligomenorrhea

decreased menstruation, either amount, time, or both

Menorrhagia

excessive menstrual bleeding

What is a tertiary intervention for IPV?

helping severely abused women and children recover and become productive members of society and rehabilitating abusers to stop the cycle of violence

Rectocele

herniation of rectal wall into vagina