Week 13 - Women's Health Pt. 1

T/F: NSAIDs can be used to treat symptoms of PMS

TRUE --> ibuprofen, aspirin, & naproxen inhibit prostaglandins

Where are fibroadenomas usually located?

upper outer quadrant of the breast

Male sexual partners of clients with vulvovaginal candidiasis should be educated that...

they may experience rash/excoriation of the skin of the penis, balanitis (inflammation of the glans penis), & possible pruritis

painful menstruation

dysmenorrhea

Differentiate stage 1 vs stage 4 breast cancer

-*stage 1*: small tumor w/out lymph involvement or metastasis -*stage 4*: cancer spreads to lymph system & metastasizes to other organs

*Syphilis*: causative agent, signs, treatment, duration

-*agent*: bacteria -*signs*: painless sore on genitals, rectum, or mouth -*treatment*: single shot of penicillin in the early stages -*duration*: after initial infection, bacteria may remain dormant in the body for decades

*Herpes*: causative agent, sx, treatment

-*agent*: herpes simplex virus (HSV) -*sx*: some people are asymptomatic, others have sx (pain, itching, blisters, ulcers from ruptured blisters) -*treatment*: no treatment; *acyclovir* antiviral can shorten outbreak & reduce risk of spreading to others

*HPV*: causative agent, sx & risks, treatment

-*agent*: human papilloma virus -*sx*: genital warts -*risk*: cervical cancer -*treatment*: HPV vaccine (recommended at age 11 or 12)

What medications can be used to treat endometriosis? How can endometriosis be treated surgically?

-*oral contraceptives*: help suppress endometrial lining proliferation -*danazol* (androgen - suppresses ovarian function) & *lupron* -lysis of adhesions/ laser vaporization by laparoscopy -hysterectomy & BSO (bilateral salpingectomy & oophorectomy - removal of both fallopian tubes & ovaries)

How often are clinical breast exams performed from ages 25-39? 40+?

-40+: once a year -25-39: 1-3 years

How is breast cancer staged? (TNM)

-Tumor -Nodes -Metastasis

What is polycystic ovarian syndrome? (3 characteristics)

-a condition characterized by 1) multiple cysts on the ovaries 2) anovulation (menstrual cycle without ovulation) 3) elevated levels of androgens (ie: testosterone)

What are the 3 positions for a breast exam?

-arms above head -hands on hips -hands on hips leaning forward

What are the 3 most common types of vaginitis?

-bacterial vaginosis -vulvovaginal candidiasis -trichomonaisis

What are examples of abnormal uterine bleeding?.

-bleeding between periods -bleeding after sex -heavier/longer bleeding -bleeding after menopause

How is HIV treated?

-currently there is *no cure*, but there is *antiretroviral therapy* which can help get the virus under control

What are 3 common symptoms of PCOS? How is PCOS usually treated?

-heavy bleeding -amenorrhea -infertility -oral contraceptives (OCs) are often prescribed to help regulate menstrual cycle and reduce androgen levels

What is vaginitis? Symptoms? Causes?

-inflammation of the vagina -*sx*: increased discharge, vulvar irritation & itching, dysuria, dyspareunia, bleeding with intercourse, foul odor -*causes*: STIs, excessive use of feminine hygiene products (ie: douches or sprays), oral antibiotics (alter normal vaginal flora --> change in vaginal pH)

Are breast self-exams recommended?

-no longer recommended - do not decrease mortality of breast cancer & resulted in additional imaging & biopsies -instead, *breast self-awareness* is recommended

list some signs of breast cancer

-painless lump -dimpling -nipple retraction -changes in skin/shape of breast -breast pain -edema of the arm -enlarged axillary lymph nodes or lumps in the armpit

What is pediculosis pubis? Causative agent? Signs (think colors)? Treatment?

-pubic/crab lice -*agent*: tiny insects that live on body hair -*signs*: itching, red/blue dots on skin (lice bites), red/brown spots on underwear (lice poo), white/yellow dots attached to hair (lice eggs) -*treatment*: lice-killing lotion

List some tips for maintaining perineal hygiene

-use plain soap and water -allow adequate ventilation by wearing cotton panties & clothes that allow air to circulate -wipe front to back

How is vaginitis diagnosed? Treated?

-vaginal wet mount culture of discharge --> look for microorganism -treated with topical/oral antibiotics or antifungals

T/F: a mammogram is a kind of ultrasound

FALSE - mammograms are soft tissue X-rays

Patients who have bacterial vaginosis are at increased risk for what complications? (pregnant/nonpregnant) (5)

1) PROM 2) preterm birth 3) low birthweight 4) PID 5) HIV

A woman comes into the ER complaining of chest pain. The provider suspects MI and has ordered tests to confirm. What medication & dosage would the nurse expect to be ordered right away?

