Med Surg Chpt 41, 42, 43, & 44
if a pt had a cell collection done by conization, what happened?
a small cone shaped sample is taken from the cervical canal, or by punch. this allows for removal of the small core of cells
what is the classic sign of endometrial cancer?
abrupt changes in bleeding patterns, especially in menopausal women
the vagin has an _____ (acidic or alkaline) pH; what does this allow?
acidic; microbial growth retardation
at what point is a women considered menopausal?
after having menses ceased for 12 months
male reproductive secretions are mostly _____ (acidic or alkaline); what does this allow?
alkaline, ensures that many sperm remain viable in the acidic environment of the vagina
when should a woman begin having mammograms?
at age 40 and yearly after that *self breast exam beginning in the 20s
patient teaching before a mammogram?
bathe; do not apply deodorant, powder, or any other substances to upper body because these may cause false shadows
what are polyps? symptoms?
benign growths that grow inside the uterus or on the cervix and may bleed after intercourse or between menstrual cycles
what are fibroid tumors? symptoms?
benign tumors made up of endometrial cells that have implanted on or within the walls of the uterus causing pain or menstrual disorders, and pressure on bowel or bladder resulting in necrosis
a pt who is 1-day post- transurethral resection of the prostate says he is having pain in his bladder, and the nurse notes urine leakage around his catheter. which of the following responses by the nurse is best?
bladder spasms are common after your surgery. take some deep breaths while I get a B&O suppository.
what are signs and symptoms of a vasovagal response?
bradycardia and falling BP
what is mastalgia?
breast pain
[hormones of female reproduction] what is the function of luteinizing hormone?
causes ovulation
typically, one mature ovum (with 23 chromosomes) is produced and released every ____ days
28
the normal vaginal pH is:
< 4.2
what is a cystocele? symptoms?
occurs when the bladder sags into the vaginal space because of inadequate support causing pelvic pressure and stress incontinence *kegel exercises will NOT help
what is a prolapsed uterus? symptoms?
occurs when the uterus sags into the vagina causing back pain, pelvic pain, pain with intercourse, constipation, and development of hemorrhoids *kegel exercise more helpful in prevention than tx
how is a bimanual palpation performed?
one hand is placed on the abdomen and the other gloved hand is inserted deeply into the vagina uterus and adnexa (ovaries and tubes) are moved about to feel the size, shape, and consistency checking for any abnormal growths
_____ hormone causes the production of milk after pregnancy
prolactin
[hormones of female reproduction] what is the function of estrogen?
promotes maturation of ovarian follicles
how is bacterial vaginosis differentiated?
release of fishy odor when potassium hydroxide is applied
what is a mastopexy?
removal of some skin and fat with subsequent resuturing so that the breast tissues are held higher on the chest to correct sagging breasts *breast lift*
what is a BSO (bilateral salpingectomy and oophorectomy)?
removal of the fallopian tubes and ovaries *woman will undergo immediate menopause
what is the most common symptom of trichomoniasis?
strawberry cervix
how is trichomoniasis differentiated?
strawberry cervix resulting from petechiae
what is augmentation?
surgery to increase the size of the breasts - silicone implants are failing d/t bursting of autoimmune problems - saline implants are now used
what is a mammoplasty?
surgical modification of the breast
what is the tx for chlamydia?
tetracyclines
what is a cystourethroscopy evaluating? how is it performed?
the degree of obstruction by an enlarged prostate gland; foley inserted, dye injected, x-rays taken with dye in bladder and while voiding after catheter is removed
what does imperforation of structures mean?
there are expected openings that do not exist
what does hypoplasia of structures mean?
they are underdeveloped
what does agenesis of structures mean?
they never developed
what is removed in a supracervical hysterectomy?
top portion of the uterus (cervix is left)
if a hydrocele is found, what is the diagnostic test used to determine if the mass is fluid filled or solid? how is it performed?
transillumination; flashlight is held behind scrotum if it glows red it is fluid, if it is opaque it is solid
what is another name for sonography?
ultrasound
what is epispadias?
urethral opening on the dorsum of the shaft
what is hypospadias?
urethral opening on the underside of the shaft
what is removed in a total hysterectomy?
uterus and cervix
what is removed in a radical hysterectomy?
uterus, tissue on both sides of cervix, upper part of vagina * done when cancer is present
if a pt's testes feels like a bag of worms, what is the diagnosis? what is causing this?
varicocele; swelling of the veins of the spermatic cord (associated most commonly with male infertility) causes pain and infertility
what is the most common symptom of herpes simplex?
vesicles
what is the tx for trichomoniasis?
Metronidazole
example of contraceptive ring?
NuvaRing
example of contraceptive patch?
