reproductive OB exam

Syphilis Causes/Diagnosis

*causes:* Sexual intercourse ​ Kissing​ Biting​ Oral sex​ ​ *diagnosis:* Microscopic exam of lesions​ Detect T. pallidum directly from exudate (drainage) to get definitive dx​ False positives common (early primary) ​ Other tests are done to confirm microscopic test (FTA-ABS & TP-PA)​

Chlamydia Treatment

*#1 = azithromycin* (single dose) doxycycline (BID for 7 days) Pregnant pt should be retested 3-4 weeks to determine if the tx was effective Exposed sexual partners should be treated Retest 3 months after tx for reinfection or tx failure *Teaching:* -abstinence for 7 days after all partners have been treated​ -"Ping-pong effect" → treatment, reexposure, reinfection -all sexual contacts in 60 days should be evaluated and treated to pvt reinfection and further transmission ​

PCOS (Polycystic Ovary Syndrome) diagnostics

*At least 2 of the following symptoms:​* -irregular periods (including periods that come too ​ often, not often enough, or not at all)​ -high levels of androgens ​(hirsutism,acne,thinning of scalp hair)​ -multiple cysts on one or both ovaries​ thorough lab work up is done to rule out other ​ conditions ​ *high levels of androgens and insulin resistance are key features*

Uterine Cancer clinical manifestations, dx, tx:

*Early symptoms:* -abnormal uterine bleeding ​ *Later symptoms:* -dysuria -dyspareunia -unintentional weight loss -pelvic pain​ *Complications:* -Metastasis in lung, liver, bone, and brain if not treated early​ -Spreads through lymph system​ Pelvic exam reveal uterine enlargement or mass​ *Treatment :​* Full hysterectomy, bilateral salpingo-oophorectomy and lymph node biopsy ​ External or internal radiation after surgery if there are metastasis​ Chemo only used for aggressive and recurrent metastasis​

Urinary incontinence Nursing interventions

*Nursing interventions:​* -Maintain privacy, dignity, and self-worth of patient​ -Containment devices to manage existing urinary leakage ​ -Have a definitive plan to reduce or resolve the factors leading to UI​ -Manage or reduce severity of symptoms ​ -Promote hygienic and skin care measures​ *Teaching:​* -Adequate fluid intake​ -Increase dietary fiber​ -Light exercise​ -Use of stool softeners​ -Reduce bladder irritants ​ -Maintain a regular, flexible urination schedule​ -Relationship between constipation, UI, and urinary retention​

Syphilis Treatments​

*Penicillin G* one IM injection: primary, secondary and early latent 3 IM injections: late- latent or unknown duration ​ *Med Alert​:* Penicillin can have a reaction called Jarisch-Herxheimer (acute febrile reaction that occurs in 1st 24 hours​) ​----> If this happens in the 2nd half of pregnancy, preterm labor can occur​ ​ *Allergy tx:* -Doxycycline -Tetracycline​ *Teaching:* -Monthly follow -additional tx may be needed ​ -Long term serology testing -even if no symptoms ​ -Sexual abstinence until tx is complete​ -Notify all partners who may have been exposed

Cervical Cancer Treatment

*Prevention​* -vaccinated between ages 11-12 ​ -Gardasil ​ -Gardasil 9 ​ -Cervarix *Preinvasive​* -LEEP​ -Laser ablation​ -Cryosurgery​ -Frequent paps *Invasive​* -Surgery​ -Chemo​ -Radiation​ -Bevacizumab *Interventions​* -Vaccination​ -Emphasize importance of follow ups​ -Early detection​ -Smoking Cessation​ -Listen/ provide emotional support

Syphilis Signs & Symptoms

*Primary:* -lesions, 5-90 days after infection -painless papules which erode into nontender ulcers​ *Secondary:* -systemic, 6 weeks- 6 mos after -symmetrical maculopapular rash on palms & soles -fever -headache -malaise -condylomata lata (pink-gray wart like infectious lesions on genitals)​ *Complications:* Untreated = latent stage​ within a year​ = early stage Late = tertiary syphilis will develop​ -Neurologic​ -Cardiovascular​ -Musculoskeletal ​ -Multi-organ complications​ -Death

Types of Leiomyomas & symptoms

*Subserous:* Develop beneath the peritoneal surface of the uterus and appear as small or large masses protruding from outer uterine surface.​ *Intramural:* Develop within the uterine walls.​ *Submucosal:* Develop in endometrium and protrude into uterine cavity. ​ Least common but often cause most symptoms. ​ *Cervical:* Develop in the cervix.​ *Pedunculated:* Grow on a pedicle or stalk.​ ​ Most women are asymptomatic but abnormal​ uterine bleeding is the most common symptom.​ Backache, low abd. pressure, constipation, ​ urinary incontinence, dysmenorrhea

Pelvic inflammatory disease (PID) Treatments

*Treatments:* broad spectrum antibiotics analgesics for pain *Nursing Interventions​:* -prevention ​ -adequate rest and a nutritionally sound diet ​ -contraceptive counseling ​ -support groups/ counseling may be needed ​ *C. trachomatis, Chlamydia are the most common cause for PID*

Endometriosis Treatment & diagnosis

*Tx based on severity of symptoms* -women without pain who do not desire pregnancy need no treatment​ -women with mild pain who desire future pregnancy, treatment includes NSAIDs​ Women who have early symptomatic disease and can postpone pregnancy may be treated with continuous *OCP that have a low estrogen to progestin ratio and will help shrink endometrial tissue* ​ *Drug therapy​:* NSAIDs (ibuprofen, naproxen, and diclofenac can relieve pain)​ *Surgical therapy​:* Surgical removal or destruction of endometrial tissue and excision of adhesions by laparoscopic laser surgery or laparotomy​ Total abdominal hysterectomy with bilateral salpingectomy and oophorectomy (removal of the uterus, fallopian tubes, and ovaries) *Dx:*​ Pelvic Exam​ MRI US

contraindications for hormone therapy for menopause

*cardiovascular issues* -breast cancer -CHD -a previous VTE or stroke -active liver disease -unexplained vaginal bleeding -high-risk endometrial cancer -transient ischemic attack

Varicocele clinical manifestations

*enlargement of the veins within the scrotum* -may develop as a result of poorly functioning valves that are normally found in veins -In other cases, it may occur from compression of a vein by a nearby structure Varicoceles are typically painless; if pain occurs, the patient may experience the following:​ -Dull to sharp pain​ -Worse with standing or exertion​ -Increases throughout the day​ -Lying down relieves pain​ Low sperm count & decreased sperm quality complications: rare for surgical treatment but may include:​ -Varicocele is unresolved or returns in the future​ -Fluid in the testicles (hydrocele)​ -Injury to testicular artery

Endometriosis symptoms

*major symptoms:* -pelvic pain -dysmenorrhea = menstrual cramps -dyspareunia ​= painful intercourse -chronic non-cyclic pelvic pain and heaviness, pain radiating into thighs​ -bowel symptoms (diarrhea, pain w/ defecation, constipation from avoiding defecation)​ -abnormal bleeding (heavy menstrual bleeding, or premenstrual staining)​ -pain during exercise resulting from adhesions *complications:* -infertility​ -adhesions ("sticky" areas of endometriosis tissue that can fuse organs together)​ -ovarian cysts (fluid-filled cysts in the ovaries that can sometimes become very large and painful)​ -pelvic pain, pain during sex, and heavy or irregular periods​ -can cause pain in the areas it affects and beyond​ -pain with urination​ -small bowel obstruction (endometriosis can cause uterine tissue to grow in the intestine)​ -bleeding and scarring that leads to intestinal obstruction​ -if left untreated, a bowel obstruction can cause pressure to build up, possibly resulting in a bowel perforation​ -ectopic pregnancy (a fertilized egg implants outside the uterus, usually in the fallopian tube which can cause the fallopian tube to rupture that leads to internal bleeding)

Gonorrhea ​ Treatments

- antibiotic therapy ​ Single dose efficacy(Ceftriaxone IM) ​ Dual Therapy (ceftriaxone + azithromycin)​ *Teaching:* ​ recent (past 30 days) sex partners examined, cultured, and treated with appropriate regimens use condoms ​ offered confidential counseling as well as testing for HIV erythromycin (ophthalmic ointment) after birth to pvt blindness ​

Prostatitis definition & manifestations

-A group of inflammatory and noninflammatory conditions affecting the prostate gland.​ 1. Acute bacterial prostatitis ​ 2. Chronic bacterial prostatitis ​ 3. Chronic prostatitis/chronic pelvic pain syndrome​ 4. Asymptomatic inflammatory prostatitis Clinical Manifestations​: -can mimic a UTI -Fever, chills -back pain, perineal pain -dysuria -urinary frequency, urgency -cloudy urine -urinary retention caused by prostatic swelling if the patient goes untreated.

