OB Chapter 4

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? "I feel irritable and moody a week before my period is supposed to start." "I have lower abdominal pain beginning the third day of my menstrual period." "I have nausea and headaches after my period starts, and they last 2 to 3 days." "I have abdominal bloating and breast pain after a couple days of my period."

"I feel irritable and moody a week before my period is supposed to start." PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.

An effective relief measure for primary dysmenorrhea would be to: reduce physical activity level until menstruation ceases. begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. Staying active is helpful since it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. Decreasing intake of salt and refined sugar can reduce fluid retention. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis.

RX for PMS/PMDD:

diuretics, NSAID's, progesterone and oral contraceptives (OCP), SSRI's: Prozac, zoloft, celexa, lexapro and paxil and approved as 1st line therapy.

The CDC-recommended medication for the treatment of chlamydia would be: doxycycline. podofilox. acyclovir. penicillin.

doxycycline. Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis.

Endometriosis:

endometerial cells growing outside of the uterus. Cysts form with blood. After menstruation, the tissue bleeds resulting in an inflammatory response w/fibrosis and adhesions to adjacent organs

Self-care instructions for a woman following a modified radical mastectomy would include that she: wears clothing with snug sleeves to support her affected arm. use depilatory creams instead of shaving the axilla of her affected arm. expect a decrease in sensation or tingling in her affected arm as her body heals. empty surgical drains once a day or every other day.

expect a decrease in sensation or tingling in her affected arm as her body heals. Loose clothing should be worn since tight clothing could impede circulation in the affected arm. The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used. A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery. Drains should be emptied at least twice a day and more often if necessary.

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: it is most commonly caused by anovulation. it most often occurs in middle age. the diagnosis of DUB should be the first considered for abnormal menstrual bleeding. the most effective medical treatment involves steroids.

it is most commonly caused by anovulation. Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: it probably is the result of a hormone deficiency that can be treated with medication. it may be caused by stress or excessive exercise or both. it likely will require the client to eat less and exercise more. it often goes away on its own.

it may be caused by stress or excessive exercise or both. Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This is usually caused by stress, body fat to lean ratio, and in rare occurrences a pituitary tumor. It cannot be treated by medication. Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. In most cases a client will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition.

Dysmenorrhea Tx:

Heating pad or hot baths minimize cramping by increasing vasodilation and muscle relaxation. Exercise and pelvic rocking.

Define Secondary dysmenorrhea

Menstrual pain that develops later in life (p25yo) and usually associated w/pelvic pathology.

PMS Sx:

More than 150 Sx: bloating, pelvic fullness, edema of the lower extremities, breast tenderness, weight gain, depression.....

Dysmenorrhea Rx:

NSAID's (prostaglandin inhibitors). SE: GI upset and report dark stool, an indication of GI bleeding. Oral contraceptives relieve symptoms fro 90% of women. * acetaminophen is less effective because it doesn't have the anti prostaglandin properties of NSAID's. *

Endometriosis S/S:

Nonexistant to incapacitating. Pelvic pain, painful intercourse, pain radiating to thighs, bowel symptoms and pain during exercise (a result of adhesions)

Define Primary dysmenorrhea

Pain associated with ovulatory cycles

Define: Dysmenorrhea

Pain during or shortly before menstruation (more common in obese and smokers)

A nurse counseling a client with endometriosis understands which statements regarding the management of endometriosis is accurate? (Select all that apply) Bone loss from hypoestrogenism is not reversible. Side effects from the steroid danazol include masculinizing traits. Surgical intervention often is needed for severe or acute symptoms. Women without pain and who do not want to become pregnant need no treatment. Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs).

Side effects from the steroid danazol include masculinizing traits, Surgical intervention often is needed for severe or acute symptoms and Women without pain and who do not want to become pregnant need no treatment. Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman's age and desire to have children. Treatment is not needed for women without pain or the desire to have children. In women with mild pain who may desire a future pregnancy, treatment may be limited to use of NSAIDs during menstruation.

PMDD: Premenstrual dysphoric disorder:

a more severe form of PMS

Define Amenorrhea

absence of menstrual flow

Amenorrhea is a classic sign of:

anorexia. Other causes are 20% underweight and athlete level exercise.

The nurse should include which information when teaching a 15-year-old about genital tract infection prevention? (Select all that apply.) Wear nylon undergarments. Avoid tight-fitting jeans. Use floral scented bath salts. Decrease sugar intake. Do not douche. Limit time spent wearing a wet bathing suit

Avoid tight-fitting jeans, Decrease sugar intake & Do not douche. Patient teaching for the prevention of genital tract infections in women includes the following guidelines: • Practice genital hygiene. • Choose underwear or hosiery with a cotton crotch. • Avoid tight-fitting clothing (especially tight jeans). • Select cloth car seat covers instead of vinyl. • Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights). • Limit exposure to bath salts or bubble bath. • Avoid colored or scented toilet tissue. • If sensitive, discontinue use of feminine hygiene deodorant sprays. • Use condoms. • Void before and after intercourse. • Decrease dietary sugar. • Drink yeast-active milk and eat yogurt (with lactobacilli). • Do not douche. Incorrect Feedback: Patient teaching for the prevention of genital tract infections in women includes the following guidelines: • Practice genital hygiene. • Choose underwear or hosiery with a cotton crotch. • Avoid tight-fitting clothing (especially tight jeans). • Select cloth car seat covers instead of vinyl. • Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights). • Limit exposure to bath salts or bubble bath. • Avoid colored or scented toilet tissue. • If sensitive, discontinue use of feminine hygiene deodorant sprays. • Use condoms. • Void before and after intercourse. • Decrease dietary sugar. • Drink yeast-active milk and eat yogurt (with lactobacilli). • Do not douche.

Several noted health risks are associated with menopause. These risks include all except: osteoporosis. coronary heart disease. breast cancer. obesity.

Breast Cancer Osteoporosis is a major health problem in the United States. It is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman's risk of developing and dying of cardiovascular disease increases significantly after menopause. Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, which may require an adjustment in lifestyle and eating patterns.

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should: point out that inappropriate sexual behavior caused the infection. position the woman in a semi-Fowler position. explain to the woman that infertility is a likely outcome of this type of infection. tell her that antibiotics need to be taken until pelvic pain is relieved.

position the woman in a semi-Fowler position. Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and reduce discomfort. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested. The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.