Nursing Care of Women

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Follicle-Stimulating hormone: a gonadotropic hormone (because it stimulates the gonads, in males, the testes, and in females, the ovaries) that is released by anterior pituitary. FSH is not necessary for life, but is essential for reproduction. FSH, in females, stimulates the ovaries causing secretion of estrogen and ovulation
Luteinizing hormone: also a gondadotropic hormone, LH is responsible for stimulating progesterone production and inducing ovulation of mature follicles on the ovary
Progesterone: -Secreted by the corpus luteum
-Role: regulates changes that occur in the uterus during menstrual cycle
-Condition endometrium: prepares for implantation
Estrogen: -Produced by the ovarian follicles
-Several types of estrogens
-Role: developing/maintaining female reproductive organs, secondary sex characteristics (breast, monthly cyclic changes in uterus)
Assessments for NCW: -Clinical breast exam
-External genitalia exam
-Speculum exam
-rectal exam
-Bimanual exam
Nursing Intervention for the abused person: -Reassure that they aren't alone
-Assure the patient that their information is confidential
-Document statements of abuse and photograph injuries
-Provide teaching/info regarding options such as shelters, hot lines
-Assist the patient to set up a safe plan in the event she decides to return home
Tests and screening for nonpregnant women: -BSE 1 week after meses stops
-Professional BE annually
-Mammography at 38yoa annually
-Pap test yearly
-Cholesterol and/or lipid profile every 5 years starting at 45yoa
-Fasting glucose every 3 years starting at 45yoa
-Sigmoidoscopy every 3-5 years at 50yoa
-Transvaginal ultrasound and/or test for CA 125
-Colonoscopy at 50yoa
Mortality in Women: -Leading cause of death: cardiovascular disease
-Leading cause of cancer: lung cancer
-Leading gynecological cancer death: ovarian cancer
Women's Health History: -Personal data
-Family history: cardiovascular disease
-Current health status
-Menstrual history: last period, characteristics
-Pregnancy history: gravida(pregnancy), para (live births), history of post pardum depression
-Lifestyle/habits
-Breast history
-Sexually active: birth control used/smoker
-Pap Smear: when/results
-Pt teaching: weight bearing exercise
Screening Tests: -Pap Smear
-Vulvar self exam
-Breast self exam
-STDs
-Rubella antibodies
-Transvaginal ultrasound
-Cholesterol
-Urinalysis
-Thyroid
-CA-125
-Bone scans
Pap Smear and Results: -Cells are scraped from the cervix for analysis
-Not after douching or on menses
-Should be done annually especially if sexually active
-Results:
*Normal
*Inflammation
*Atypical
*Koilocytosis
*Mild-Moderate to Severe Dysplasia
*Invasive Carcinoma
-If abnormal Pap Smear:
*Colposcopy
*Cervical biopsy
*Cryotherapy
*Cone Biopsy/LEEP
*Laparoscopy
Disease Conditions of Female Reproduction System: -Infections
-STDs
-Benign Tumors
-Endometriosis
-Uterine Displacements
-Fistulas
-Uterine Prolapse
-Cancer
Vaginal Discharge: -Physiologic (normal): clear, odorless
-Candidia Infection: cottage cz, yeast odor, itchy
-Bacterial vaginosis: fishy smell
-Trichomonas species infection: foul odor, green frothy discharge, lots of drainage
-Atrophic: menopause, dryness, slight odor, scant drainage/blood
STDs: -Gonorrhea: bacterial
-Chlamydia: bacterial (often have gonorrhea too)
-Herpes simplex 2: viral
-HIV: viral
-Trichomonas: bacterial
-Candidiasis: yeast
-Syphlis: bacterial
Bacterial Symptoms: -Discharge
-Redness
-Burn with urination
-Treat with antibiotics
-Educate on changing behaviors
Benign Tumors of the Uterus: -Fibroids: 95.9% are benign and asymptomatic
-Myomas: tumors within the muscle
-Usually occur between the ages of 25-40
-Shrink with menopause
Stages of syphlis: -Primary: usually occurs 2-3 weeks after inoculation, a painless lesion at the site of infection forms (cancre)
-Secondary: A rash appears usually 2-8 weeks after the cancre on the trunk and extremities, including the palms of the hand and soles of the feet
Tertiary: slowly progressive inflammatory disease
Endometriosis: -Endometrial tissue implanted outside the uterus
-S/S: Painful menstruation, painful intercourse, pelvic discomfort, painful bowel movements, and radiation of pain to the back or leg
Tx: NSAIDs, oral contraceptives, GnRH agonists, or surgery
Gynecological Cancers: -Cervical
-Endometrial
-Ovarian
-Vulvar
Cervical Cancer: -Risk factors include: multiple sex partners, repeated STDs
