Chapter 11: The Nurse's Role in Women's Health Care

Goal healthy people 2020 related to women health (Achievement of these goals require preventive care, screenings, and increase accessibility to health care)

- Increase number of women over age 40 who have mammograms to help curb the rise in breast cancer - Increase number of women over age 18 who have papanicolaou (pap) test to reduce the number of deaths from cervical cancer - Reduce the occurrence of vertebral fractures in older women with osteoporosis - Reduce the occurance of STI

Three approaches for early detection of breast cancer

- Monthly self breast exam - Annual profession exam - mammograms as appropriated

Symptoms of PMDD

- depressed mood - anxiety, tension, feeling "on edge" - increase sensitivity to rejection - irritability - decrease interest in usual activities - difficulty concentrating - lethargy - Change in appetite- food cravings - Change in sleep habits - feeling overwhelmed - physical symptoms such as breast tenderness, bloating, weight gain and headache

What should the women NOT do 48 hours before pelvic exam?

- don't douche - don't have sexual intercourse

Common causes for any type of abnormal bleeding

- pregnancy complications, such as identified that is ending spontaneous abortion - Lesions of the vagina, cervix or uterus(benign or malignant) - Break through bleeding that may occur in a woman taking oral contraception Endocrine disorder such as hypothyroidism - Failure to ovulate or respond appropriately to hormones secreted with ovulation (dysfunctional uterine bleeding)

Early detection of breast cancer

1. monthly breast selft exam 2. annual professional breast exam 3. mammography as appropriate

What amount blood loss per month is consider excessive?

80 ml result in anemia

Healthy People 2020 goals and strategies r/t women's health

> no. of women over 40 to have mammograms, > no. of women over 18 to have pap smears, reduce occurence of vertebral fractures in women w/ osteoporosis, reduce occurance of STIs

Can be inserted up to 4 hours before sex

A diaphragm

Warning signs to report when taking OCs

ACHES acronym: severe Abdominal pain, Chest pain with dyspnea and bloody sputum, sever Headache with weakness or numbness of the extremeties, Eye problems such as blurring, dbl vision, blindness, Severe leg pain or swelling and speech disturbance

premenstrual dysphoric disorder (PMDD) (premenstrual syndrome PMS)

Abnormal secretion response to normal changes in estrogen levels during menstrual cycle. Symptoms occur between ovulation and the onset of menstruation not present after menstruation

What amount of blood is lost during a normal menstrual cycle?

About 35 ml Blood loss 80 ml month is considered excessive

Increases the risk for vaginal infections

Douching

A word that should be avoided when discussing which member of the infertile couple has the identified problem

Fault

Should be used only by women who have no current pelvic infection and are in a relationship that is monogamous for both partners

IUD intrauterine device

A reliable temporary, reversible BC method

Ortho-Evra transdermal patch

A word that should be used when discussing sexual issues until the couple indicates a preference for an alternative term

Partner

Increases the chance of experiencing complications related to oral BC, particularly women over 35

Smoking

Depo-Provera is administered via

Subcutaneous injection

A nurse recommends __________ to relieve or reduce symptoms of premenstrual dysphoric syndrome

The use of oral contraceptive medication

Can a woman become pregnant while breastfeeding?

Yes a woman can become pregnant while breastfeeding

osteoporosis

a decrease in the overalll mass of bones due to an increase in the trabeculae of the bone. it can be caused by age, sedentary lifestyle, smoking, diet, and many other factors

endometriosis

a medical condition in which endometrial tissue is found in areas of the body other than the uterus

leiomyomas

a tumor in the myometrium of the uterus; also known as a fibroid

Surrogate mother

a woman allows her ova to be inseminated, then she carries the fetus and agrees to relinquish the infant after birth

16. When a woman asks what she can do to reduce the discomfort of hot flashes, the nurse advises:

a. "Aerobic exercise helps control hot flashes." b. "Increase the amount of calcium and vitamin D in your diet." c. "Dress in layers of cotton clothing." d. "Drink plenty of fluids, particularly caffeinated beverages." ANS: C Cotton allows easier passage of air than synthetic fabrics. Layering allows the woman to take off or put on clothes when symptoms occur.

