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Diseases & Female Reproduction
Diseases of female reproduction
58
Nursing
Undergraduate 2
09/22/2014

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Cards

Term
Hypothalamic – Pituitary Cycle: Basics
Definition
Estrogen/progesterone levels drop at end of cycle • Hypothalamus stimulated/secretes GnRH • GnRH stimulates anterior pituitary to secrete FSH • FSH stimulates development of follicle • Then GnRH stimulates ant pituitary to secrete LH • LH causes expulsion of ovum from graafian follicle • If fertilization doesn’t occur, corpus luteum disintegrates, estrogen/progesterone levels fall and menses begins
Term
Amenorrhea
Definition
Absence of Menstruation
Term
Amenorrhea - Primary
Definition
Absence of menses by age 16 years or within 4 years of breast development
Term
Amenorrhea- Secondary
Definition
Cessation of menses for @ least 3-6 months. This is a classic symptom of what psychiatric disorder primarily seen in younger women?
Term
Hypogonadotropic Amenorrhea
Definition
Hypothalamic suppression from stress, weight loss, eating disorders, strenuous exercise and mental illness may lead to amenorrhea.
Rare cases linked to pituitary disease or genetics
Term
Hypogonadotropic Amenorrhea

Treatment
Definition
address the underlying issues
Term
Exercise Associated Amenorrhea #1
Definition
At risk: > 20% under weight Excessive/rapid weight loss Engaging in rigorous exercise
Term
Exercise Associated Amenorrhea #2
Definition
Focus on decreasing activity and improving nutrition: Intake of 1500mg Ca+/D plus weight gain as needed to support physiological processes
Term
Dysmenorrhea
Definition
Painful menstruation
• Onset 1 to 2 days before menses and generally lasts several days after menses begins
• Primary form occurs within 3 years of menarche
• R/T uterine cramping and associated with ovulation and changes in progestin levels. May ease after pregnancy
• Secondary dysmenorrhea r/t pathology, treat underlying problem
Term
Treatment for Primary Dysmenorrhea
Definition
NSAIDS • Oral Contraceptives (inhibits ovulation) • Supplemental vitamins E and B6 may help, but
best forms are naturally occuring • Low fat, lower Na, well balanced diet
• Heating pad • TENS
Term
Premenstrual Syndrome - PMS
Definition
Cyclic and predictable not well understood
• Late in luteal phase of the cycle(after ovulation) and ends soon after menstruation begins
• 85% of women experience some mood and somatic complaints
• ~ 9% report physical, mood and behavioral symptoms as disabling
Term
PMS
Definition
Symptoms range from irritability, depression, HA and GI disturbances to urinary retention, breast tenderness and acne flair-ups.
• Treatment is discussed in next slide, but a brief word about YAZ *(drospirenone) first. It is associated with increased risk for clots so use with caution!!!
Term
PMDD
Definition
Rarer form of PMS is Premenstrual Dysphoric Disorder (~5% of women affected) that entails meeting very specific criteria for diagnosis. Multifactorial etiology.
• Management of PMS & PMDD includes diet with additional calcium, magnesium, vitamin B6 and E, exercise, medications (possibly SSRI’s) and counseling. OC’s may help*
Term
Endometriosis
Definition
Presence of endometrial tissue implanted outside uterine cavity, primarily in pelvis
• Common signs: pelvic pain r/t menses and abnormal uterine bleeding (may be asymptomatic)
• Peak incidence between 20 and 45 years • Affects > 10% childbearing aged women in US
• ~ 30% of women with severe menstrual cramping have endometriosis
Term
Endometriosis is also found?
Definition
Pelvic area is primary site, but found in other areas including lung, abdomen or bladder
Term
Endometriosis is diagnosed by
Definition
laparoscopic exam
Term
Endometriosis Etiology and Pathophysiology
Definition
Multifactorial disorder with probable autoimmune component
Implanted tissue responds to hormones and leads to cyclic bleeding.
Results include inflammation, scarring, adhesion formation in the peritoneum and generally pelvic pain
Delaying childbearing increases risk for endometriosis and infertility
Term
Medical Treatment of Endometriosis
Definition
NSAIDS
• Medications include: Oral contraceptives that may decrease bleeding/amenorrhea), progestin's (Depo) or other agents that suppress endometrial growth, ovulation and bleeding (GnRH agonist such as Lupron)
Term
Surgical Treatment of Endometriosis
Definition
Laparoscopy either abdominal or vaginal resection or ablation with or without concurrent use of hormones
Term
Nursing Diagnoses
Definition
Pain r/t peritoneal irritation of endometriosis
• Ineffective coping r/t depression regarding infertility or pain
Term
Outcomes of Care Evaluation
Definition
Patient reports approaches that effectively decrease pain
• Patient able to discuss condition and treatment options
Term
Management Plan
Definition
Patient assessment, care and teaching regarding pain issues and desire for fertility.
Mild pain: NSAID’s ModeratePain:OC’s Severe Pain: GnRH agonists or Lupron Debilitating Pain: TAH with BSO
Term
Management Plan continuation
Definition
Reinforce practitioners explanation of pharmacological care and surgical options so patient can make an informed choice.


