OB— Chapter 4- common gynecologic issues

Contraception— OC Complications acronym**

ACHES

An abortion is considered a woman's....

Constitutional right based on the fundamental right to privacy

Whatever decision is made concerning contraception... It needs to work for the...

Couple

Rhea

Flow

dys

Not or pain

PAINS

P- period late, abnormal bleeding A- abdominal pain, pain with intercourse I- infection exposure, abnormal vaginal discharge N- not feeling well, fever, chills S-String length shorter or missing

Contraception— IUD/IUS/IUC complications acronym**

PAINS

20% of 40% of reproductive age women experience...

Premenstrual symptoms 10% experience PMDD

Memometrorrhagia

Prolonged, excessive, irregular menstrual period

DUB/AUB— if medication's do not work...

Surgery, DNC, endometrial ablation, hysterectomy

What to types of abortions are safe and legal in the United States?

Surgical and medical

rhagia

excess or abnormal

menorrhagia

excessive menstrual bleeding Menstrual related/excess or abnormal

oligio

few

Secondary infertility***

inability to conceive after a previous pregnancy

Infertility - male factor assessment

-Semen analysis, sexual characteristics, external and internal reproductive organ examination, digital prostate examination

Primary amenorrhea— therapeutic intervention

-depends on the cause of amenorrhea

Infertility - nursing management

-respect for a couple -non-judge mental -education, anticipatory guidance, stress management, counseling, referrals -assistance in decision-making, advocacy -Assistance with financial strategies

Chemical contraception

-spermicides may be used along with mechanical barrier devices— Creams, jellies, phone, suppositories, and vaginal film

endometriosis treatments

-surgery and meds

At the beginning of the menstrual cycle lining of the uterus sheds and these implant swelling bleed causing...

"Mini periods" Where are the endometrial tissue is located

ACOG criteria for premenstural sysndrome

- Having at least one of the following affective and somatic symptoms during the five days before menses in each of the three previous cycles - Symptoms relieved from days for 13 of the menstrual cycle

barrier contraception

-15 to 25% failure rate, no hormones are used but chemicals (Check for chemical and latex allergies)

emergency contraception

-20% failure rate... Given within 72 hours... The sooner the more effective

tubal ligation cutting**

-30 day concert required and again right before procedure

Amenorrhea (menstrual disorder)

-Absence of menses during reproductive years

secondary amenorrhea

-Absence of menses in the woman who previously menstruated that is not related to another condition or disorder

DUB/AUB— possible causes (menstrual disorder)

-Adenomyosis -pregnancy -hormonal imbalance -fibroid tumors -endometrial polyps or cancer -endometriosis -intrauterine device... IUD -polycystic ovary syndrome -morbid obesity -steroid therapy -hypothyroidism -Blood/clotting disorder

Primary amenorrhea —etiology

-Extreme weight gain or loss -congenital abnormalities of the reproductive system -stress from a major life event -eating disorders -polycystic ovary syndrome -Turner syndrome -ovarian or adrenal tumors -pregnancy -hypothyroid -excessive exercise -chronic illness -Cushing's disease -cystic fibrosis -imperforate hymen -congenital heart disease... Cyanotic

somatic symptoms

-Breast tenderness, abdominal bloating, Adema, headache

DUB/AUB— Laboratory and diagnostic test

-CBC(anemia), prothrombin time (PT) (dyscrasias), BHCG, thyroid stimulating horomone (TSH) -Transvaginal ultrasound -pelvic ultrasound -endometrial biopsy -D&C for diagnostic evaluation

primary dysmenorrhea (spasmodic)

-Caused by increased production of prostaglandins

Where is the endometrial tissue commonly found attached to during endometriosis?

