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859-III Women's Health
Prolapse
34
Nursing
Graduate
01/15/2012

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Cards

Term
Define pelvic organ prolapse.
Definition
herniation of pelvic organs to or beyond the vaginal walls
Term
Define cystocele.
Definition
herniation of the upper front vaginal wall, bladder protrudes into the vagina
Term
Define uterine prolapse.
Definition
descent of the uterus below its normal position
Term
What two major components support the pelvic organs?
Definition
  • levator ani muscle complex
  • endopelvic fascia
Term
How does the levator ani muscle complex work to support the pelvic organs?
Definition
provides a firm, elastic base where pelvic organs rest
Term
How does the endopelvic fascia work to support the pelvic organs?
Definition
stabilizes the pelvic organs in the correct position, which allows the muscles to provide optimal support
Term
How does a prolapse occur?
Definition
muscular and fascial tissue lose tone and strength, which leads to failure of these complexes to maintain organs in their correct position, and results in organ descent
Term
Is a prolapse common?
Definition
Yes, 25% to 65% of women have evidence of a prolapse.
Term

T or F

All women with a prolapse are symptomatic.

Definition
False.  Many women are asymptomatic and the prolapse is identified upon clinical exam.
Term

Who has a higher incidence of prolapse:

parous or non-parous women?

Definition
Parous women. 75% of prolapse occurs among parous women.
Term

T of F

Advanced age is a risk factor for prolapse.

Definition
True. 
Term

T of F

BMI is unrelated to prolapse risk.

Definition
False. BMI>25 results in a 2 fold higher risk.
Term
List other situations that increase a woman's risk of prolapse.
Definition
  • Pelvic surgery
  • Connective tissue disorder
  • Heavy lifting
  • Chronic constipation
  • Coughing
Term
Women commonly report feeling pressure when they present for clinical exam.  How will they typically verbalize this sensation?
Definition
"something is falling out"
Term
What are common symptoms of uterine prolapse?
Definition
  • pressure-vaginal bulge, something falling out
  • sexual-dyspareunia, embarrassment
Term
What are common symptoms of a cystocele?
Definition
  • pressure- vaginal bulge, heaviness
  • urinary-stress urinary incontinence, urethral obstruction, splinting during urination, slow stream
Term
In addition to obtaining a thorough medical/surgical/OB/GYN history, how will prolapse be diagnosed?
Definition
Speculum and bimanual exam performed in the standing and dorsal lithotomy position.
Term
When assessing a women for prolapse, while performing the exam it is necessary to instruct her to do what?
Definition
Valsalva is necessary in order to observe the full extent of the prolapse.
Term

T or F

Obtain a clean catch urine when evaluating for prolapse.

Definition
True.  Randy said so!
Term
It is necessary to document prolapse using a classification system.  How many degrees of prolapse are typically used? (Reference is Secor)
Definition
Four degress-1st, 2nd, 3rd, 4th
Term
Define 1st degree prolapse.
Definition
prolapse without symptoms, mild organ descent
Term
Prolapse with descent halfway into the vagina and usually asymptomatic is which degree of prolapse?
Definition
2nd degree
Term
Define 3rd degree prolapse.
Definition
Prolapse is at the level of the introitus, usually symptomatic.
Term
What degree of prolapse is characteristic of prolapse outside the vagina with severe symptoms?
Definition
4th degree
Term
Uterine prolapse and cystocele both have non-surgical options for treatment.  List them.
Definition
  • Expectant-no intervention necessary if asymptomatic
  • Kegels
  • Vaginal pessary
  • ERT
Term
What are the surgical options for treatment of uterine prolapse?
Definition
  • hysterectomy
  • uterine suspension
Term
What are the surgical options for treatment of cystocele?
Definition
  • bladder suspension/sling
  • periurethral bulking (treats stress incontinence)
Term
What are the benefits of a vaginal pessary?
Definition
  • supports prolapsed organs
  • women can independently care for them
  • some can be worn during intercourse
Term
On average, how often do women need to be evaluated while undergoing treatment with a vaginal pessary?
Definition
4-6 wks
Term

T or F

Women should be counseled that pessaries are going to be uncomfortable during the entire course of treatment.

Definition
False.  Once properly fitted, the pessary should not be felt.
Term

T or F

Pessaries can only be managed by physicians.

Definition
False.  NPs can manage pessary therapy.
Term
Patients can be educated to reduce their risk of prolapse.  What areas should we address?
Definition
  • Maintain a healthy weight
  • Exercise (include Kegels)
  • Stop smoking
  • Use correct body mechanics when lifting
  • Consider ERT peri/post menopause
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