Cervical Cancer ​ Risk Factors​

-Infection with high-risk strains of HPV 16 and 18 ​ -Immunosuppression ​ -Using OCPs for a long period of time ​ -Being exposed to the drug diethylstilbestrol (DES) ​ -Giving birth to many children ​ -Smoking

Chlamydia Signs/Symptoms

-Often asymptomatic​ -Spotting; postcoital bleeding; mucoid; purulent cervical discharge; or dysuria. ​ -Bleeding results from inflammation and erosion of the cervical columnar epithelium. ​ Men:​ -Dysuria​ -urethral discharge​ -pain or swelling of testicles caused by infection of epididymis (rare) ​ -Rectal chlamydia:​ anorectal pain, discharge, bleeding, purutis, tenesmus (cramping rectal pain), mucus-coated stools, or painful bowel movements Incubation period is 1-3 weeks​ Most common site: -men is urethra -women is cervix *Complications:​* -untreated infection leads to acute salpingitis or PID in women -ectopic pregnancy​ -tubal factor infertility​ -HIV​ -premature rupture of membranes​ -preterm labor​ -chorioamnionitis. ​ Infants born to infected mothers may develop: -conjunctivitis -pneumonia after Men rarely have long-term complications -epididymitis, can result in male infertility Both men/women can develop rare reactive arthritis (autoimmune response to infection)

Breast Cancer Diagnostic Testing

-Ultrasound​ -Mammography - 2D or 3D​ --->3D for women <50, women w/ high density breast, women not yet menopausal or have been in menopause < a year​ -MRI​ -Biopsy *Fibrocystic Changes:* #1 test = ultrasonography (determines if fluid filled or solid) ---> fluid-filled cysts = aspirated, and the woman is monitored on a routine basis for development of other cysts ---> solid lump and > 35 = mammography ​ ​ *Fibroadenoma:* -client history -physical exam -mammography -ultrasonography -magnetic resonance imaging (MRI) -core needle bx (determines type of lesion) -surgical excision (if lump is suspicious / symptoms are severe) ​ *Breast Cancer:* -mammography = gold standard (2D or 3D) -MRI = women who have silicone injects, at high risk for breast cancer, and those w/ hx of breast cancer When a suspicious finding on a mammogram is noted or a lump is detected, *diagnosis is confirmed by core needle biopsy* (stereotactically or ultrasound-guided core) or by needle localization biopsy

Ovarian Cancer clinical manifestations

-abdominal bloating -noticeable ↑ in abdominal girth -pelvic/ abdominal pain -difficulty eating or feeling full quickly -urinary urgency or frequency​ Ovary 5cm or more than normal during lab examination requires careful dx workup​ Late Stage: -pelvic pain -anemia -general weakness -malnutrition *Complications:* -fatigue and weakness​ -N/V -constipation​ -edema -anemia​ -ascites -bowel or bladder obstruction (large tumors may block the intestines or bladder)​ -pleural effusion -nutrition issues

Benign Prostatic Hyperplasia clinical manifestations

-condition in which the prostate gland increases in size, leading to disruption of the outflow of urine from the bladder to the urethra -caused by Hormonal changes as men age irritatie symptoms: -nocturia -urinary frequency -urgency -dysuria -bladder pain and incontinence.​ obstructive symptoms: -decrease in the caliber, force of urinary stream -difficulty initiating a stream -intermittency ​ complications​: -urinary retention -UTI -bladder calculi (stones) -renal Failure

Prostate Cancer Clinical Manifestations

-prostate = small walnut shaped gland in males that produces seminal fluid that nourishes and transports sperm -Prostate cancer = most common types of cancer Clinical Manifestations​: -may have no signs or symptoms in the early stages ​ -trouble urinating erectile dysfunction ​ -blood in the urine blood in the semen​ -bone pain unexplained weight loss ​ -decreased force in the stream of the urine Complications:​ -tumor can spread to pelvic lymph nodes, bones, bladder, lungs and liver. ​ -as the cancer spreads to the bones, pain can become severe, especially in the back and legs due to spinal cord compression and destruction of bone.

Risk factors for ovarian cancer include: (Select All That Apply)​ A. Previous breast cancer diagnosis​ B. Ovarian cysts​ C. Multiparity​ D. Infertility​ E. Family history of ovarian cancer

A. Previous breast cancer diagnosis​ D. Infertility​ E. Family history of ovarian cancer Rationale: Identified risk factors for ovarian cancer include a family history of ovarian or breast cancer, nulliparity, infertility and previous breast cancer

Gonorrhea ​ Causes/Diagnosis:

20-24 yr age group among both men and women (most common)​ Caused by sexual contact of aerobic gram negative diplococcus bacteria Neisseria gonorrhoeae. Nucleic acid amplification test (NAAT) ​ Thayer-Martin cultures are recommended to dx gonorrhea in women. ​ Any women suspected of having gonorrhea should have a chlamydial culture and serologic test for syphilis if not done in the last 2 months.​ Screen all sexually active women younger than 25 years of age at risk for gonorrhea​ Pregnant women screened at 1st prenatal visit​ Rescreened at 36wks if at high risks *thayer-martin cultures are recommended to diagnose*

Uterine Cancer (Endometrial cancer) Risk factors

A slow growing cancer of the endometrial lining of the uterus​ Most common gynecologic cancer, if diagnosed and treated early there is an 88% survival rate.​ Risk factors:​ -Increased estrogen levels​ -Obesity​ ->60 yrs old​ -Nulliparity​ -Diabetes​ -Late menopause ​ -Early menarche ​ -Smoking​ -Genetics​ -PCOS

Which discharge instructions does the nurse give to a patient with a cystocele who underwent a posterior colporrhaphy? ​ Select all that apply.​ ​ A. "You should consume a high-fiber diet."​ B. "You should avoid voiding frequently."​ C. "You should take a stool softener every night."​ D. "You should avoid frequent change of positions."​ E. "You should avoid intercourse until your health care provider gives permission."​ ​

A. "You should consume a high-fiber diet."​ C. "You should take a stool softener every night."​ E. "You should avoid intercourse until your health care provider gives permission."​ ​ The patient who underwent a posterior colporrhaphy will have difficulty passing stool. Therefore the nurse instructs the patient to consume a high-fiber diet to avoid constipation. Stool softeners will ease defecation and prevent further complications. The patient should avoid intercourse to reduce strain on the pelvic muscles. The nurse instructs the patient to void frequently because an empty bladder reduces strain on the sutures. The patient should move frequently because standing or sitting in the same position for a prolonged time might strain the patient.​ ​

The client has undergone a wedge resection for cancer of the left breast. Which discharge instruction should the nurse teach?​ ​ A. Don't lift more than 5 lbs with your left hand until released by you HCP.​ B. The cancer has been totally removed and no f/u therapy is required.​ C. Client should empty hemovac every 12 hours.​ D. Client should arrange for an appointment with a plastic surgeon for breast reconstruction.

A. Don't lift more than 5 lbs with your left hand until released by you HCP.​ Rationale: Pressure on the incision should be limited.

