NR 602 WEEK 5

54324yo female is dx'd w/primary dysmenorrhea. Which med would be used as first-line to help control symptoms? a. Antianxiety meds b. Progesterone-only contraception c. Oral steroids d. NSAIDs

D

What are some diagnostic lab studies for DUB?

-*Serum hCG: always do first before examining pt of menstruating age w/vag bleeding -CBC -ABO/Rh if preg. suspected/severe bleeding -STD tests/wet prep -Cervical cytology -CMP (w/renal & liver panel) -Coags -If hx indicates: screen for bleeding disorders for DUB at menarche. -If hx indicates: thyroid panel -Endometrial bx

What are some things that can cause menstrual irregularities?

-Disturbances in normal hormone release -Significant wt loss -Strenuous exercise -Substantial changes in sleep/eating habits -Severe stressors

What are some diagnostic studies for polyps in DUB?

-TVUS -Saline infusion sonography -Hysteroscopy

What are some diagnostic imaging studies for DUB?

-TVUS: first-line if imaging needed -Saline infusion sonohysterography (helpful for leiomyoma) -Hysteroscopy (can be used for guided endometrial bx) -MRI

What is the average age of menarche for Caucasians?

12.6 years

Most cycles range from ___________.

21-34 days

PMS occurs with greatest frequency and severity in the: a. Late luteal phase b. Midfollicular phase c. Proliferative phase d. Early luteal phase d. Early luteal phase

A

What is abnormal/dysfunctional uterine bleeding?

Acute or chronic bleeding from uterine corpus; abnormal in regularity, volume, frequency, or duration; occurs in pregnancy absence

A female patient is concerned about having irregular menstrual bleeding. Which of the following is not a common cause of this problem? Endocrine disorders Anatomical abnormality Stress Anovulation

Anovulation

Name some risk factors for dysfunctional uterine bleeding (DUB)?

Anovulation Hormone replacement anovulation Obesity Nulliparity >35yo DM Personal/fam h/o coagulation disorder Liver disorder Anticoagulant therapy/chemo

A patient is completing a diary of her premenstrual syndrome (PMS) symptoms. The nurse practitioner understands that PMS occurs with greatest frequency and severity in the ____. luteal phase menstrual phase midfollicular phase proliferative phase

luteal phase

What is ACUTE dysfunctional uterine bleeding?

Episode of sufficient quantity to require immediate intervention to prevent further blood loss

What are some objective findings for dysfunctional uterine bleeding DUB?

Excessive bleeding on exam Hypotension Tachycardia Diaphoresis Vag atrophy Mass Trauma Enlarged uterus/adnexa Hirsutism Thyromegaly Bruising Galactorrhea

What phase is menstrual days 1-14 in ovarian cycle?

Follicular Prominent hormones: FSH, estrogen Description: maturation of ovarian follicle

There are several phases to the menstrual cycle. What phase begins with menses cessation and ends with ovulation? Ovulatory phase Follicular phase Menstrual phase Luteal phase

Follicular phase

What are some subjective findings for dysfunctional uterine bleeding DUB?

Heavy bleeding Bleeding >7 days Cycles closer than 21 days Pain Post-coital bleeding Passing clots/tissue Dizziness Hot flashes Temp intolerance Uterine/cervical tenderness

The first line treatment of severe menstrual cramps that have been occurring for four months in a patient with primary dysmenorrhea includes which of the following Ibuprofen Amitriptyline Combination hormone replacement therapy (HRT) Acetaminophen

Ibuprofen

What phase is menstrual days 15-28 in ovarian cycle?

Luteal Prominent hormones: Progesterone, estrogen Description: follicle becomes corpus luteum

What cycle are follicular, ovulation, & luteal phases?

Ovarian

What are the 2 cycles that occur simultaneously in the menstrual cycle?

Ovarian and endometrial

What phase is menstrual day 14 in ovarian cycle?

Ovulation Prominent hormones: LH Description: ovulation 36h after LH surge; increased basal body temp

What are some diff dx's for DUB?

PALM-COEIN Traumatic injury Pregnancy-related bleeding (ectopic, SAB, placenta previa/abruptio)

Name 4 structural abnormalities that are causes of dysfunctional uterine bleeding.

PALM: Polyps Adenomyosis Leiomyoma Malignancy

Tanisha is a twenty-two-year-old woman who presents with extreme irritability and mood swings, bloating, constipation, fluid retention, and headache. She tearfully tells you, "This happens every month in my cycle. I get like a crazy woman, lashing out at everyone. I'm afraid I'll lose my job if I can't stop this. Sometimes, it's so bad. I just want to quit living. I need help!" Tanisha's symptoms are typical of what disorder? Premenstrual syndrome (PMS) Depression Premenstrual dysphoric disorder (PMDD) Bipolar disorder

Premenstrual dysphoric disorder (PMDD)

What is chronic dysfunctional uterine bleeding (DUB)?

Present for the majority of the last 6mo

A patient who a nurse practitioner is seeing for the first time has the past medical history of primary dysmenorrhea. She recalls that which of the following is considered as the primary etiology? Ovarian cysts Prostaglandin production Adenomyosis Endometriosis

Prostaglandin production

A thirty-two-year-old woman presents to your practice with a chief complaint of postcoital bleeding. Which of the following would not be included in the initial assessment of this patient? Pelvic ultrasound Papanicolaou smear CBC with diff Uterine biopsy

Uterine biopsy

A thirty-five-year-old woman, presents with a six-month history of hypermenorrhea, backache, and pelvic pressure. On examination, you discover a twelve-week size uterus with irregular contour. Which of the following does this represent? Uterine fibroid Uterine cancer Fecal impaction Dysfunctional uterine bleeding (DUB)

Uterine fibroid

The nurse practitioner is caring for a menopausal patient reporting vaginal dryness with intercourse. How would this best be managed? Vaginal estrogen Oral progestin Transdermal estrogen Oral estrogen

Vaginal estrogen

Post-coital Bleeding

bleeding occurring after intercourse

28yo female c/o breast tenderness, fatigue, abd bloating, fluid retention, irritability 1wk before her menses onset. What is most important info to obtain from this pt to determine if the pt has PMS? a. Severity of symptoms b. Occurrence of symptoms in menstrual cycle c. Frequency and number of symptoms over past 4mo

B

Dysfunctional uterine bleeding (DUB). She is concerned about why this is happening to her. You recall which of the following is the most common cause of DUB? a. Endocrine disorders b. Stress c. Anovulation d. Anatomical abnormality

C

Name 5 non-structural abnormalities that are causes of dysfunctional uterine bleeding.

COEIN: Coagulopathy Ovulatory disorders Endometrial Iatrogenic Not classified