-Commonly found attached to the ovaries, fallopian tubes, the outer surface of the uterus, the bells, the area between the vagina in the rectum, and the pelvic sidewall

endometriosis surgery

-Conservative versus definitive

Primary amenorrhea— treatment

-Correction of any underlying disorders and estrogen replacement therapy to stimulate the development of secondary sexual characteristics

Affective symptoms

-Depression, angry outburst, irritability, anxiety

Mechanical contraception

-Devices are placed over the penis or cervix to physically obstruct the passage of sperm through the cervix (EX— condoms, diaphragm, cervical cap, contraceptive sponge)

Adenomyosis

-Growth of endometrium into utero musculature

Infertility — laboratory and diagnostic testing

-Home ovulation predictor kits -clomiphene citrate challenge test -endometrial biopsy -postcoital testing -Hysterosalpingogram -laparoscopy

Endometriosis **

-Implants can cause pain and make it difficult to get pregnant

Methotrexate

-Induces abortion

Menstrual disorders— lab and diagnostic tests

-Karotype -ultrasound -pregnancy test -thyroid function studies -prolactin level -CT scan of head if a pituitary tumor is suspected -FSH level -LH level - 17-ketosteroids -laparoscopy

Endometriosis medication

-NSAIDS, OCs, progesterone, anti-estrogen's, GnRH-a -Danazol (synthetic androgen - male hormone)

endometriosis (menstrual disorder)

-One of the most common gynecologic disorders -It's of functioning endometrial tissue located outside of their normal site, the uterine cavity

Contraception - hormonal methods

-Oral contraceptives(8% failure rate) -injectable contraceptives (3% failure rate) -transdermal patches (8% failure rate) -vaginal rings (8% failure rate) -implantable contraceptives (0.5% failure rate) -intrauterine systems (IUD/IUS/IUC) (1% failure rate) -emergency contraception

Infertility - female factor assessment

-Ovarian function, pelvic organs

Abortion

-Purpose is to terminate a pregnancy

Hallmark sign of endometriosis***

-Tender nodular masses on uterosacral ligament, posterior uterus, or posterior cul-de-sac

ACOG defines premenstrual syndrome as

-The cyclic occurrence of symptoms that are sufficiently severe to interfere with some aspects of life and then a peer with consistent and predictable relationship to menses

Primary infertility***

-The inability to conceive a child after one year of regular sexual intercourse unprotected by contraception, or the inability to carry a pregnancy to term -ONE FULL YEAR*

Medical abortion

-The woman take certain medication to induce a miscarriage to remove the products of conception

IUD... think what?

-Think string length... Like tampon string

Primary amenorrhea— if a pituitary tumor is the cause, what do you treat with?

-Treat with drug therapy, surgical resection, or radiation therapy

secondary dysmenorrhea (congestive)

-Who is my pelvic or are you doing pathology

Primary amenorrhea

-absence of menses by age 14 with absence of development of secondary sexual characteristics OR -Absence of menses by age 16 with normal development of secondary sexual characteristics

Behavioral contraception methods include...

-abstinence -fertility awareness -withdrawal (coitus interruptus) -lactational amenorrhea method (LAM) -Affordable, high failure rate except abstinence, no side effects

Secondary amenorrhea— Disease and therapeutic management

-anovulation -Hyperprolactinemia -anorexia, bulimia, or obesity -hypothalamic failure -hypothyroidism -Surgery

Cervical mucous ovulation method

-assess cervical mucus - Used as contraception

Contraception—Natural behavioral methods

-behavioral methods—Natural contraception (no hormones, no barriers, no surgery (These have a high failure rate, need to be consistent, and clients trying to get pregnant may use them)

fertility awareness methods

-cervical mucus ovulation method -basal body temperature -symptomtothermal method -The standard days method

postcoital test

-cervical mucus stretchability— spinnbarkeit

Nursing interventions of the woman choosing a contraceptive method

-client/couple participation in decision-making -client education (misconceptions, mechanism of action, advantages and disadvantages, danger signs to report, method failure and backup method)

Menstrual disorders— nursing management

-education and counseling -educated on medication therapy -exercise -limit salty foods -increased water consumption -increase fiber intake... Fruits and veggies -use heating pad or warm baths -sip on warm beverages... Decaffeinated green tea -keep legs elevated while laying down -use stress management techniques -practice relaxation techniques -stop smoking and decrease alcohol use

DUB/AUB— medications

-estrogens -progestins -oral contraceptives -NSAIDS -levonorgesterel- 20/ intrauterine system/Mirena IUD -iron salts

Cultural and religious considerations of infertility

-expectations for reproduction -Impact on perceptions and management of infertility

Contraception: Barrier Methods

-forms of birth control that prevent pregnancy by preventing the sperm from reaching the ovum (Mechanical and chemical)

(menstrual disorder)— Nursing assessment and work out

-history and physical including bi manual exam -manifestations -systemic symptoms -physical symptoms -Laboratory and diagnostic test

What factors increase the risk of endometriosis?