Ortho Evra
what is the tx for syphilis?
Penicillin G if they are allergic: tetracycline
what occurs in the fallopian tubes?
fertilization
what is the most common symptom of condylomata (HPV)?
fleshy tumors
what should we tell women to expect after a radioactive implant is inserted to detect malignant disorders?
foul smelling vaginal discharge is expected
what is PSA (prostate-specific antigen)?
glycoprotein produced by the prostate cells elevated level indicates prostatic hypertrophy or cancer normal: <4ng/L
a pt with benign prostatic hyperplasia expresses concern that he has cancer. which response by the nurse is best?
hyperplasia means your prostate is growing too many cells. they are not cancerous, but they could interfere with your ability to urinate, so it is important to have it treated.
where is sperm stored?
in the epididymis
what should we teach women whose estrogen levels have decreased to do to help prevent fractures?
increase in dietary calcium and vitamin D
what are Bartholin's cysts? symptoms?
infected Bartholin's glands at either end of the vaginal opening d/t obstruction of the glands causing pain with sitting and intercourse
what is mastitis? what is the tx?
inflammation of the breast caused by injury and introduction of bacteria into the breast *occurs most often when breastfeeding tx: antibiotics or incision and drainage *if pt is breastfeeding it is okay to continue (promotes drainage and the infant is already colonized so further exposure makes no difference)
what is prostatitis? symptoms?
inflammation of the prostate gland resulting in pain, especially when standing symptoms: urgency, frequency, hesitancy, dribbling, dysuria, low back pain, perineal, postejaculation pain, fever, chills *tx is antibiotics **should avoid alpha-adrenergic agonist and anticholinergic medications (can cause urinary retention)
ovaries produce egg cells by _____
meiosis (or oogenesis)
normal healthy sperm in a concentration of at least _____ per milliliter of semen are needed to be considered fertile
20 milion per milliliter
who is most at risk for cancer of the penis? is it contagious? tx?
- at risk: men who were not circumcised as infants or adolescents or have acquired HPV - contagious: yes, to sexual partners - tx: minor surgery, radiation, chemo
what medication can be used to treat a vasovagal response?
- atropine - epinephrine
what are the "three C" of cancer?
- color - contour - consistency
what is retrograde ejaculation?
- common result of prostate surgery - decrease in amount of semen produced and a part of ejaculatory ducts may be removed - results in: less seman being pushed outside the body, it instead falls back into the bladder causing no harm (semen is passed during next urination)
what is phimosis?
- condition in which the foreskin of an uncircumcised male becomes so tight that it is difficult or impossible to pull back away from the head of the penis - smegma (cottage cheese-like secretion) becomes trapped under the foreskin, grows bacteria - circumcision may be recommended
what is Peyronie's disease? symptoms?
- curved or crooked look when penis is erect - fibrous bands or plaque form on dorsal part of the later of tissue that surround one of the corpora cavernosa of the penid - if this plaque is thick enough, it can cause: curvature, painful erection, difficulty in baginal penetration, and ED *may need surgery to remove plaque
what are symptoms of PMDD?
- depression - irritability - tension before menstruation more severe than with PMS
what is pelvic inflammatory disease?
- infection of the upper genital tract that can cause chronic pelvic pain due to inflammation - s/s: lower abdominal pain and tenderness, pain with intercourse, fever, N/V, adnexal tenderness upon palpation, pain in uterus and cervix when moved during bimanual examination - tx: antibiotic; laparoscopic surgery to release adhesions and reduce complications
what is mucopurulent cervicitis (MPC)?
- inflammation of the cervix that may produce a mucopurulent yellow exudate on the cervix or may have no noticeable symptoms
what is enteritis?
- inflammation of the lining of the intestine - may occur as a result of contamination during anal intercourse
what is proctitis?
- inflammation of the rectum and anus
what is vulvovaginitis?
- inflammation of the vulva and vagina - may be asymptomatic or involve redness, itching, burning, excoriation, pain, swelling of the vagina and labia, and discharge
examples of Testosterone suppressing/blocking medications?
- leuprolide (Lupron) [suppress testosterone] - goserelin (Zoladex) [decreased FSH]
what are early s/s of hepatitis B?
- loss of appetite - rashes - malaise - muscle and joint pain - headache - N/V - urine darkening - stool color lightening - liver enzymes may raise - jaundice
what is urethritis?
- men: inflammation of the urethra, prostate, and epididymis - may cause female partners to suffer from urethritis also, and may develop mucopurulent cervicitis (MPC)
what is chlamydia?
- most commonly diagnosed STI - often asymptomatic in women but may cause urethritis - can be passed from mother to baby during birth
what are symptoms of cervical cancer?