A 25-year-old woman presented to her gynecologist asking about what signs she should be aware of in regard to a cystocele. What are signs and symptoms of a cystocele? ​ Select all that apply. ​​A. Frequent UTI's ​​B. Bulging of the bladder​ ​C. Pain in pelvic area ​​D. Ease inserting tampons​ ​E. Urinary incontinence

A. Frequent UTI's​ B. Bulging of the bladder ​C. Pain in pelvic area​ E. Urinary incontinence​ ​ Frequent UTIs, bulging of the bladder, pain in pelvic area, and urinary incontinence are clinical manifestations of a cystocele.

What people are at most risk for developing uterine fibroids (Leiomyomas)? (Select all that apply)​ ​ A. Women who are obese.​ B. Women under 30.​ C. African-American women.​ D. Women with a family history of hypertension.​ E. Women taking hormone replacements. ​ ​

A. Women who are obese.​ C. African-American women.​ E. Women taking hormone replacements. ​

Human Papillomavirus (HPV)​

AKA condylomata acuminata (genital warts) ​ Some types of HPV infection cause warts and some can cause cancer of the: ​-cervix -anus -penis -vagina -vulva -back of the throat (oropharyngeal) ​ often transmitted sexually or through other skin-to-skin contact. Vaccines can help protect against the strains of HPV most likely to cause genital warts or cervical cancer.​ ​

Benign Prostatic Hyperplasia treatments

Active surveillance - annual PSA and DRE. Drug Therapy - urinary retention medications. Minimally Invasive Therapy - TUMT, TUNA, YUVP, or laser prostatectomy. Invasive Therapy - TURP, TUIP, or open prostatectomy. ​ Nursing Interventions​: -Early detection and treatment for BPH. ​ -Teach men to get a prostate exam annually from age 50.​ -Teach lifestyle changes to relieve/prevent symptoms of BPH. ​ -Pre- and Post-op teaching for patients undergoing invasive therapy for BPH.

erectile dysfunction treatment

Diagnosis of testicular failure (hypogonadism):​ -Androgen replacement therapy may be prescribed​ Erectogenic Drug Therapy:​ -Avanafil (Stendra)​ -Sildenafil (Viagra)​ -Tadalafil (Cialis)​ -Vardenafil (Levitra, Staxyn)​ Devices and Implants:​ -Intraurethral medication pellet​ -Intracavernosal self-injection​ -Penile implants​ -Vacuum erection device (VED)

when are pap smears needed?

Ages 21-65 be screened every 3 years ​ 30-65 every 5 years

Uterine Leiomyoma

Also known as fibromas, myomas, or fibromyomas​ Slow growing, benign tumors arising from uterine muscle tissue.​ Rarely become malignant. ​ Most common benign tumors of reproductive system and arise mostly after 50 in African-American women, women who have never been pregnant and those who are overweight. ​ May become large during pregnancy or hormone therapy due to increase in hormones.​ Often spontaneously shrink after menopause. ​

Herpes Signs/Symptoms

An initial genital infection is characterized by multiple painful lesions, fever, chills, malaise,severe dysuria that last 2 to 3 weeks.​ *Primary episode* = incubation 2 to 12 days, most people do not have any recognisable symptoms during this stage​ *If symptoms do occur, they follow these stages:* #1 = Prodromal stage (period before lesions appear) ---> may have burning,itching, or tingling at the site, ​ #2 = Vesicular stage (few to multiple often painful vesicles may appear on the buttocks, inner thigh, penis, scrotum, vulva, perineum, vagina, or cervix) ---> they contain large quantities or infectious viral particles. ​ #3 = Ulcerative stage (lesions will rupture and form shallow moist ulcerations) #4 = Final Stage (spontaneous crusting occurs) *Complications:​* -activate vaginal lesions at the time of delivery indicate a need for a cesarean delivery ---> primary episode of HSV near time of delivery = highest risk of transmitting to neonate ---> virus can infect the neonates skin, eyes, mouth, and CNS resulting in morbidity and mortality Rarely both HSV-1 and HSV-2 can cause serious complications including:​ -Blindness​ -Encephalitis​ -Aseptic meningitis ​

John Smith, a 34 year old man, comes into the clinic with an enlarged scrotum. He explains that he is in no discomfort but he is worried since he and his wife are trying to start a family. Upon closer inspection, Mr. Smith is diagnosed with Hydrocele. Mr. Smith is very concerned and asks how invasive the treatment of Hydrocele will be. You explain to him that...​ A. The treatment of hydrocele is very invasive and he should begin treatment right away ​ B. There is no need for treatment because he is not in any discomfort​ C. Treatment of Hydrocele involves complete removal of the scrotum​ D. Until treatment is started, he will be sterile​ ​

Answer: B​ No treatment is needed unless the swelling becomes large and uncomfortable for the patient, then surgical repair will be needed.​ A - Because Mr. Smith is in no discomfort, no invasive surgery is needed​ C - Treatment of Hydrocele does not include removal of the scrotum​ D - Hydrocele repair is avoided in men who have not started their family yet as repair can contribute to subfertility or infertility​ ​

A 60 year old woman asks the nurse if there are any lab tests that would show she is in menopause. The nurse responds that which test can be done to confirm diagnosis?​ ​ A. Estrogen levels​ B. Complete blood count​ C. Follicle-stimulating hormone (FSH) levels​ D. Thyroid-stimulating hormone (TSH) levels​

Answer: C. FSH testing can be done to confirm a diagnosis of menopause after a woman has no periods for at least a year. Testing is not recommended during menstrual cycles due to hormone changes throughout the cycles, FSH levels are increased during menopause and will be consistently elevated. The other options are not used in the diagnosis of menopause.​

Which of the following drugs does not promote an erection in men suffering with Erectile Dysfunction?​ A. Avanafil (Stendra)​ B. Sildenafil (Viagra)​ C. Captopril (Capoten)​ D. Tadalafil (Cialis)

Answer: C​ Captopril (Capoten) is an ACE inhibitor which is an antihypertensive drug. This may actually cause a man to experience Erectile Dysfunction.​ A, B, D are all erectogenic drugs. They cause smooth muscle relaxation and increased blood flow into the corpus cavernosum, promoting penile erection

disease. Which intervention should the nurse suggest as the most beneficial?​ ​ A. Menopausal hormonal therapy​ B. Black cohosh​ C. Calcium intake of at least 1500mg/day​ D. A combination of lifestyle changes, such as weight-bearing exercises and strength training, and medications​ ​

Answer: D. Weight-bearing exercises and strength training have positive effects on cardiorespiratory function and bone density, this combined with certain medications are the most beneficial interventions to prevent complication. MHT and black cohosh may help with symptoms of menopause but are not proven to prevent complications. Calcium supplements can help prevent osteoporosis but is not the most beneficial.

A 33 year old, male patient comes into the hospital for a scheduled radical inguinal orchiectomy. As the nurse, we know that we are preparing the patient for...​ ​ A. Removal of the inflamed prostate gland​ B. Resection of the ductus deferens​ C. Resection of the penis​ D. Removal of the affected testicle, spermatic cord and regional lymph nodes

Answer: D​ A radical inguinal orchiectomy is removal of the affected Testicle, spermatic cord and regional lymph nodes on a patient who has been diagnosed with testicular cancer​ A - This is a radical prostatectomy​ B - This is done during a vasectomy for the purpose of sterilization​ C - Resection of the penis is done when a portion of the penis is cancerous and has spread

5. The nurse is assessing a client experiencing menopause, which findings should the nurse expect to find with this client? Select all that apply.​ ​ A. Mood changes​ B. Hot flashes​ C. Muscle weakness​ D. Thinning hair​ E. Vaginal dryness​ F. Breast swelling

Answers: A, B, D, E. Mood changes, hot flashes, changes in hair amount/distribution, and vaginal dryness are all manifestations of perimenopause. The other options are not classic symptoms.