325 mg of aspirin

Which of the following should be included in teaching about menstruation for a premenstrual girl? (select all that apply) A) cycles typically last 28-30 days B) the average length of cycle is 4-7 days C) the typical amount of blood loss is 70-100mL

A & B C--> typical blood loss is 25-60mL

Which of the following is the treatment for fibroadenoma of the breast? (select all that apply) A) observation for several months B) analgesics C) reduce caffeine intake D) excisional biopsy

A & D B--> analgesics are part of the treatment for fibrocystic breast disease C--> reducing caffeine helps with fibrocystic breast disease, not fibroadenoma

heavy or long period

menorrhagia

distinguish primary vs secondary amenorrhea

-*primary*: no menarche by age 16, or no menarche within 4 years of beginning breast development -*secondary*: when an established menses (>3 months) ceases; *most commonly caused by pregnancy*

distinguish primary vs secondary dysmenorrhea

-*primary*: pain that is NOT associated with underlying disease; primarily caused by prostaglandins -*secondary*: pain associated with a pathology of the reproductive tract (ie: endometriosis, PID, cervical stenosis, fibroids, ovarian cysts, tumors, IUDs)

What is scabies? Causative agent? Signs/sx? Tx?

-*scabies* = infestation of human itch mites into the outer layer of the skin where they live and lay eggs -*S/Sx*: intense itching, pimple-like rash *Tx*: cream/lotion (apply & keep on overnight; rinse after 12 hrs)

A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: A) Endometriosis B) PMS C) Primary dysmenorrhea D) Secondary dysmenorrhea

A) endometriosis

A female client comes to the clinic complaining of irritation and swelling in her vulva. The doctor rules out infection. The nurse would record the patient's condition in the chart as what? A) vulvitis B) vaginitis C) bacterial vaginosis D) pelvic inflammatory disease

A) *vulvitis* = Inflammation of the skin of the perineum (vulva & perianal area)

A patient receiving a routine checkup complains that she's been experiencing pain and lumpiness in her breasts consistently every month before her period begins. The nurse recognizes that this is a sign of what breast disease? A) fibrocystic breast disease B) ductal ectasia C) fibroadenoma D) intraductal papilloma

A) fibrocystic breast disease

While palpating a patient's breast, the nurse feels firm, nodular, movable lumps. The nurse understands that these are characteristics of A) normal tissue B) abnormal tissue

A) normal tissue - firm, lumpy, nodular, tender, thickened, movable Abnormal feels like a raisin, watermelon seed, or grape, and feels fixed to underlying tissue

Which of the following are signs/symptoms of endometriosis? (select all that apply) A) infertility B) cyclic abdominal pain C) dyspareunia D) yellow discharge E) bleeding between periods F) rectal pain

A, B, C, F

A female client has just been diagnosed with bacterial vaginosis. Which of the following would the nurse identify as risk factors for this client? (select all that apply) A) the client frequently douches B) the client has had 2 sexual partners in the last 6 months C) the client changes her tampon every 3-6 hours while menstruating D) the client was recently treated for pneumonia

A, B, D B--> having multiple sexual partners within 6 months is a risk factor D--> oral antibiotics can disturb the vaginal flora

Which of the following are signs of coronary artery disease in women? (select all that apply) A) pain in the neck and jaw B) nausea C) sweating D) fatigue/weakness E) dyspnea F) light-headedness

ALL OF THE ABOVE Additional signs: -chest pain (only in 1/2 of women) -angina with exertion or pain at rest -dizziness, faintness -upper abdominal pain -heartburn -loss of appetite -vomiting -pain in the upper body (NOT chest) (arm, neck, back, jaw, throat, teeth)

Which of the following are symptoms of PMS (premenstrual syndrome)? (select all that apply) A) depressive sx B) migraines C) breast tenderness D) sleep disturbance E) decreased concentration F) bloating

ALL OF THE ABOVE other sx: low morale, crying, hostility, social withdrawal, headache, irritability, myalgias & joint/muscle pain, fatigue, diarrhea, constipation, food cravings)

Which of the following are characteristics of intraductal papilloma? (select all that apply) A) rubbery nodules in the breast >1cm B) small protuberances in the epithelium of the breast ducts C) nodules are often located under the areola D) thick yellow discharge from the nipple

B & C A--> rubber nodule is characteristic of fibroadenoma; nodules for intraductal papilloma are <1cm (non-palpable) D--> thick discharge is associated with ductal ectasia; intraductal papilloma results in serosanguineous discharge