• www.endometriosis.org
Term
Uterine Fibroids aka myomas
Definition
Benign tumors of smooth muscle Symptoms may include heavy bleeding - menorrhagia.
Urinary urgency, frequency or retention Bowel complaints, pain Occasionally infertility or recurrent pregnancy loss
Term
Medical Management of Fibroids
Definition
OCs reduce heavy bleeding • IUD’s reduce bleeding, minimize pain • NSAIDs such as ibuprofen or naprosyn for
cramps or pain
• Short-term hormonal therapy injections to help shrink the fibroids -GnRH agonists
• Iron supplements to prevent or treat anemia due to heavy periods
Term
Surgical Treatment for fibroids
Definition
• Uterine Artery Embolization • If childbearing is important, myomectomy • Severe cases may require hysterectomy or
endometrial ablation
Term
Pelvic Inflammatory Disease “PID”
Definition
May result from untreated Chlamydia trachomatis or Neisseria gonorrhea or both
• Up to 85% of women with chlamydia or GC have no obvious symptoms.
• Symptoms of PID (always symptomatic!) include fever, pain, N/V, muco-purulent cervical or vaginal discharge, cervical motion/adenexal tenderness and bleeding.
• Risk factors include age 15 – 24 yrs, early onset of sexual activity, multiple partners, history of PID, and recent GYN procedures
Term
Consider the Impact Primary Prevention has on Women’s Health
Prevent
Definition
Pain
Anxiety
Depression
Ineffective coping
Term
Consider the Impact Primary Prevention has on Women’s Health
Promote
Definition
Wellness
Centeredness
Joy
Assertivenes
Term
Examples of Prevention
Definition
Nursing focuses on prevention • Primary: Teaching “safe sex” • Secondary: Screening a high risk client • Tertiary: Treating infection and it’s
complications
Medical Management stresses eradication of infection in order to prevent complications
Term
Nursing Care - PID
Definition
May Require Hospitalization • Labs • IV fluids • Antibiotics intravenous or PO • Management of pain • General comfort measures • Teaching • IUD if present, is removed after ~48 hours of ABX
Term
Effects on Patient and Baby
Definition
Closely associated with infertility, ectopic pregnancy and chronic pain in women.
• Neonates at risk for conjunctivitis and pneumonia with latter requiring mother to be treated prior to birth with antibiotics like erythromycin.
• What is the most common SE of erythromycin?
• With what should you reconstitute Rocephin powder?
Term
Human Papilloma Virus “HPV”
Definition
Most common STD caused by a virus
• Many types of genital warts
• Leading cause of cervical and penis cancer
• Picture shows 7 month old born to mother with HPV who was successfully treated with Imiquimod cream
Term
Management of the Client
Definition
Treatment consists of
cryotherapy or topical agents (Imiquimod aka Aldara).
• Cryo-therapy if pregnant
• No treatment is completely effective
• Women need regular PAP exams even after lesions have disappeared
• Associated with oral and rectal cancer
• Non judgmental
• Vaccine available for some strains – see next slide
Term
Gardasil or Cervarix for Prevention of HPV
Definition
Available to women and girls aged 9-26 yrs.
• 3 shot series
• Approved for use in boys and men.
Protects against HPV types 16 – 18 which cause ~70% of cervical cancers.
• Also protects against strains 6 and 11.
Term
Herpes Simplex Virus - HSV
Definition
1 in 6 Americans infected (Reuter’s 2010)
• HSV-1 or HSV-2 with type 2 causing more outbreaks than type 1.
• Following primary infection clearing, viral shedding continues for up to 3 months. Subsequent outbreaks vary thereafter.
• 50% risk of fetal transmission with presence of lesion and primary infection
• 60-90% of infections are truly asymptomatic or unrecognized
Term
Herpes Simplex Virus - HSV
Diagnosis
Definition
More than one in five pregnant women have antibodies in their blood to HSV, indicating a past or present infection. (WebMD-2010)
• Viral culture primary test in most clinics. Confirm diagnosis by PCR
• Lesions begin as small macules that progress to vesicles on an erythematous base that eventually ulcerate. Very painful
Term
Treatment of New Onset HSV
Definition
Acyclovir or a similar antiviral agent • Hygiene measures to avoid secondary infection • Pain management with an NSAIDs or a lidocaine
based topical if needed • Diet rich in B vitamins, Vit C, zinc and calcium • amino acid L-lysine reduces replication during
active phase and can use for prevention (FYI) • Education and emotional support
Term
Treatment of HSV
Definition
Acyclovir reduces length of time of outbreak and severity and asymptomatic viral shedding (AVS). Use as suppressive Rx to reduce transmission and @ 36 weeks gestation to protect fetus.
• Teach clients about AVS
• Condoms not 100% protective, but reduce spread
• Most important STD in enhancing HIV transmission
• Psychosocial support. Need to empower client
Term
HSV Effects on Neonate
Definition
Infant may be asymptomatic at birth, but 2-12 days later may develop fever or hypothermia, jaundice, seizures and poor feeding and half develop vesicular lesions.
• Herpes encephalitis untreated is fatal • Anti-virals tremendously helpful. • Best treatment is primary prevention. Treat
mom when symptoms present and consider C/S. Acyclovir does not appear to harm fetus but best avoided in 1st trimester
Term
Effects on Client - Nursing Diagnosis
Definition
Nursing Diagnoses
• Pain r/t lesions secondary to HSV • Sexual Dysfunction • Pre-natal visit includes assessing for history of
HSV in woman and partner