John Smith, a 49 year old man, comes into the clinic complaining that he cannot maintain an erection. After learning about Erectile Dysfunction, he understands that some risk factors for Erectile Dysfunction include: Select All That Apply​ A. Alcohol​ B. Maintaining a healthy weight​ C. Nicotine​ D. Antihypertensives​ E. Depression​ F. Regular Exercise​

Answers: A, C, D, E​ These are all risk factors for developing Erectile Dysfunction. Other risk factors may include cardiovascular disease, hypertension, diabetes mellitus, and metabolic syndrome​ B - Maintaining a healthy weight may decrease someone's risk for ED​ F - Regular exercise can also decrease a risk for ED​ ​

Leiomyoma dx & tx

Assessment of history of symptoms; usually diagnosed by elimination.​ Pelvic exam shows uterine enlargement.​ Ultrasound Laparoscopy​ Medications:​ -NSAIDs -OCs to inhibit ovulation -GnRH agonist to reduce size​ Goal is to reduce circulation level of estrogen and progesterone​ Surgery:​ Uterine Artery Embolization - PVA injected to block blood supply, shrinking ​fibroid​ --Laser Surgery- destroys small fibroids.​ --Myomectomy- removal​ --Hysterectomy- removal of entire uterus.

A patient is being treated for gonorrhea. Which medication would the nurse expect the physician to prescribe?​ A. Imiquimod​ B. Ceftriaxone​ C. Penicillin​ D. Amoxicillin

B. Ceftriaxone​ Ceftriaxone is the treatment of choice for gonorrhea

A 26 year old female patient with a history of ​ PID arrives at the ER with complaints of sudden right sided lower abdominal pain, bleeding, and a positive pregnancy test. The nurse would expect which diagnosis A.Premature rupture of membranes ​ B. Ectopic Pregnancy​ C. Spontaneous abortion​ D.Placental abruption

B. Ectopic Pregnancy Woman who have had PID are at a high risk for Ectopic Pregnancy. One sided pain, bleeding, with a positive HCG are all signs of Ectopic pregnancy.

You've just provided education to a 24 year old woman whose pap test was negative. Which statement by the patient indicates a need for further teaching?​ ​ A. I should repeat this test in 3 years​ B. I will need to schedule a colposcopy​ C. I can decrease my risk of developing HPV if I quit smoking​ D. I will keep follow up appointments even i'm feeling well​

B. I will need to schedule a colposcopy​ ​ The clients pap results were normal, a colposcopy is not necessary at this time. It is recommended that women between the ages of 21-29 have a pap smear every three years. Smoking is a modifiable risk factor for HPV. Patients should be encouraged to keep follow up appointments even if they feel well because preinvasive cervical cancer is often asymptomatic. ​

Removal of which structures will cause a woman to experience menopause?​ ​ A. Cervix ​ B. Ovaries​ C. Fallopian tubes​ D. Bladder

B. Ovaries​ Removal of your ovaries, which produce estrogen, will cause you to go into menopause immediately

A pregnant patient presents to the Labor and Delivery unit with a history of Herpes. What indicates a need for a Cesarean delivery? Select all that apply A. Patient currently taking Zovirax​ B. Patient has active genital lesions present ​ C. Patient complaining of low flank pain ​ D. Patient in the stage Primary of HSV​

B. Patient has active genital lesions present D. Patient in the stage Primary of HSV​ Active genital lesions and being in the primary stage of HSV indicate a need for a cesarean delivery because the risk of shedding the virus onto the neonate through the vaginal canal

A nurse is caring for a patient who presents to the clinic with purulent cervical discharge, dysuria, bleeding and a history of Chlamydia. The nurse realizes further teaching is needed when Select all that apply A. The patient explains that she has been sexaully abstinent since her last dose of treatment for chlamydia.​ B. The patient states that she never told her husband about when she had chlamydia because she only needed to be treated. ​ C. The patient will finish her full 7 day treatment of doxycycline. ​ D. The patient states that she will continue laying out by the pool while taking doxycycline. ​

B. The patient states that she never told her husband about when she had chlamydia because she only needed to be treated. ​ D. The patient states that she will continue laying out by the pool while taking doxycycline. Both partners need to be treated for chlamydia in order to prevent reinfection ​ Patient should avoid prolonged exposure to sunlight while taking doxycycline

A female client has just been diagnosed with genital warts. What information is appropriate to tell this client? A. The HPV, which causes condylomata acuminata, cannot be transmitted during oral sex​ B. This condition puts her at a higher risk for cervical cancer; therefore, she should have a pap smear annually ​ C. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7-10 days​ D. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse ​

B. This condition puts her at a higher risk for cervical cancer; therefore, she should have a pap smear annually ​ Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. This also can occur on the vulva, a condom won't protect sexual partners. HPV can be transmitted to other parts of the body, such as mouth, oropharynx, and larynx.

A provider has ordered Gardasil to be given to a prepubertal 9-year-old female. The parent asks the nurse if this vaccine can be postponed until the child is in high school. The nurse will tell the parent that Gardasil​ A. is less effective in older adolescents.​ B. is more effective if given before sexual activity begins.​ C. is more effective if given prior to the hormonal changes of puberty.​ D. is not effective if given after the onset of menses.​

B. is more effective if given before sexual activity begins.​ Rationale: Gardasil is most effective when the client is not yet sexually active.​

Ovarian Cancer Treatment​

Based on family and health history include prophylactic removal of the ovaries and fallopian tubes and the use of oral contraceptive pills​ Initial treatment = total abdominal hysterectomy (TAH) and bilateral salpingectomy and oophorectomy with removal of the omentum and much of tumor as possible​ treatment options include: -intraperitoneal and systemic chemotherapy -intraperitoneal instillation of radioisotopes -external abdominal and pelvic radiation therapy​ Targeted therapy used to treat ovarian cancer includes Avastin, Rubraca, and Lynparza *Teach the patient what to expect after surgery:* -she will not menstruate -activity restrictions -sexual intercourse should be avoided until the wound is healed

OSteoporosis diagnosis

Bone density test = guideline for diagnosis in all women over 65 ---> A scan can be ordered for women younger than 65 who are at high risk as well, such as low body weight, smokers, postmenopausal women, and prior fractures BMD (bone mineral density) = peak bone mass and amount of bone loss ---> measured by quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DEXA) and are reported as T scores: ​ ---> T score between -1 and +1 is normal ---> T score between -1 and -2.5 indicates osteopenia ---> T score of -2.5 and lower indicates osteoporosis

A 42-year-old patient notices a lump in her left breast, nipple retraction, and skin dimpling. She reports the symptoms to her doctor. What test is the doctor most likely to order?​ ​ A. Ultrasound​ B. 3D Mammogram​ C. Biopsy​ D. 2D Mammogram

B​. 3D Mammogram ​ Rationale: The doctor will most likely order a 3D mammogram due to the patient being younger than 50 years of age with nipple retraction, skin dimpling, and a lump which are signs of breast cancer.

A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. Which condition is this client experiencing? ​ ​ A. fibroadenoma​ B. lipoma​ C. intraductal papilloma​ D. mammary duct ectasia

B​. lipoma​

A 24 year old female comes into the clinic to receive her first dose of the Gardasil 9 vaccine. How many scheduled doses will this patient receive?​ A. 1​ B. 2​ C. 3​ D. 4

C. 3 Rationale: Patients who are immunocompromised or start vaccine between ages of 15-45 are required to receive 3 doses, vs 2​

What intervention should the nurse implement for a client diagnosed with rectocele?​ ​A. Limit oral intake to decrease voiding. ​B. Encourage a low-residue diet​ C. Administer a stool softener daily.​ D. Arrange for the client to take sitz baths​

C. Administer a stool softener daily.​​ Stool softeners are laxatives are used to prevent and treat constipation, which is common with rectocele. Because of the position of the rectum, stool can stay in the rectal pouch, causing constipation.