PCOS is associated with what chronic conditions? (select all that apply) A) high cholesterol B) hyperinsulinemia C) HTN D) obesity

B (hyperinsulinemia) & D (obesity)

Which of the following medications may be used to produce a "pseudo menopausal" state in women with endometriosis? (select all that apply) A) tamoxifen B) danazol C) herceptin D) lupron

B&D) danzol & lupron

Which of the following medications is indicated for immunotherapy treatment of breast cancer? A) tamoxifen B) Herceptin C) raloxifene D) aromatase inhibitor

B) Herceptin

Which of the following STIs is associated with cervical ectropion and a friable cervix? A) gonorrhea B) chlamydia C) trichomoniasis D) syphylis

B) chlamydia

A 48 year old woman comes into the clinic complaining of thick sticky discharge from her nipples and nipple retraction. An ultrasound is performed and doesn't reveal any masses in the breast. What is the likely explanation for the woman's symptoms? A) fibrocystic breast disease B) ductal ectasia C) fibroadenoma D) intraductal papilloma

B) ductal ectasia --> occurs in perimenopausal women - dilation of collecting ducts --> fill with cellular debris --> can cause thick sticky nipple discharge & possible nipple retraction

Which of the following are risk factors for vulvovaginal candidiasis? A) frequent douching B) pregnancy C) diabetes D) OC use E) scented menstrual pads

B) pregnancy C) diabetes D) oral contraceptive use A & E (douching & scented pads) are risk factors for bacterial vaginosis Other risk factors: use of antibiotics & immunosuppressant drugs

Which of the following is treatment for intraductal papilloma? A) excisional biopsy B) testing & monitoring for 6 months to ensure it's benign C) oral contraceptives D) needle biopsy

B) testing & monitoring for 6 months to ensure it's benign

Which of the following are risk factors for breast cancer? (select all that apply) A) multiparity B) early menarche C) high fat diet D) early menopause E) history of cervical cancer

B, C A--> nulliparity is a risk factor D--> late menopause is a risk factor E--> personal hx of breast, ovarian, uterine, or colon cancer OTHER RISK FACTORS: family hx, BRCA-1 or BRCA-2 mutations, late pregnancy, no breastfeeding, long-term estrogen & progesterone therapy, cigarette smoke, ionizing radiation, lack of physical exercise, chemicals, alcohol consumption, radiation to chest btw ages 10-30

Which of the following should be included in teaching about menstrual hygiene with pads and tampons? (select all that apply) A) change pads and tampons every 6-10 hours B) use pads during light days to prevent vaginal irritation C) wash hands before and after changing a pad/tampon D) saturating a maxi pad every 1-2 hours for 2-3 days is normal

B, C A--> pads & tampons should be changed every 3-6 hrs D--> saturating a maxi pad that frequently is not normal and may indicate an underlying problem

A female client asks about natural ways to relieve bloating during periods. What would the nurse recommend? (select all that apply) A) increase sodium intake B) try a vitamin E supplement C) eat asparagus, peaches, and watermelon D) eat spinach, legumes, or drink prune juice

C A--> decrease sodium intake B--> vitamin E helps with cramping & breast tenderness; the patient should try magnesium or vitamin B6 D--> other naturally diuretic foods are cranberry juice and parsley

Which of the following should be included in patient teaching for management of fibrocystic breast changes? A) taking oral contraceptives may make your symptoms worse B) the lumps in your breast are malignant and will need to be surgically removed C) reducing your caffeine and tobacco intake can help reduce symptoms

C A--> oral contraceptives may relieve symptoms because they prevent ovulation B--> fibrocystic breast changes are benign

A patient with bacterial vaginosis has just been prescribed intravaginal Flagyl. The nurse has just completed patient education. Which of the following statements indicates that more teaching is needed? (select all that apply) A) I should administer the gel once a day at bedtime B) I should not drink alcohol during while taking this medication C) it is okay for me to have intercourse while taking this medication D) this medication will destroy the fungal infection in my vagina

C & D C--> the nurse should discourage intercourse while the patient is taking this medication D--> bacterial vaginosis is a *bacterial*, not a fungal infection

A young adolescent female asks the nurse about vitamins/supplements that can help relieve bloating and irritability caused by PMS. Which supplement(s) would the nurse recommend? A) vitamin E B) calcium C) magnesium D) vitamin B6

C& D: vitamin B6 (bloating & irritability) & magnesium (bloating) A--> vitamin E can ease cramping & breast tenderness B--> calcium (1200mg) can alleviate physical & psychological sx C--> magnesium (400mg) can help with bloating