18. The nurse realizes that a man considering a vasectomy needs further information if he says:

a. "Sterility does not occur immediately after the procedure." b. "We will need to use some form of birth control for about a month afterward." c. "The procedure involves the use of local anesthesia." d. "I'll need to remain in the hospital for a few days." ANS: D A vasectomy takes about 20 minutes and is performed on an outpatient basis under local anesthesia.

19. At her 6-week postpartum checkup, a woman states, "I am wondering about birth control. I used oral contraceptives before, and I'm breastfeeding now. Can I use the pill again?" The nurse's best response is:

a. "You should know that oral contraceptives increase your milk production." b. "Oral contraceptives can be taken once lactation is well established." c. "You don't need to use any form of birth control as long as you are breastfeeding." d. "Oral contraceptives are contraindicated for the lactating woman." ANS: B Oral contraceptives decrease breast milk production and are contraindicated until lactation is well established. Women who breastfeed their infants usually will not ovulate for 10 weeks and do not need contraception until that time.

7. On day 13 of a 28-day cycle, a woman's basal body temperature is 36.5 C (97.7 F). If she ovulates on day 14, her temperature measurement on day 14 would most likely be:

a. 35.9 C (96.7 F). b. 36.3 C (97.3 F). c. 36.7 C (98.1 F). d. 37.1 C (98.9 F). ANS: C At the time of ovulation, body temperature will increase slightly, about 0.2° C (0.4° F).

24. The nurse instructs the woman taking oral contraceptives to report which possible side effect(s)? Select all that apply.

a. Abdominal pain b. Weight gain c. Headache d. Eye or visual problems e. Speech disturbances ANS: A, C, D, E The memory aid ACHES is helpful: Abdominal pain, Chest pain, Headaches, Eye problems, Speech disturbances. Weight gain is an expected side effect of oral contraceptives.

27. The patient who has been dealing with urge incontinence tells the nurse that the symptoms have gotten worse lately. The nurse reminds the patient that which food(s) and drug(s) can increase incontinence? Select all that apply.

a. Antihypertensive drugs b. Coffee c. Alcohol d. Diuretics e. Anticholinergics ANS: A, B, C, D, E Foods and drugs that increase the symptoms of urge incontinence are antidepressants, angiotensin converting enzyme (ACE) inhibitors, caffeine, alcohol, diuretics, and anticholinergics.

28. The nurse advises the woman with pelvic floor dysfunction that she can do what for relief of the associated discomfort? Select all that apply.

a. Lie down with feet elevated. b. Practice Kegel exercises. c. Assume knee-chest position periodically. d. Perform leg lift exercises. e. Prevent constipation. ANS: A, B, C, E Elevating the feet, performing Kegel exercises, assuming the knee-chest position, and preventing constipation will reduce the pelvic discomfort of pelvic floor dysfunction.

26. The nurse cautions that women with a history of which disorders are not candidates for HRT? Select all that apply.

a. Melanoma b. Estrogen-dependent breast cancer c. Hepatitis C d. Thromboembolic disease e. Hyperthyroidism ANS: A, B, C, D Persons who are absolutely restricted from HRT are those with melanoma, estrogen-dependent breast cancers, chronic liver disorders, thromboembolic disease, and seizure disorders.

4. The nurse would tell the patient to expect what after she had an intrauterine device (IUD) inserted?

a. Menstrual flow will be lighter. b. Menstrual cramps will be eliminated. c. A string should be felt in the vagina. d. The device should be changed every 2 years. ANS: C A woman should feel for the string periodically, especially after her period, to confirm the presence of the IUD.

25. What are anonymous sperm donors screened for? Select all that apply.

a. Particular physical features b. Genetic defects c. Infections d. High-risk behaviors e. Nationality ANS: B, C, D Sperm donors are screened for genetic defects, infections, and high-risk behaviors. As an added precaution, the sperm are kept frozen for 6 months before the sample is used.