- most women are asymptomatic - slight spotting or serosanguineous discharge
what is paraphimosis?
- occurs when uncircumcised foreskin is pulled back and not immediately replaced in a forward position - leads to edema and pain
what is priapism? symptoms?
- painful erection that last longer than 4 hours - blood cannot drain, penile tissue does not get oxygen, permanent tissue damage can result - may be complete loss of erection ability after priapism episode, may cause inability to pass urine - tx: ice pack, sedatives, analgesics, injection of medication to relax vein spasms, needle aspiration, irrigation of the corpora
myths about STIs:
- people who have STIs are easily identifiable - avoiding persons who have a hx of engaging in casual sex, IV drug use, homosexual activity, bisexual activity, or a previous sexual relationship with persons who engage in these high risk practices effectively protects one from infection with STIs. (yes, but not every is honest, not everyone is aware of their previous partner's hx, asking such questions is difficult) - STIs never happen the first time - Intact genital skin is impervious to the pathogens - Condoms prevent the spread of all STIs - The female condom prevents all transmissions of STIs - Manual, oral, and anal stimulation cannot transmit STIs - Spermicide kills all STI germs - People get AIDS only by homosexual sexual activity or by blood transfusion - A woman cannot transmit HIV to a man/woman - Sexual activity during menstruation is less likely to result in STIs - Lesbian sexual activity cannot transmit STIs - Those who have not infected after sexual activity with several people are naturally immune to STIs - Those who have have had an STI and have been cured of it by taking medicine are now immune to that infection - People can be certified free of all STIs by having a blood test and taking a simple medication if infection is present - Oral contraceptive pills give protection against STIs
what are symptoms of vulvar cancer?
- persistent itching of the vulva or appearance of white or red patches - rough areas - skin ulcers - wartlike growths
what is a transurethral resection of the prostate (TURP)?
- pt is anestetized - resectoscope is inserted into the urethra - prostate is chipped arway a piece at a time - special instruments are used to "vaporize" or "microwave" the pieces and cut down on the amount of bleeding during surgery - foley in place afterward with 30 to 60 mL of sterile water inflating the balloon to compress the prostate area and stop the bleeding
examples of vasodilators for ED?
- sildenafil (Viagra) - tadalafil (Cialis) - vardenafil (Levitra) relax smooth muscle, produce vasodilation *avoid use when taking nitroglycerin preparations*
what are symptoms of toxic shock?
- sudden high fever with sore throat - headache - dizziness - confusion - redness of the palms and soles of the feet - rash - blisters - petechiae, followed by peeling of the skin - muscle pain and weakness - gastrointestinal upset
cancer of testicles
- symptoms: small, usually painless lump on the testicle; scrotum feels heavy and is swollen - diagnosed: HCG, ultrasound, blood tests - tx:complete removal of cancerous testicles, spermatic cord, and local lymph nodes *if he wants to have kids - encourage a deposit at a sperm bank
examples of alpha-adrenergic medications?
- tamsulosin (Flomax) & terazosin (Hytrin) [relax smooth muscle, produce vasodilation] - finasteride (Proscar) & dutasteride (Avodart) [alpha reductase inhibitor - inhibit enzyme responsible for formation of potent androgen from testosterone]
what is cryptorchidism?
- undescended testicles *testicles that are not brought down into the scrotum decrease a man's chances of producing a child
what should we teach pts after a vasectomy?
- use another form of birth control method for about 3 months after the surgery to be sure there are no sperm left in the tract about the surgical site
what is condylomatous?
- wartlike growths caused by STIs
what are symptoms of PMS?
- water retention - headache - discomfort in the joints, muscles, and breasts - changes in affect, concentration, and coordination - sensory changes
what is epididymitis?
-inflammation or infection of the epididymis that can be caused by bacteria, viruses, parasites, chemicals, or trauma -risk factors: STI, complication of urological procedures, reflux of urine -tx: antibiotics
what is the tx for herpes simplex?
-ovir medications
what is orchitis?
-rare inflammation or infection of the testicles caused by trauma or infection from epididymitis, UTI, STI, or systemic diseases -symptoms: swollen, extreme tender testicles, red scrotal skin, and fever -tx: scrotal support, antibiotics, medication to relieve pain and fever
a couple is considered infertile if they have been unsuccessful at becoming pregnant after at least _____ of unprotected intercourse
1 year
example of implanted contraceptive?
Depo-Provera
what complication is associated with chlamydia?
Fitz-Hugh-Curtis syndrome
which statement by a pt shows the need for more education about erectile dysfunction?