-S/S: leukorrhea, vaginal spotting, metrorrhagia
-Dx: pap smear
-Removal and adjunct
Ovarian Cancer: -Risk Factors: nulliparity, infertility, anovulation
-S/S: no early signs
-Dx: transvaginal ultrasound, Ca-125 antigen
-Tx: surgery, chemotherapy, radiation, Taxol
Hysterectomy: -TAH: total abdominal hysterectomy
-BSO: Bilateral salpingo-oophrectomy: ovaries, tubes, and uterus
-Vaginal hysterectomy: requires vagnial packing
-Laparoscopic hysterectomy
Nursing Care for Hysterectomy: -Complications following surgery: hemorrhage, deep vein thrombosis, urinary retention
-Check abdominal incesion
-Pad count: more than a normal period (more than 1 an hour)
Alternatives to Hysterectomy: -Myomectomy: removal of tumor of uterine wall
-Endometrial ablation: lasering of the uterine lining
-Hormonal therapy
Fibrocystic Breast Disease: -Benign disease
-Ducts dilate and cysts form
-Average age: 30-50 years old
-Change in size (especially with menses)
-Usually tender and painful
-Tx:
*Diet: no caffeine, chocolate, alcohol, low sodium, vitamin E (400mg), ibuprofen (200-400mg), oil of evening primrose
*Supportive Bra day and night
Fibroadenoma: -A benign tumor made up of fibrous tissue (clump of)
-Dx: biopsy
-Tx: surgical removal
Malignant Conditions of the Breast: -Carcinoma in situ (incapsulated):
*Ductal and Lobular: 98-99% cure rate
*Tx: masectomy, radiation
-Invasive carcinoma:
*Infiltrating ductal CA: most common 75% of cases
*Infiltrating lobular CA:
*Tumors hard on palpation (but not painful)
*Usually metastases to the: lymph, bone, liver, lung, brain
-1 in 8 woman will contract breast CA
Breast CA Risk Factors: -history of breast CA or other CAs
-first degree relative with breast CA
-Early menarche, late menopause
-Nulliparity, late maternal age first birth
-Increased weight
-Oral contraceptive, HRT
-Alcohol intake
Test Procedures: -Mammography
-Ultrasound
-Fine Needle Aspiration
-Surgical Biopsy
-Wire Needle localization
-Sentinel Node Biopsy: major drainage for particular area (lymph node), dye used
Management of Breast CA: -Determined by Type, Grade, Stage
-In situ
-Staging I-IV
-Surgery
-Chemotherapy
-Radiation
-Reconstruction
Mastectomy: Simple: removal of the breast
-Modified Radical Mastectomy: removal of the breast and thy lymph nodes
-Radical Mastectomy: removal of the breast, the lymph nodes, and the muscle under the breast (pectoralis major and minor)
-Partial mastectomy/breast sparing: removal of the lymph and partial or segmental removal of the breast
SERMs: -Selective Estrogen Receptor Modulators
-Although SERMs are non-hormonal, they act like the hormone estrogen in some parts of the body, such as the bones and heart. In other parts of the body, such as the uterus and breast, they block the effects of estrogen.
-Tamoxifen (Novadex)
-Raloxifene (Evista)
Nursing Care Following a Mastectomy and Nursing Considerations: -Hemorrhage: check dressing
-Nerve Impairment: Check radial pulse
-Drains: Jackson-Pratt
-Lymphodema
-Psycological Care: Altered body image
-Surgical: pain (top priority), drains, dressings
-Open communication
-Teaching/Patient education
-Coping/Adjusting
Hormone Replacement Therpay vs Estrogen Replacement Therapy: -Hormone Replacement Therapy: Estrogen with Progestin
-Estrogen Replacement Therapy: Estrogen only
-Contraindications: breast CA, liver disease (Hep, of alcohol disease)
Osteoporosis: -Loss of total bone mass, changes in bone structure
-Risk Factors: small framed, non-obese white women, family history, nulliparity, early menopause, alcohol, smoking, caffeine, low calcium diet
Tx: weight bearing exercises, calcium supplements, Vitamin D, SERMs
PMS: -Cyclical, after ovulation
-Cause unknown
-S/S:
-Treatment: multi-vitamin
Peri-menopause: -Period extending from first sign of menopause
-Starts around age 40
-S/S:
Menopause: -Physiologic cessation of menses associated with decrease ovarian function
-Reproduction function diminshes and ends
Hormone Replacement Therapy: -Estrogen
-Prgesterone
-HRT: progeterone and estrogen
-ERT: Estrogen
-SERMs
-Delivery: pill, patch, cream, vaginal ring, injection
cystocele: A buldge caused by the bladder protruding into the submucosa of the anterior vaginal wall
Rectocele: A bulge caused by the protrusion of the rectal cavity into the posterior vaginal wall
Uterine Prolapse: The cervix may descend under pressure through the vaginal canal and be seen at the introitus

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