17. Which statement made by the nurse would teach an adolescent using tampons how to prevent toxic shock syndrome (TSS)?

a. Super-absorbency tampons are effective for overnight absorption. b. Tampons should be changed at least every 4 hours. c. Gloves should be worn when changing tampons. d. TSS can be prevented by using a pad for the first 2 days of menstrual flow. ANS: B Tampons should be changed every 4 hours because a blood-soaked tampon is an excellent environment for bacteria.

2. A 25-year-old woman has a family history of breast cancer. The nurse reviews the procedure for breast self-examination (BSE) and tells her that the best time for a woman to perform a breast self-examination is:

a. a few days before her period. b. during her menstrual period. c. on the last day of menstrual flow. d. one week after the beginning of her period. ANS: D The best time for BSE is 1 week after the beginning of the menstrual period.

6. The nurse reminds a group of high school students that the most effective choice of birth control for preventing pregnancy and sexually transmitted diseases is to:

a. abstain from sex. b. use the male condom. c. use the female condom. d. use the barrier method. ANS: A Abstinence is 100% effective in preventing pregnancy and sexually transmitted diseases.

22. The nurse warns that the effectiveness of oral contraceptives is decreased in women who are taking:

a. antihistamines for seasonal allergies. b. iron preparations for treatment of anemia. c. appetite suppressants for weight reduction. d. anticonvulsants for treatment of epilepsy. ANS: D Anticonvulsants decrease the effectiveness of oral contraceptives.

1. The nurse is preparing a community education program on preventive health care for women. The nurse plans to tell the women attending the program that a screening test common in women's health care is:

a. breast examination by a health professional. b. breast self-examination. c. breast biopsy. d. mammography. ANS: D Mammography is a screening test used to detect breast cancer

21. A 21-year-old college student has come to see the nurse practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva, and vaginal discharge has a cottage cheese appearance. These findings are consistent with:

a. candidiasis. b. trichomoniasis. c. bacterial vaginosis. d. Chlamydia. ANS: A The signs and symptoms of candidiasis include inflammation of the vagina and vulva and a cottage cheese appearance to the vaginal discharge.

8. The nurse tells a woman who is trying to conceive to check her cervical mucus for changes. A few days before ovulation, the cervical mucus is:

a. cloudy and tacky. b. scant and thick. c. thin and white. d. clear and slippery. ANS: D Within a few days of ovulation, cervical mucus will become clear and slippery to aid the passage of sperm into the cervix.

5. The woman using a diaphragm correctly would tell the nurse that the diaphragm:

a. does not require the use of a spermicidal cream or jelly with it. b. should be left in place for at least 6 hours after intercourse. c. is removed immediately after intercourse for douching. d. is effective for up to 48 hours if positioned properly. ANS: B To act as a barrier, the diaphragm must be left in place for at least 6 hours after intercourse and can be left in place up to 24 hours.

10. In the week before her menstrual period, a woman experiences irritability, anxiety, and difficulty concentrating. The nurse suggests that a remedy to relieve these symptoms is to:

a. drink tea or hot chocolate before going to bed. b. take a daily folic acid and vitamin C supplement. c. include complex carbohydrates and fiber in the diet. d. avoid exercise when symptoms occur. ANS: C A diet rich in complex carbohydrates and fiber is recommended for premenstrual dysmorphic disorder.

9. The nurse is discussing cervical mucus changes with a woman who wishes to use natural family planning methods. The nurse determines the woman understands the information presented when she says the changes in cervical mucus at ovulation:

a. enhance the motility of the sperm. b. indicate endometrial readiness for implantation. c. facilitate movement of the ovum through the fallopian tube. d. provide vaginal lubrication during intercourse. ANS: A Around the time of ovulation, the slippery, clear cervical mucus enhances the motility of the sperm.

15. When a woman starts hormone replacement therapy (HRT), the nurse would instruct her to look for the side effect of:

a. fatigue. b. headache. c. weight loss. d. amenorrhea. ANS: B Patients initiating HRT are reminded to have regular follow-up care and report headaches, vision changes, and symptoms of thrombophlebitis or cardiac symptoms.