Which is a true finding of uterine cancer?​ A. A rapid growing cancer or the uterus​ B. Most commonly found in women under the age of 45​ C. Early clinical manifestations include postmenopausal bleeding ​ D. Chemotherapy used in early detection to prevent metastasis ​

C. Early clinical manifestations include postmenopausal bleeding

What two complications are most common in women with PCOS?​ A. Diabetes and ovarian cancer​ B. Ectopic pregnancy and miscarriage​ C. Infertility and ovarian cysts​ D. Endometrial cancer and infertility

C. Infertility and ovarian cysts​ Rationale: PCOS causes irregular periods which results in issues with infertility and the formation of fluid-filled sacs, or cysts, on the ovary

Uterine cancer spreads through the lymph system and is more likely to metastasise in the?​ ​ A. Heart​ B. Kidneys​ C. Lungs ​ D. Intestines​

C. Lungs ​ Lungs.... Uterine cancer metastasizes in the lungs, liver bone and brain

The physical assessment and history of a 25 year old patient are indicative of HPV infection. You would perform patient teaching related to:​ ​ A. Gardasil​ B. Antibiotic therapy​ C. Wart removal options​ D. Treatment with antiviral drugs

C. Wart removal options.​ ​ Rationale: ​ Since the patient most likely does have HPV the goal of treatment would be wart removal options. Antibiotic and antiviral drugs would not be effective for HPV treatment. Gardasil vaccine is most effective if given before the women has her first sexual contact. ​

The nurse is teaching a client about dietary changes that can reduce the chances of developing cancer. Which statement by the client indicates that additional teaching is needed?​ ​ A. "I'll have to cut down on the amount of caffeine that i consume."​ B. "Foods high in vitamin A and C are important."​ C. "I don't have to give up eating my juicy ribeye steaks."​ D. "Fruit, vegetables, and high-fiber are important."

C.​ "I don't have to give up eating my juicy ribeye steaks."​ ​ Rationale: The consumption of high saturated fat and red meats should be reduced to decrease the chances of developing cancer.

Urinary incontinence Clinical manifestations

Clinical manifestations: (DRIP)​ D = delirium, dehydration, depression​ R = restricted mobility, rectal impaction​ I = infection, inflammation, impaction​ P = polyuria, polypharmacy​ Complications:​ -Has a major effect on quality of life​ -Negative impact on social and personal life ​ -Skin problems (rashes, skin infection, and sores)​ -Recurrent UTIs

TREATMENTS FOR MENOPAUSE​

Common Meds for menopause that help with osteoporosis: ​ -Calcitonin ​ -Bisphosphonates​ -Raloxifene​ -Parathyroid hormone​ -Estrogen hormone Other treatments: -HORMONE THERAPY​ -SSRI​ -Vaginal creams and lubricants for vaginal dryness and atrophy​ -Bioidentical hormones and custom-compounded hormones ​ Nutrition: -Eat foods high in calcium - dairy products ​ -Avoid high protein, alcohol, soft drinks, and caffeine​ -Choose foods high in nutrients, moderate in calories, low in fat​ Exercise:​ -walking -weight bearing exercises -aerobic exercises -water aerobics Teaching: ​ *During the day:* -Layer clothes to take off during hot flashes ​ -Avoid triggers causing hot flashes​ -Splash face with cold water, drink ice water, take a cool shower​ -Try slow, deep breathing ​ *At night:​* -Sleep in cotton, use cotton sheets​ -Keep room cool, avoid heavy blankets ​ *Insomnia :* -Avoid late night caffeine, tobacco, alcohol, exercise, and liquids​ -Avoid tv and electronics in bed​ -Develop routine bedtimes and avoid daytime naps ​ *Urogenital:* -Provide safe sex teaching - STDs​ -drink a lot of water (8 glasses a day) -empty bladder frequently -kegels -cotton underwear

Cystocele vs Rectocele Clinical Manifestations

Cystocele: -Complete emptying of the bladder becomes difficult ​ -Bearing down sensation ("something is in my vagina")​ -Urinary frequency, retention, and incontinence ​ -Recurrent cystitis and UTIs ​ Rectocele: (symptoms typically absent when lying down) ​ -A soft bulge of tissue in your vagina that may or may not protrude through the vaginal opening​ -Bowel function disturbances ; difficulty having BM​ -Sense of bearing down ​ -Sensation pelvic organs are falling out ​

Cystocele vs Rectocele

Cystocele: "fallen bladder" ​ Bladder hernia; injury to the vesicovaginal fascia during labor and birth may allow herniation of the bladder into the vagina. ​ Rectocele: ​ Herniation or protrusion of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. ​ ​ Cystocele and rectocele almost always accompany uterine prolapse, causing the uterus to sag even further backward and downward into the vagina. ​

A 33-year-old patient tells the nurse that she has fibrocystic breasts but reducing her sodium and caffeine intake and other measures have not made a difference in the fibrocystic condition. An appropriate patient outcome for the patient is​ ​ a. calls the health care provider if any lumps are painful or tender.​ b. states the reason for immediate biopsy of new lumps.​ c. monitors changes in size and tenderness of all lumps in relation to her menstrual cycle.​ d. has genetic testing for BRCA-1 and BRCA-2 to determine her risk for breast cancer.

C​. monitors changes in size and tenderness of all lumps in relation to her menstrual cycle.​ ​ Rationale: Because fibrocystic breasts may increase in size and tenderness during the premenstrual phase, the patient is taught to monitor for this change and to call if the changes persist after menstruation. Pain and tenderness are typical of fibrocystic breasts, and the patient should not call for these symptoms. New lumps may be need biopsy if they persist after the menstrual period, but the biopsy is not done immediately. The existence of fibrocystic breasts is not associated with the BRCA genes.

Mild pain during menstruation with endometriosis is usually treated with:​ A. Gabapentin​ B. Tylenol​ C. Morphine​ D. Motrin

D. Motrin Rationale: Women with mild pain from endometriosis who would like to get pregnant can be treated with NSAIDs during menstruation

While examining the introitus, the nurse practitioner asks the patient to "bear down." The nursing student observing the examination knows that the nurse practitioner is assessing the patient for which of the following conditions?​ A. Human Papillomavirus (HPV)​ B. Female Genital Mutilation​ C. Colorectal Cancer​ D. Uterine Prolapse

D. Uterine Prolapse Uterine prolapse occurs when the cervix and uterus descend under pressure through the vaginal canal and can be seen at the introitus. To identify such protrusions, the examiner asks the patient to "bear down."​

A patient who has been diagnosed with primary syphilis is in need of further teaching when the patient states: ​ A. "I should notify all my sexual partners to prevent further spread of the disease." ​ B. "I should remain abstinent, even when I don't have symptoms."​ C. "I will need to have my blood checked monthly, even if I don't have any symptoms."​ D."If I use a condom, I can still have multiple sex partners."​ ​

D."If I use a condom, I can still have multiple sex partners."​ When having primary, secondary and latent syphilis the recommendation is abstinence to prevent further spreading of the disease.

Types of Hysterectomy

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus​ Types:​ *Subtotal hysterectomy:* removes only the upper part of the uterus, keeping the cervix in place ​ *Total hysterectomy:* removes the whole uterus and cervix ​ *Radical hysterectomy:* removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina​ Usually only done when cancer is present *After the Hysterectomy:* complications include:​ -Urinary incontinence​ -Vaginal prolapse​ -Vaginal fistula ​ -Chronic pain ​ *After a hysterectomy, if the ovaries were also removed, you'll be in menopause.* If the ovaries were not removed, you may enter menopause at an earlier age than you would have otherwise​ In most cases after surgery people are told to abstain from sex and avoid lifting heavy objects for 6 weeks after ​

Prostate Cancer Diagnostics ​& treatment

Diagnostics: -Ultrasound - transrectal ultrasound ​ -Magnetic Resonance Imagine (MRI) ​ -Biopsy - sample of the prostate tissue Treatments​: -Surgery -Radiation Therapy ​ -Freezing/Heating Prostate Tissue -Hormone Therapy ​ -Chemotherapy -Immunotherapy Nursing Interventions:​ -Encourage annual prostate screening. ​ -Provide sensitive caring support to help patient and family cope with the diagnosis ​ -Provide ongoing pain assessment and give prescribed medications.