I can try some herbal remedies such as ginseng before consulting my physician
what is hydrocele?
a fluid-filled mass found on the testes *no tx is necessary unless it is so large that it causes discomfort, embarrassment, or threats the blood supply
what is the tx for gonorrhea?
cephalosporins
what is the most common symptom of syphilis?
chancre
what is endometriosis? what are symptoms?
condition in which functioning endometrial tissue is located outside the uterus symptoms: - pain - swelling - damage to abdominal organs and structures - scar tissue development - infertility
how does candidiasis discharge look?
cottage cheese appearance
how is a postcoital test performed?
couple is advised to have intercourse when luteinizing hormone and estrogen levels are high, specimen of cervical mucus is taken from the woman 2 to 12 hours later
what is done during a hysterosalpingogram?
dye is injected into the uterus until it comes out the ends of the fallopian tubes used to identify congenital abnormalities in the shape or structure of the uterus and blockages of the fallopian tubes
what are signs and symptoms of prostate cancer?
early: rare later: urinary obstruction, hematuria, urinary retention advanced: pain in back of hip (from metastasis of the bone), anemia, weakness, weight loss, overall tiredness
what part of the uterus is lost and regenerated with each menstrual cycle?
endometrium
what is PAP (prostatic acid phosphatase)?
enzyme that normally affects metabolism of prostate cancer cells increase indicates prostate cancer normal: <3ng/L
as women age and approach menopause, ______ production slowly decreases, which decreases the processes of building and remodeling bones putting these women at risk for fractures
estrogen
during pregnancy, high levels of _____ and _____ hormones prepare glands for milk production
estrogen and progesterone
how should we teach pts to take a basal body temperature?
every AM before getting up or moving
______ is the term used to describe a procedure that requires the pt to be pumped with CO2. what are side effects of this? what could we teach to help them?
insufflation causes: pain in neck, shoulders, and upper back tx: lying fat on back to decrease discomfort
what are the different types of endoscopy procedures and what do they view?
laparoscopy: abdominal cavity salpingoscopy: fallopian tubes hysteroscopy: uterus colposcopy: cervix culdoscopy: vagina
[hormones of male reproduction] what is the function of testosterone?
maturation of sperm and development of male secondary sex characteristics
what is amenorrhea?
menses absent for more than 6 months
what is hypermenorrhea?
menses lasting more than 7 days
what is polymenorrhea?
menses more frequently than 21-day intervals
what is hypomenorrhea?
menses with less than expected amount of bleeding
what is oligomenorrhea?
menstrual cycles of more than 35 days
what is thermography?
method of mapping the breast using photographic paper that records the temperature variations throughout the tissue in different colors
what is the mons pubis?
mound of hair-covered adipose tissue overlying the symphysis pubis
what is benign prostatic hyperplasia?
nonmalignant growth of the prostate gland causing urinary obstruction, normal process in older men age 50+ symptoms: decrease in size or force of the urinary stream, difficulty starting stream, dribbling when complete, urinary retention, feeling that bladder is not empty
what is para?
number of births whether alive or stillborn
what is gravida?
number of pregnancies *tip: remember gravida by thinking of gravity because a woman is typically heavier when pregnant
what is a rectocele? symptoms?
occurs when a portion of the rectum sags into the vagina because of inadequate support causing pelvic pressure, fecal incontinence, constipation, and hemorrhoids *kegel exercises will help
what are the options for a radical prostatectomy?
open: - suprapubic: incision made through lower abdomen into the bladder - retropubic: no incision in bladder, goes through lower abdomen as well - perineal: incision between the scrotum and the anus to remove the gland minimally invasive: - use laparoscopy and tiny robot arms to perform radical prostatectomy through 5 small "porthole" incisions in the abdomen
what is menometrorrhagia?
overly long, heavy, and irregular menses
what is fibrocystic breast changes? how is it diagnosed? what tx may help?
overresponsiveness of cells in the breasts to hormonal stimulation which may cause long-term changes resulting in replacement of normal tissue with fibrous tissue, overdevelopment of cells, and blockage of ducts that cause cysts to form around and trap fluids diagnosed with mammogram or biospy tx: limitation of dietary fat and caffeine and addition of oral contraceptive use (controls hormones)
breastfeeding stimulates the release of _____, which in turn stimulates the release of milk and contractions of the uterine muscle
oxytocin
rising _____ levels increase uterine contractions to bring about birth
oxytocin
what is dysmenorrhea?
painful menstruation primary: caused by action of endogenous prostaglandins stimulating uterine contraction, producing cramps secondary: caused by reproductive disorder
what is menorrhagia?
passing more than 80 mL of blood per menses *weigh pads - a 1g increase in pad weight = 1 mL of blood
what is gynecomastia?
presence of excess breast tissue from an excess of female hormones