Nursing Diagnoses
• Pain r/t lesions secondary to HSV • Sexual Dysfunction
Term
Infectious diseases can be contracted in a variety of ways.
Definition
Infections of Pregnancy

• T - Toxoplasmosis • O – other like hepatitis • R - Rubella • C – CMV • H - Herpes Simplex
Symptoms of some may appear in mother as flu-like, while effects on developing fetus are more serious. Most of these are not STD’s
Term
Sexually Transmitted Infections con’t
Definition
The following can lead to preterm birth
• Syphilis
• HIV
• Chlamydia: Fastest spreading STD in US women ~1 in 20 girls between 14-19 yrs. has had it
• Trichomoniasis
• Bacteria Vaginosis “BV” (Technically not an STD)
Term
Effects of Syphilis on Pregnant Women
Definition
• 25% will have stillbirth or neonatal death
40-70% will have syphilis-infected babies


if untreated
Term
Syphilis is divided into four stages:
Definition
1. Primary
2. Secondary
3. Latent
4. Tertiary (late)
• An untreated infected person may infect others during the first 2 stages (1-2 years).
• Even though untreated syphilis is not contagious in the late stage serious complications can occur:
• blindness
• mental disorders or neurological problems
• serious heart abnormalities
• death
Term
Syphilis is divided into four stages:
continuation
Definition
Babies with congenital syphilis can have symptoms at birth or symptoms may take weeks to develop:


Anemia Fever Rashes and skin sores Moist sores of congenital syphilis are infectious
Liver and spleen and various deformities
• The rise in infant syphilis morbidity is a public health concern
Term
Factors That Increase Transmission
Definition
Previous child with HIV
Chorioamnioitis
Preterm birth
Decreased maternal CD4
Firstborn twin
SVD


Chorioamnioitis Intrapartum blood exp. Failure to treat mom
and fetus/newborn during perinatal period with zidovudine “AZT” aka “ZDV
Term
Case Management - HIV #1
Definition
Screen all women
• Test HIV + women for other STD’s, CMV and Toxoplasmosis and offer PPD
• Check varicella and rubella titers • PAP • All positive pts. receive AZT throughout
pregnancy regardless of CD4 counts (watch for BM depression)
• CD4 counts < 200 get PCP prophylaxis • Immunize against Hep B, Hib, PCV, flu
Term
Case Management - HIV#2
Definition
Consider social, cultural & spiritual needs of the mother and confidentiality
• A disproportionate number of women are minorities • Identify family strengths and capitalize on them • Teaching includes “safe sex” throughout pregnancy • While pregnancy is discouraged in HIV positive
women, provide a hopeful milieu if the patient is pregnant
Term
HIV Case Management Continued
Definition
Support for immune system by discussing importance of rest, diet, activity & stress reduction
• Treatment and teaching for substance abuse • Deliver within 4 hours of ruptured membranes • C/S if viral load high • Avoid internal fetal monitoring • Avoid vacuum and forceps delivery • Watch for postpartum bleeding and infection • Avoid breastfeeding
Term
Bacterial Vaginosis “BV” aka vaginitis gardenella
Definition
The whiff test
• Very common in pregnant pts.
• Interruption of normal vaginal
bacterial flora
• Treat as it can lead to preterm labor, PROM or chorioamnionitis
Term
Bacterial Vaginosis “BV”
Symptoms of BV and treatment
Definition
Although more than 50% of women with Bacterial Vaginosis (BV) have no symptoms, when symptoms do occur they include:
• excessive, thin gray or white vaginal discharge that sticks to the vaginal walls
• fishy or musty, unpleasant vaginal odor, most noticeable after sexual intercourse
• vaginal itching and irritation
• Rx with metronidazole or clindamycin
Term
Menopause
Definition
Permanent cessation of menstrual flow.
• Just one event occurring over months when ovarian function & hormone production declines. Decreasing levels of estrogen and progesterone result in many of the classic symptoms.
• Labs: FSH and LH levels rise with menopause
• This transitional phase is known as climacteric
Term
Symptoms of Menopause
Definition
Vasomotor symptoms “hot flashes” r/t low levels of estrogen and increased levels of LH
• Sleep disturbances
• Urogenital Atrophy leading to vaginal thinning, incontinence (urge and stress), cystocele and rectoceles
• Osteoporosis
• Hair loss and hair growth
Term
Menopause
Definition
• Alt in thermoregulation
• Alteration in Comfort
• Trauma, Risk for r/t bone loss
• Sleep Pattern Disturbance
• Altered Urinary Elimination
• Knowledge Deficit
Term
Menopause Management
Definition
Hormone Replacement Therapy “HRT”
Heart, Estrogen, Progestin Replacement Study “HERS”
Women’s Health Initiative Study “WHI”
Term
Women’s Health Initiative Study “WHI”


Best Candidate for HRT
Definition
• Dosing and Administration recommendations for estrogen and progesterone
Term
Menopause Management con’t
Definition
Herbal remedies
Alternative approaches
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