Fibroadenoma Treatments ​

Do not respond to dietary changes or hormonal treatment​ ​ · Surgical excision if symptoms are severe​ ​ · Periodic observation during physical exam or mammography used for masses without symptoms and the size stays less than 3cm​

PCOS (Polycystic Ovary Syndrome) treatment

Early diagnosis and treatment to improve quality of life and decrease risk for complications​ *Based on symptoms:* -oral contraceptive pills help regulate menstrual cycles​ -hyperandrogenism can be treated with flutamide and a GnRH agonist such as Leuprolide​ -fertility drugs (Clomid) may induce ovulation​ -lifestyle modifications such as losing weight​ -metformin and other insulin medications for type 2 diabetes ​ ----> reduces hyperinsulinemia, improves hyperandrogenism, and can restore ovulation​ ----> not approved by the FDA to treat PCOS​ -hormonal birth control (pill, patch, shot, vaginal ring, and hormone IUD) ​ -anti-androgen medicines​ ---> lock effect of androgens​ ---> helps reduce scalp hair loss, facial and body hair growth, and acne

Nursing interventions​ for pap smear

Have woman empty bladder before ​ Assist with relaxation techniques ​ Encourage patient to be involved with examination if she shows interest​ Assess for signs of problems such as supine hypotension​ Warm speculum before procedure ​ Instruct patient to bear down when speculum is inserted​ Can assist with collection ​

Cervical Cancer Diagnostics

Hispanic women are most commonly diagnosed with cervical cancer but mortality is higher among black women.​ ​It is recommended that all women start screenings for cervical cancer at the age of twenty one. *Papanicolaou Test* -Every 3 years for women ages 21-29​ -Every 5 years + HPV screen for women ages 30-65​ -Colposcopy/ biopsy if results are abnormal​ *HPV Screening​* cervical cancers are caused by HPV

Benign Prostatic Hyperplasia diagnostics ​

History and physical Digital rectal examination ​ Urinalysis with culture Prostate-specific antigen(PSA) ​ Serum Creatinine Post-void Residual ​ Transrectal ultrasound(TRUS) Cystoscopy Uroflowmetry

Pelvic inflammatory disease (PID) Diagnostics/ Clinical manifestations

Infectious process that most commonly involves the fallopian tubes,​ uterus and sometimes ovaries​ *high risk for:* -ectopic pregnancy -infertility -chronic pelvic pain​ ​ *Diagnostics:* no specific test -have to ​rule out all other illnesses and meet a group of criteria ​ ​ *Clinical manifestations:* -fever -foul-smelling vaginal discharge ​ -pain in the lower abdomen -abnormal uterine bleeding -pain with intercourse -tenderness or pain in the uterus, affected ovary, or fallopian tube on ​bimanual pelvic examination​

PCOS (Polycystic Ovary Syndrome) symptoms

Irregular menstrual cycle​ Hirsutism​ Acne on the face, chest, and upper back​ Thinning hair or hair loss on the scalp; male-pattern ​ baldness​ Weight gain or difficulty losing weight​ Darkening of skin, particularly along neck creases, ​ groin, underneath breasts​ Skin tags *complications:* -infertility -fluid-filled cysts develop in the ovaries​ -diabetes​ -high Blood Pressure​ -high LDL and low HDL = heart disease ​or stroke​ -sleep apnea​ -depression and anxiety -endometrial cancer

clinical manifestations of menopause

Irregular periods, anovulatory cycles, may miss periods, changes in menstrual flow​ Vaginal dryness, painful intercourse, vaginitis​ Urinary frequency increases​ UTI's are common​ Hot Flashes and night sweats (may disturb sleep)​ Mood changes Hair loss Headaches Burning mouth / bleeding gums Aching breasts Heart problems / palpitations Osteoporosis / aching joints & muscles Electric shocks Tingling extremities Dry skin Weight gain / bloating Dizziness, anxiety, depression, mood swings

Hysterectomy

Is the surgical removal of the uterus with or without the ovaries and fallopian tubes ​ The surgery may be done for different reasons, including:​ -Uterine fibroids that cause pain, bleeding, or other problems​ -Uterine prolapse​ -Cancer of the uterus, cervis, or ovaries ​ -Endometriosis ​ -Abnormal vaginal bleeding​ -Adenomyosis

Symptoms indicating cervical cancer or HPV ​

Itching or warts​ Pain in pelvic area​ Abnormal or heavy menstruation

Uterine Prolapse Nursing Interventions​

Nurses can educate women on how to perform Kegel exercises​ Use of a pessary - a prosthetic device inserted into the vagina to support internal structures​ Some women are taught to remove it at night, cleanse it, and replace it in the morning. ​ If always left in place, douching is recommended to remove increased secretions and keep the vaginal pH normal​

*Fibrocystic Changes* Clinical Manifestations

Lumpiness in both breasts ​ ---> Simple cysts can occur ​ Symptoms develop a week before period​ ---> Subside a week after period​ ---> Included are dull, heavy pain, sense of fullness, and tenderness (in the upper quadrant of breast-increases in premenstrual period) ​ Physical Examination​ ---> Reveals excessive nodularity ​ ---> Cysts are soft on palpation ​ ---> Well differentiated and movable

Uterine Prolapse Medical and Surgical Management​

Pessary device​ Usually used for only a short time because it can lead to pressure necrosis and vaginitis​ Estrogen therapy to improve tissue tone​ If conservative treatments don't work a hysterectomy with a vaginal vault suspension is usually recommended​

hydrocele clinical manifestations

Nontender, fluid-filled mass and swelling of one or both testicles​ Results from interference with lymphatic drainage of the scrotum​ Discomfort may be experienced if the scrotum becomes too heavy​ Swelling might be worse in the morning complications: -Surgical repair is not recommended for men who wish to start a family or add to their family​ -The repair can contribute to subfertility or infertility

Varicocele treatment

Not all varicoceles require surgical treatment​ --->Surgery is considered if the patient is infertile​ Ibuprofen for pain/discomfort ​ Repair through injection of a sclerosing agent​ Surgical treatment includes:​ -Varicocelectomy​​ -Laparoscopic surgery​ -Percutaneous embolization (uncommon) nursing interventions: -Teach patient no exercise for ~ 2 weeks​ -Monitor for testicular growth in teens with surgical treatment​ -Fertility test 3-4 months after procedure​ -Promote comfort and consoling if test results determine infertility

Herpes Causes/Diagnosis:

Often asymptomatic transmission through direct contact with skin or mucous membranes.​ *caused by two antigen subtypes​:* -HSV-2 normally transmitted sexually and typically has genital lesions "below the waist" genital tract, perineum, or anus ​ -HSV-1 is more commonly associated with fever blisters/cold sores "above the waist" gingiva, dermis, upper respiratory tract, and rarely in central nervous system. ​ -viral culture will be obtained by swabbing exudate during the vesicular stage of the disease​ -type specific serologic tests for HSV-2 antibodies ​ (many people infected with HSV-2 are asymptomatic therefore they may be undiagnosed)

Gonorrhea ​ Signs/Symptoms

Often asymptomatic​ -Purulent endocervical discharge -menstrual irregularities -severe pelvic / lower abdominal pain -longer/more painful menses​ Rectal gonorrhea: ​ -profuse purulent anal discharge​ -rectal pain​ -blood in the stool​ -Rectal itching, fullness, pressure,and pain​ diarrhea. ​ Prepubertal girls may experience:​ -Diffuse vaginitis with vulvitis (most common)​ -Vaginal discharge​ -Dysuria​ -swollen/reddened labia​ Ophthalmia neonatorum is the most common manifestation of neonatal gonococcal infection. It's highly contagious. If left untreated, it may lead to blindness of the newborn *Complications:​* - potential infertility ​ -Drug resistant cases of gonorrhea has increased dramatically ​ -Declining susceptibility to Cefixime

Cervical Cancer Clinical Manifestations​

Often no symptoms early on​ Abnormal uterine bleeding​ Poistcoital bleeding​ Abnormal discharge​ Foul smelling/ dark color​ Pain, weight loss, anemia, and cachexia (wasting syndrome) are late symptoms *Complications​:* -Early menopause​ -Infertility​ -Death

Testicular Cancer treatment

One of the most curable types of cancer​ Orchiectomy (Surgical removal of testes, spermatic cord, and regional lymph nodes)​ Radiation or chemotherapy​ Retroperitoneal lymph node dissection nursing interventions: -All patients with testicular cancer require surveillance and regular physical examinations, chest x-rays, CT scans, and serum tumor marker assessment. ​ -Because of high risk of infertility, cryopreservation of sperm in a sperm bank should be discussed and recommended.