-increasing age -Family history of endometriosis in a first-degree relative -short menstrual cycle -Long menstrual flow -Young age of menarche -few or no pregnancies

Endometriosis diagnosis

-infertility and pain -non-specific pelvic tenderness

dysfunctional uterine bleeding (DUB/AUB)— (menstrual disorder)

-irregular, abnormal bleeding that occurs with no identifiable anatomic pathology -occurs more frequently and women at the beginning and end of the reproductive years -associated with anovulatory cycles -Related to a hormone disturbance

Nursing assessment of the woman choosing a contraceptive method

-medical history -Family history -OB/GYN history -personal history -diagnostic testing -Physical exam

DUB/AUB are similar and may overlap with other uterine bleeding disorders-

-menorrhagia -oligomenorrhea -metrorrhagia -menometrorrhagia -polymenorrhea

Medical abortion— methotrexate (Antineoplastics agent) followed by misoprostol (Prostaglandin agent)

-methotrexate is followed by misoprostol 3 to 7 days later -(90-98% effective)

Contraception hormonal method side effects

-mood changes -Weight gain -bleeding -With iOS can have infection

premenstrual dysphoric disorder (PMDD) (menstrual disorder)

-more severe variant of PMS -interaction between hormonal events and neurotransmitter function -serotonin (transition of nerves related to the mood)

dysmenorrhea (menstrual disorder)

-painful menstruation "cyclic perimenstrual pain" (CPPD) -affects more than half of menstruating women -Uterine contractions occur during all periods, But in some women these cramps can be frequent and very intense

secondary amenorrhea— etiology

-pregnancy -emotional stress -pituitary, ovarian, or adrenal tumors -hyper thyroid or hypo thyroid conditions -Hyperprolactinemia -rapid weight gain or loss -use of tranquilizers or antidepressants -postpartum pituitary necrosis (Sheehan syndrome) -breast-feeding -depression -malnutrition -kidney failure -colitis -early menopause -chemotherapy or radiation therapy to the pelvic area -Vigorous exercise, such as long distance running

Two types of Dysmenorrhea

-primary (spasmodic) - secondary (congestive)

Contraception - women's sterilization

-tubal ligation cutting -tying -Burning Fallopian tubes (GYN or PP)

How to diagnosis endometriosis?

-ultrasound and laparoscopy (Biopsy to confirm

Basal body temperature

-used as a contraceptive -take temperature every day at same time**

surgical abortion

-vacuum aspiration or suction curettage

Contraception - men's sterilization

-vasectomy sealing -tying vas deferens (Performed in urology office) -Semen no longer carries sperm, not immediate, need to specimens with no sperm

premenstrual dysphoric disorder (PMDD)— Therapeutic management

-vitamin supplements (vitamin E, calcium, magnesium) -diet changes -exercise -lifestyle -Medication

Pre-Menstrual Syndrome (PMS) (menstrual disorder)

-wide range of recurrent symptoms that occur during the luteal phase (last half of the menstrual cycle) and resolve with the onset of menstruation

ACHES**

A- abdominal pain (gallbladder or liver problems) C- chest pain or SOB H- headaches (Not relieved by Tylenol) E- eye problems S- Severe leg pain

PMS symptoms are categorized by...***

A— anxiety C— craving D— Depression H— hydration O— other

TOP

Termination of pregnancy

Metro

Time

What is the ideology of premenstrual dysphoric disorder?

Unknown

What are the main symptoms of premenstrual dysphoric disorder?

What disorders

a

Withiut, none, or lack of

Diaphragms***

a barrier contraceptive that prevents the sperm from reaching and fertilizing the egg -requires fitting and RX -need to get refitted if change in weight is 10 pounds either way and requires a RX

symptothermal method

a contraceptive method that involves monitoring both cervical mucus and basal body temperature to determine ovulation

AUB

abnormal uterine bleeding -Painless endometrial bleeding that is prolonged, excessive, and irregular

metrorrhagia

bleeding between periods Irregular time intervals

Meno

menstrual related

polymenorrhea

more than normal frequency of menses (A lot... Less than 21 day interval)

oligomenorrhea

scanty menstrual flow

What is the cause of endometriosis?

unknown