13. A 48-year-old woman tells the nurse, "I missed my period last month. Am I in menopause?" The nurse would respond that a woman is considered to be menopausal when:

a. her periods have stopped for 1 year. b. her periods have been irregular and light for 12 months. c. she has symptoms of vasomotor instability. d. she experiences symptoms of decreased estrogen, such as dyspareunia. ANS: A When a woman's menstrual periods have stopped for 1 year, she is considered menopausal.

11. The nurse explains that the drug clomiphene (Clomid) is used in infertility treatment because it:

a. induces ovulation. b. reduces endometriosis. c. promotes implantation of a fertilized ovum. d. inhibits excess prolactin secretion. ANS: A Clomiphene (Clomid) induces ovulation. It may also increase sperm production, although this is an unlabeled use.

23. The nurse instructing a man considering a vasectomy should state that after a vasectomy:

a. intercourse should be delayed for 6 weeks. b. sperm will still be ejaculated for a month. c. erections will be difficult to maintain. d. monthly sperm counts for a year will be necessary. ANS: B Because sperm are distal to the severed vas deferens, sperm will be in the ejaculate for about a month. A sperm count after that period of time should be performed to confirm the absence of sperm. Intercourse does not have to be delayed, but an alternate method of contraception should be used. Erections and sexual pleasure are not affected by a vasectomy.

20. A 17-year-old girl comes to the emergency department complaining of severe pain in her left lower quadrant. When an ovarian cyst is suspected, the nurse explains that the diagnosis is confirmed by:

a. laparotomy. b. oophorectomy. c. transvaginal ultrasound. d. hysteroscopy. ANS: C Diagnosis of an ovarian cyst is made by transvaginal ultrasound.

3. A woman asks the nurse, "How do oral contraceptives prevent pregnancy?" The nurse explains that the combination of estrogen and progesterone in oral contraceptives:

a. makes cervical mucus hostile to sperm. b. prevents ovul ation. c. prohibits implantation of the egg. d. acts as a barrier by destroying sperm. ANS: B Oral contraceptives contain a combination of estrogen and progesterone that suppress ovulation.

14. The nurse planning to teach a woman about perimenopause would include that lowered estrogen levels:

a. prevent osteoporosis. b. decrease vaginal lubrication. c. raise the level of low-density lipoproteins. d. raise the level of high-density lipoproteins. ANS: C Estrogen increases the amount of high-density lipoproteins that carry cholesterol from body cells to the liver for excretion. With lowered levels of estrogen, low-density lipoproteins increase, causing an increase in the incidence of heart attacks and strokes.

12. At her regular gynecological examination, a woman tells the nurse that she is concerned about osteoporosis. The nurse could suggest to the patient to:

a. take a vitamin E supplement daily. b. do isometric exercises that can be practiced every day. c. include more dairy products and green, leafy vegetables in her diet. d. try to limit her intake of caffeine. ANS: C Foods rich in calcium include milk, dairy products, and green, leafy vegetables.

amenorrhea

absence of menstruation, the absence or suppression of menstruation; normal before puberty, during pregnancy and lactation, and after menopause

ARTs

assisted reproductive therapies

HIV

asymptomatic at first, diagnosis with serology test (positive ELISA), infant should be bottle fed, no cure, VIRs given during pregnancy

3 ways you should examine your breast

before a mirror, lying down, and in the shower

myomas

benign uterine muscle tumors

basal temperature

body temperature at rest

climacteric

change of life, premenopausal period, 2 to 8 yrs before menstruation ceases

Correct teaching for breast self examination

do the exam 1 week after the beginning of your period, squeeze each nipple gently to identify any discharge, use the sensitive pads of your fingers, use soapy fingers in the shower

Patient teaching to prevent osteoporosis in the menopausal woman should include:

doing low-impact weight-bearing exercise several times each week

Therapeutic insemination

donor sperm are placed in the uterus or fallopian tube

HPV condylomata acuminata papillomarivus

dry, wartlike growths, growths may obstruct birth canal, tx w/ laser or cold therapy, CDC recommends vaccination of all females before deciding to become sexually active

spinnbarkeit

elasticity seen in cervical mucus at the time of ovulation

primary amenorrhea

failure to menstruate by age 16

bacterial vaginosis, gardnerella vaginalis

fishy odor, thin grayish-white discharge, id bacteria, associated w/ preterm delivery, tx w/ flagyl, goal to restore normal flora, avoid alcohol during and 24hrs after flagyl tx