Menopause definition

One year without a menstrual cycle ​ Typically occurs between age 51-52 yrs​ ​ Surgical Menopause: occurs with a hysterectomy and bilateral oophorectomy​ ​

Postmenopause: ​ Perimenopause:

Postmenopause: the time after menopause​ ​ Perimenopause: transition from normal ovulatory cycles to the cessation of menses; it is marked by irregular cycles ​

Urinary incontinence Diagnostic studies

​Focused history​ Physical assessment​ --Functional issues associated with urination​ --Assess perineal skin​ --Pelvic exam and evaluation of pelvic floor muscle strength​ Bladder log or voiding record​ UA to identify contributing factors ​ --UTI​ --Diabetes​ Post void residual (PVR)​ --Catheterization​ --Bladder scan​ Urodynamic testing for select cases

Testicular Cancer​ clinical manifestations

Painless lump noted on scrotum​ Swelling in scrotum​ Dull / heavy ache in lower abdomen​ During advanced stages:​ -Lower back pain​ -Chest pain​ -Cough & dyspnea​ Complications: -Men may become infertile​ -May cause ejaculatory dysfunction -Drugs used to treat testicular cancer can cause serious long term side effects​: --->Pulmonary toxicity​ --->Kidney damage​ --->Nerve damage​ --->Hearing loss​

Breast Cancer Clinical Manifestations ​

Palpable lump or ill-defined thickening in the breast ​ Usually painless ​ *Symptoms:* -nipple retraction -skin dimpling -skin changes (nipple or redness w/ edema and pitting of the skin) Suggestive as a locally advanced and aggressive form of breast cancer Lymph nodes are clinically examined to determine extent of the clinical stage *Compliations:* -dimpling (Orange peel appearance)​ -breast / nipple pain​ -nipple retraction (turning inward)​ -dry, flaking, red, or thickened​ nipples / breasts -nipple discharge​ -metastasis -swollen lymph nodes -infection​ -seroma = build up of fluid under the skin. -hematoma = build up of blood under the skin.​ -blood clots​ -frozen shoulder = restricted movement of the shoulder after surgery -chemobrain = difficulty with cognition​ -infertility​ -recurrence

Testicular Cancer diagnostic studies

Palpation of the scrotal contents​ Ultrasound​ CT scan​ Serum tumor markers

erectile dysfunction clinical manifestations

Patient describing an inability to attain or maintain an erection​ Gradual onset: usually r/t physiologic factors​ Sudden onset: my be r/t psychologic issues​ It is common for younger men who seek care for ED to be diagnosed with diabetes, HTN, depression, or cholesterol abnormalities complications: -inability to perform sexually =distress in his interpersonal relationships and may interfere with his concept of himself as a man​ -can affect the relationship between the man and his partner -can lead to personal issues, including anger, anxiety, and depression

Rectocele Risk Factors

Pregnancy and childbirth ​ Constipation ​ Intense coughing (ex: bronchitis) ​ Repeated heavy lifting ​ Being overweight/obese ​

Ovarian Cancer diagnosis

Routine pelvic examination cont to be the only practical screening method for detecting early disease​ Any ovarian enlargement should be considered highly suggestive and needs further eval by laparoscopy or laparotomy​ Transvaginal ultrasound and CA-125 screening​ --->Not recommended for routine screening in general population​ --->Are recommended in women who are at high risk (ex: BRCA1 mutation carriers)

HPV Clinical Manifestations

​ In most cases, your body's immune system defeats an HPV infection before it creates warts. When warts do appear, they vary in appearance depending on which kind of HPV is involved:​ -Genital Warts​ -Common Warts​ -Plantar Warts​ -Flat Warts (Lesions) ​ ​ Women- profuse irritating vaginal discharge, itching, dyspareunia, postcoital bleeding, "bumps" on vulva or labia​ ​

Rectocele Treatment

Small rectoceles may not need treatment; mild s/s may get relief from high-fiber diet and adequate fluid intake, stool softeners, or mild laxatives. ​ Vaginal pessaries and Kegel exercises ​ Large rectoceles that are causing significant symptoms are usually repaired surgically. ​ A posterior repair (colporrhaphy) is the usual procedure. ​ This surgery is performed vaginally and involves shortening the pelvic muscles to provide better support for the rectum. ​ Anterior and posterior repairs can be performed at the same time and with vaginal hysterectomy.​ ​

Uterine Prolapse Symptoms

Symptoms generally relate to the structure involved such as the urethra, bladder, uterus, vagina, or rectum​ Most common complaints are pulling and dragging sensations, pressure, protrusions, fatigue, and low backache​ Symptoms may worsen after prolonged standing or sexual intercoaurse​

hydrocele diagnosis

Testicle will not be able to be felt very well through fluid-filled sac​ Diagnosis is aided by shining a flashlight through the scrotum (transillumination)​ Transillumination will show​ clear fluid surrounding ​ the testicle

Endometriosis

The growth of endometrial tissue outside of the uterus, such as in the ovaries, round ligaments, sigmoid colon, appendix, and cervix​ common in 30-40 year old women but can occur in woman anywhere from 15-44 cause = retrograde menstruation (during menstruation endometrial tissue is refluxed back up into the fallopian tubes and into the peritoneal cavity causing implantation on the ovaries and other organs)

Menopause complications

The two most common health risks associated with menopause are: ​ 1. Osteoporosis (Decreased bone mass due to decreased estrogen production) ​ 2. Coronary Heart Disease / Cardiovascular disease (due to less estrogen production)

Herpes Treatment

There is no cure but antiviral drugs can shorten the duration of HSV viral shedding and shorten the healing time of eruptions and reduce outbreaks by up to 80 %​ Treatment should start before diagnostics results are confirmed because early treatment reduces the duration of the ulcers and risk of transmission ​ 3 antivirals are recommended: Acyclovir, famciclovir, valacyclovir​ IV Acyclovir is used when hospitalization is required​ *Teaching:* -keep eruptions clean and dry​ -avoid sexual activities even with condoms during an outbreak until completely healed ​ -use ice packs, lidocaine gel, ibuprofen, tylenol, aspirin for pain relief​ -to reduce pain with urination pour water onto the perineal area or void when in shower​ -maintain good hygiene during an outbreak, loose fitting cotton clothing, ​ -avoid non antiviral ointments especially those with cortisone​ -*stress, menstruation, trauma, febrile illnesses, chronic illnesses, ultraviolet light, and heat can trigger an outbreak*

erectile dysfunction diagnosis

Thorough sexual, physical, and psychosocial history​ Digital rectal exam (DRE):​ ---> to assess prostate size, consistency, and presence of nodules​ CBC​ PSA​ (Prostate-specific antigen) GLU, Hgb, A1C, and lipid profile​ ---> Recommended to rule out diabetes​ Testosterone, prolactin, and thyroid hormone levels​ ---> May help identify endocrine-related problems Vascular studies​: -Nocturnal penile tumescence and rigidity testing​ -Penile blood flow study and Doppler ultrasound​ ---> used to assess penile blood inflow & outflow

Chlamydia Causes/Diagnosis:

Transmission by exposure to sexual fluids during vaginal, anal, or oral sex Nucleic acid amplification test (NAAT) of urinary, vaginal, or endocervical specimens ​ Yearly screening of sexually active men/women:​ < 25 years old and clients​ >25 years with risk factors of (high risk behaviors, high risk medical hx, high risk populations) ​ Pregnant women should be screened for chlamydia at the first prenatal visit. *PID is most common risk factor* *high risk population:* <25, ethnicity (black, hispanic, etc.) men who have sex with men persons in correctional facilities