What teaching should be provided for patients about to receive mammograms? A) fast 1 hour before the exam B) apply moisturizing lotion to the breast before the exam C) there is deceased accuracy of results for patients with dense breasts D) all symptomatic breast cancers can be found with a mammogram

C) A--> fasting is not necessary B--> no deodorant, lotions, powders, or cosmetic substances should be on the torso D--> 5% of symptomatic breast cancers are NOT found with mammogram

A patient asks the nurse when the best time to schedule a mammogram would be for the least amount of breast discomfort. The nurse recommends scheduling during A) menstruation B) ovulation C) first 2 weeks of menstrual cycle D) second 2 weeks of menstrual cycle

C) 1st 2 weeks of menstrual cycle --> decreased breast sensitivity

A female client comes to the clinic complaining of thin, watery discharge that is white with a "fishy" smell. The nurse recognizes that this is a sign of what condition? A) vulvitis B) vulvovaginal candidiasis C) bacterial vaginosis D) trichomoniasis

C) bacterial vaginosis

Yellow-green, frothy, foul smelling discharge is a sign of what infection? A) gonorrhea B) chlamydia C) trichomoniasis D) vulvovaginal candidiasis

C) trichomoniasis A--> *gonorrhea*: purulent, greenish-yellow vaginal discharge B--> *chlamydia*: thin mucopurulent discharge D--> *candidiasis*: white cheesy discharge

A client comes to the clinic complaining of non-malodorous thick white cottage-cheese-like vaginal discharge. The nurse recognizes that this is a sign of what condition? A) bacterial vaginosis B) trichomoniasis C) vulvovaginal candidiasis D) chlamydia

C) vulvovaginal candidiasis (fungal/yeast infection)

Your friend calls to tell you that she noticed a small amount of nipple retraction in her right nipple when she was showering. As a nurse, you should advise her to: A) Perform a complete SBE to determine whether any lumps are present B) Wait until 1 week after her next menstrual period and then do a SBE C) Note whether there is any change in the amount of nipple retraction for 2 weeks D) See her primary health care provider for a professional examination

D --> nipple retraction is a sign of cancer, so it is important to see a provider right away for early detection B - it is best to perform a SBE 3-5 days after menstruation BEGINS

T/F: vaginal sprays and douching are helpful in maintaining vaginal pH

FALSE - bacteria in the vagina help maintain pH balance to deter fungal & bacterial growth --> use of douches can leave the vagina susceptible to infection

T/F: breast cancer is the leading cause of cancer deaths in the US

FALSE - lung cancer is the leading cause of cancer death in the US

T/F: everyone with HIV will eventually get AIDS

FALSE --> if HIV is treated soon enough with antivirals, a person won't get AIDS bc the medication stops the disease progression

How does HIV cause aids?

HIV (human immune deficiency virus) attacks WBCs --> virus will enter WBC, hijack nucleus & multiply DNA --> cell lysis (destroy cell) --> new virus particles find other WBCs to attack --> this weakens the immune system --> Acquired Immune Deficiency Syndrome

pain caused by the growth of a follicle in the ovary/follicular rupture at ovulation

Mittelschmerz

What breast disorder is characterized by firm, rubbery, mobile nodules in the breast that are nontender and do not change during menstruation? A) fibrocystic breast disease B) ductal ectasia C) fibroadenoma D) intraductal papilloma

fibroadenoma

What is endometriosis?

a condition in which endometrial tissue grows outside the uterus (common sites: small intestine, large intestine, round ligament, broad ligaments)

What is uterine ablation?

a procedure in which the endometrium of the uterus is destroyed to reduce heavy menstrual bleeding

absence of period

amenorrhea

How often should women ages 40-45 receive mammograms?

annually

A female client asks the nurse if douching during menstruation is acceptable to help maintain cleanliness. How should the nurse respond?

in general, douching is not recommended as a form of hygiene, since it can disturb the normal pH balance of the vagina and leave you more susceptible to infection

surgical procedure to remove breast tissue, axillary nodes, and some chest muscles

modified radical mastectomy

What screening test is used to detect for cervical cancer? How does the test work?

pap smear -patient in lithotomy position --> speculum is inserted to open up vagina --> provider inserts swab to collect cells from cervix --> examined under a microscope

Explain why aging is a risk factor for coronary artery disease in women

prior to menopause, the presence of estrogen protects blood vessels from cholesterol deposits --> after menopause, LDLs increase & HDLs decrease

surgical procedure to remove a breast quadrant

quadrantectomy

What is premenstrual dysphoric disorder? (PMDD)

severe form of PMS characterized by more severe sx of depression, irritability, and anxiety

surgical procedure to remove the entire breast but not all the lymph nodes

simple mastectomy