Nursing diagnoses for the woman experiencing perimenopausal symptoms

impaired comfort r/t vasomotor symptoms (hot flashes), ineffective sexuality patterns r/t painful intercourse, stress urinary incontinence and infection r/t genital atrophy

Gestational surrogate

infertile couple undergoes IVF but resulting embryos are placed in the uterus of a woman who has agreed to carry the fetus for them. the woman doesn't donate any of her genetic components

candididasis, yeast, candida albicans

inflamed urination, inflamed vagina, cottage cheese discharge, id causative fungus, can affect newborn at birth, tx w/ monistat, gyne-lotrimin, and diflucan

metrorrhagia

irregular uterine bleeding that is usually normal in amount

stress incontinence

leakage caused by a sudden increase in intraabdominal pressure (sneezing or coughing)

menorrhagia

menstrual bleeding that is excessive in amount

dysmenorrhea

menstruation that is painful

mittelschmerz

middle pain is pain that many women experience around ovulation, near the middle of their menstrual cycle

Donor oocyte

multiple ova are retrieved from a woman. they are fertilized and placed in the prepared uterus of the infertile woman

Purpose of spermacides

neutralize vaginal secretions, destroy sperm, and block entrance to uterus

Primary dysmenorrhea

no evidence of pelvic abnormality

herpes virus

painful blisters, viral culture, can cause miscarriage, stillbirth, CNS neonatal problems, c-section necessary if active during labor, no cure, tx w/ VIRs

dyspareunia

painful sexual intercourse

secondary dysmenorrhea

pathological condition is identified

Treatment for PMDD

prescribing calcium, magnesium and vitamin B6(helps convert tryptophan to serotonin) and diet rich in complex carbohydrates and fiber( to lengthen the effect of the carbohydrate meal) Stress management and exersice

Goal of preventive health care?

prevention or early detection

3 stages of syphillis

primary-painless chancre, secondary-2 mos later, spleen and liver megaly, headache, anorexia, wart-like growths on vulva, tertiary-many yrs after secondary causing heart, vessel, and nervous system damage

gonorrhea

purulent discharge, painful urination and sex, culture, causes blindness to newborn during birth, tx w/ antibiotics, can result in PID

coitus interruptus

removal of the erect penis from the vagina before ejaculation

STIs

sexually transmitted infections

ICSI intracytoplasmic sperm injection

sperm are inserted directly into the ova

retrograde ejaculation

sperm is released into the bladder rather than from the penis

spermicides

sperm killing chemicals

menopause

the permanent cessation of menses

trichomoniasis, trichomonas vaginalis

thin, grn, ylw, foul smelling discharge, vaginal edema, inflamed vagina, id bacteria, dna & pcr, doesn't cross placenta, tx w/ gyne-lotrimin, flagyl contraindicated during first trimester

syphillis

transmitted across placenta, causes congenital syphillis, stillbirth, and miscarriage, diagnosis by serology test, tx w/ penicillin or erythromycin if allergic to PCN

Treatment for amenarrhea

treatment depends on the cause

cystocele

unexpected loss of urine when laughing , cough or sneezing

Preventing toxic shock syndrome

wash hands well when using tampons or a diaphragm, diaphragm should not be used during menstruation, tampons should be changed every 4 hours

Preventing vaginal infections

wearing cotton underwear, avoiding tight-fitting nylon or spandex pants, wiping front to back, and frequent handwashing. excercise and a high-fiber, low-fat diet strengthens the immune system

The women's health NP recommends ibuprofen to relieve menstrual cramps. She should be taught to take the drug:

with food just before her period begins or soon after it begins

chlamydia

ylw discharge and painful urination, often asymptomatic, urine spec and culture, causes conjunctivitis and pneumonia in newborns during birth, tx w/ mycins during pregnancy, all newborns have eyedrops, can cause infertility