PCOS (Polycystic Ovary Syndrome) causes and characteristics

​ caused by a reproductive hormonal imbalance resulting in high levels of​ -estrogen -testosterone -luteinizing hormone -decreased levels of FSH​ ​ Issues with hormone production in turn causes problems in the ovaries with egg development or the ​ release of the egg during ovulation​ irregular periods ​ no cure but symptoms can be managed effectively w/ medications woman can​ work w/ her doctor if she plans to get pregnant to control weight and comorbidities to prevent prenatal​ complications

HPV Treatments

Untreated HPV resolves spontaneously in young women because their immune systems may be strong enough to fight the infection​ ​ If the virus persists (depending on type) gential warts or cancer can develop months or years after the woman has been infected ​ ​ No treatment has been shown to eradicate HPV ​ ​ Removal of warts and relief of signs & symptoms​ ​ Healthy lifestyle to aid the immune system: women can be counseled regarding diet, rest, stress reduction, and exercise​ ​​ *Teaching:* -most cases will clear up spontaneously​ -no immunity is conferred with infection -use latex condoms -Gardasil 9 vaccine ​ ---> can be administered to girls and boys as early as 9 years of age. ​ ---> given to men and women of ages 15-26, if they did not receive it previously​ ---> given in 2 dose schedule for girls and boys who initiate vaccine series at ages 9-14 years​ ---> 3 dose schedule remains for those who are immunocompromised or initiate vaccine series at ages 15-45

hydrocele treatment

Usually resolves without treatment​ Surgical repair may be needed if swelling becomes large and uncomfortable​ --->Hydrocelectomy nursing interventions: After surgery, avoid anything that involves straddling for 3 weeks​ Assess surgical sight for infection​ Give pain meds as needed, pain should subside in about a week

Uterine Prolapse ​ Causes/Contributing factors​

Uterine displacement and prolapse can be caused by congenital or acquired weakness of the pelvic support structures.​ Many cases can be a result of vginal childbirth-related injury​ Pelvic trauma, stress, and strain, and the aging process are also contributing factors​ Other causes include obesity, reproductive surgery, and pelvic radiation​

Cystocele Risk Factors:

Vaginal births​ Obesity ​ Family hx​ Intense physical activity ​ Constipation ​ Frequent coughing ​ Aging and drop in estrogen ​

Cystocele Treatment

Vaginal pessary or surgical repair. ​ An anterior repair (colporrhaphy) for large symptomatic cystoceles.​ Shortening of pelvic muscles to provide better support for the bladder and is often combined with a vaginal hysterectomy. ​ Kegel exercises to strengthen pelvic floor muscles ​ Prevent constipation; admin stool softeners ​ Encourage fluids and fiber ​ ​

Varicocele diagnosis

Varicoceles are found upon self-assessment that warrants professional evaluation ​ A health care professional will examine the scrotum, which may reveal a nontender mass that "feels like a bag of worms" above the teste on one side (usually left)​ Further examination involves a scrotal ultrasound

HPV Diagnostics

Viral screening & typing for hpv is available but not standard practice ​ History​ Evaluation of signs & symptoms​ Pap test​ Physical examination​ HPV-DNA test for types of HPV that are likely to cause cancer in women older than 30 or in those with abnormal pap test results​ Biopsy is the only definitive diagnostic test *Complications:* Genital warts that go untreated may eventually cause abnormal urine flow in men (if warts are present in the urethra); bleeding from the urethra, vagina, or anus; or vaginal discharge.​

Typical signs and symptoms of Endometriosis include: (Select All that Apply)​ a.Pain during intercourse​ b.Diarrhea​ c.Weight loss​ d.Heavy menstrual bleeding

a.Pain during intercourse​ b.Diarrhea d.Heavy menstrual bleeding Rationale: Signs and symptoms of Endometriosis include pelvic pain, dysmenorrhea, dyspareunia, abnormal bleeding, chronic pain and pain radiating to the thighs, pelvic heaviness, pain with exercise, pain with defecation, diarrhea, constipation and infertility

OSteoporosis clinical manifestations

bone pain w/ tenderness fractures w/ little to no trauma loss of height over time neck / lower back pain from fractures stooped posture Complications: -increased bone fractures -loss of mobility due to weakening of the bones -respiratory and cardiovascular complications when multiple fractures shorten the torso and compress the abdomen -loss of self-esteem and independence​

OSteoporosis definition

bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.​ Postmenopausal decrease in estrogen levels leads to an imbalance between bone formation and resorption. This leads to faster deterioration of bones.​

OSteoporosis treatment

calcium intake and supplements sun exposure and vitamin D supplements exercise program drug therapy vertebroplasty kyphoplasty​ Nursing interventions: -Proper nutrition​ -calcium and vitamin D supplementation​ -exercise​ -prevention of falls and fractures​

A patient presents to her annual check up complaining of periods that only come every other month, thinning of her hair and sudden issues with acne. What condition do you suspect?​ a. Endometriosis​ b. Pregnancy​ c. Endometrial cancer​ d. PCOS​

d. PCOS​ Rationale: Diagnosis of PCOS occurs if a patient has at least two of the following symptoms or findings: irregular periods, hirsutism,acne,thinning of scalp hair, high serum androgens or multiple ovarian cysts

*Fibroadenoma* Clinical Manifestations​

discrete, usually solitary lumps < 3cm in diameter​ *symptoms:* tenderness in the tumor during menstrual cycle do not increase in size (in response to menstrual cycle)​ mass stays the same or increases slowly over time increase in size during pregnancy and decreases in size as woman ages ​

total hysterectomy vs hysterectomy with bilateral salpingo oophorectomy vs subtotal hysterectomy

supracervical/subtotal hysterectomy = removal of the upper part of the uterus leaving the cervix behind total hysterectomy = removal of the uterus and cervix total hysterectomy with bilateral salpingo-oophorectomy = removal of the uterus, cervix, fallopian tubes (salpingo) and ovaries

Breast Cancer Treatments​

· Surgery ​ -Breast-conserving surgery (BCS)​ ---> removal of tumor and small rim of healthy tissue​ -Mastectomy​ ---> removal of the entire breast​ ​ · Radiation​ -external and internal radiation​ ​ · Chemotherapy​ ·Hormonal therapy​ -Tamoxifen​ ---> Selective estrogen receptor modulator : attaches to hormone receptors and prevent hormones from attaching to the receptors​ ​ -Raloxifene​ --->Selective estrogen receptor modulator​ ​ -Letrozole​ ---> Aromatase inhibitor: inhibits the conversion of androgens to estrogen​ ​ *Nursing interventions​:* -Demonstrate correct BSE technique​ -Discuss the intervals for and facets of breast screening, including professional examination and mammography​ -Encourage the verbalization of fears and concerns about treatment and prognosis -Provide specific information regarding the woman's condition and treatment, including dietary changes, drug therapy, comfort measures, complementary and alternative therapies, stress management, and surgery​ -Describe pain-relieving strategies in detail, and collaborate with the primary health care provider to ensure effective pain control.​ -Encourage discussion of feelings about body image.​ -Refer to a stress management resource if needed to cope with long-term consequences of benign breast conditions.

Fibrocystic Changes Treatments​

·Dietary changes​ -reducing fat and methylxanthines such as coffee, tea, cola, chocolate​ · Vitamin supplementation​ -primrose oil and vitamin E​ · Smoking and alcohol cessation​ · Analgesics, NSAIDS, Compresses, Ice ​ · Hormonal therapy​ -Danazol,Tamoxifen, oral contraceptives ​ · Surgical removal ​ -used in rare cases, multiple nodules, and severe pain​

Cystocele & Rectocele Diagnosis

​Pelvic exams (for both cystocele and rectocele) ​ ---> They reveal bulging of anterior wall of the vagina when the women is asked to bear down