MATERNAL NEONATAL NURSING CHAPTER 22

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MATERNAL NEONATAL NURSING CHAPTER 22

• WOMENS HEALTH ISSUES

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WOMENS HEALTH ISSUES

• Vulvovaginal Candidiasis
• most common vaginal infection
• caused by Candida albicans
• s/s intense itching, painful intercourse,
  thick, white, odorless discharge
• treatment OTC local or topical meds such as
  clotrimazole oral meds only need 1 dose are
  less messy, but can cause systemic reactions

• Endometriosis
• the presence of endometrial tissue in places
  other than the uterusovaries, fallopian tubes,
  cul-de-sac, uterine ligaments
• inflammatory response due to hormone changes,
  pain, pressure
• Mgmt NSAIDS, surgery, laser or removal of
  tissue, rest, heat to area, exercise, diet

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Toxic Shock Syndrome

• Multi system failure due to response to toxins
  produced by Staphlococcus aureus potentially
  fatal
• causes use of high absorbency tampons,
  diaphragm or cervical cap if left in gt 48 hrs
  early dx intervention very important
• s/s sudden fever, flulike symptoms
  hypotension, generalized rash skin peeling from
  hands feet 1-2 weeks after onset of illness

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Premenstrual Syndrome (PMS) or ovarian cycle
syndrome

• occurs during the luteal phase of the menstrual
  cycle, (between ovulation the onset of menses)
  then goes away or lessens during the rest of
  the cycle
• A more severe form is premenstrual dysphoric
  disorder (PMDD)
• s/s include physical, psychologic, or behavioral
  symptoms wt gain, bloated feeling, irritability,
  loss of concentration, mood swings
• Treatment drugs that inhibit ovulation, vit B6,
  calcium multivitamins with vit E diuretics,
  stress management, exercise

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Dysmenorrhea

• painful menstrual cramps that occur during or
  before the onset of menses disappear by the end
  of the cycle
• primary caused by prostaglandins. Treated
  with ocp use, prostaglandin inhibitors such as
  asa ibuprofen, exercise, rest proper
  nutrition
• secondary caused by pathological conditions of
  the reproductive tract. They are treated with
  use of vitamin E, warmth to the area, massage
  daily exercise

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Menstrual Irregularities(Dysfunctional Bleeding)

• Menorrhagia excessive bleeding during menses
• Metrorrhagia bleeding from the uterus between
  menstrual cycles
• Postmenopausal vaginal bleeding
• Amenorrhea absence of menstrual bleeding
• Cause of bleeding, if unknown, needs to be
  investigated treated

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Leiomyomas

• Uterine fibroids/tumors that develop during the
  womans reproductive years
• Can cause excessive bleeding, anemia, problems
  during pregnancy such as antepartum bleeding,
  dystiocia, potential c-section birth, early
  pregnancy loss
• Treatment removal of the tumor, hysterectomy

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MENOPAUSE

• Cessation of menstruation for 1 year. Causes
  various changes. Average age is 52.5 years
• Psychological depends on the womans
  expectations , marital financial stability,
  family views socioethnocultural values
• Physical result from lowered estrogen levels.
  Hot flashes, vaginal dryness, chills
  palpitations, dizziness tingling of the skin
• Loss of protective estrogen leads to increased
  risk for cardiovascular skeletal changes
• Treatment use of soy products, black cohash,
  vit E, exercise, HRT with precautions, box 22-1

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Pelvic Floor Dysfunction

• Occurs when the supporting structures of the
  pelvic organs are damaged or weakened
• Vaginal wall prolapse
• cystocele-bladder may lead to incontinence
• enterocele-loop of bowel herniates
• rectocele-rectum

• Uterine prolapse-when the uterus protrudes
  through the vagina.
• S/S-pelvic pressure, fatigue, backache
• Treatment-Kegel exercises, surgery to repair
  vaginal walls, use of a pessary to support
  structures if unable to have surgery

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Screening Tests for Cancer Detection

• Papsmear
• screening for precancerous cancerous cells
  that may be shed by the cervix
• detects early changes enables early treatment
  that increases survival rates for cervical cancer
• Self breast exam
• should be done monthly to detect early breast
  cancer changes
• Mammogram
• soft tissue radiographic image taken without
  the use of contrast medium
• detects lesions before they can be felt by SBE
• recommended for all women age 40 over

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Breast Cancer

• Risks
• family hx
• age gt 50
• use of alcohol
• high fat diet
• smoking
• high caffeine intake
• early menarche
• late menopause
• no pregnancies

• Treatment
• Lumpectomy
• Simple mastectomy
• Modified radical mastectomy
• Adjuvant Therapy
• Use of estrogen blocking drugs-Tamoxifen
• Discharge Teaching follow-up care, box 22-3

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Cervical Dysplasia Cancer

• Dysplasia is a precancerous lesion that grows on
  the surface of the cervix detected by pap smears
• Risks
• Human Papilloma virus (HPV) without treatment
• early sexual intercourse
• multiple sex partners
• partners with penile cancer

• Treatment of dysplasia
• cryotherapy, laser abalation, loop
  electrocautery excision (LEEP) or conization
• S/S
• dysfunctional uterine bleeding
• bleeding after intercourse

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Violence Against Women

• Is widespread underreported
• Also known as battering or intimate partner
  violence
• May start or become worse during pregnancy
• May involve physical, sexual, emotional,
  societal, or financial abuse
• Involves power control over women
• Nurses role is providing information about
  available community support providing emotional
  support

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Rape Trauma Syndrome

• Immediate response
• fear of death and/or mutilation
• may appear calm be focused inward
• anxiety irritability gradually change to
  shock, disbelief, fear, guilt shame
• Long-term response
• change in lifestyle, distrust of men,
  development of phobias fears
• Nursing care
• help the women gain a sense of control during
  the exam
• allow choices whenever possible
• obtain informed consent
• HIV testing
• postcoital contraception offered
• psychologic referral is highly recommended

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Pelvic Inflammatory Disease (PID)

• infection of the upper genital tract involving a
  tubal infection.
• Most common causes are chlamydia gonorrhea.
• Early onset of sexual activity multiple sex
  partners increases risks
• Increases risk of infertility, ectopic
  pregnancies, pelvic abcess, adhesions

• S/S pelvic pain, adnexal tenderness, cervical
  motion tenderness, painful intercourse, fever,
  purulent discharge.
• May require hospitalization for IV cefotaxime or
  doxycycline hyclate (Vibramycin) or
• Outpt treatment with levofloxacin
  metronidazole for 14 days
• Sexual partner must also be treated

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Sexually Transmitted Infections (STI)

• Formerly known as sexually transmitted diseases
  (STD)
• Specific infections that are transmitted
  primarily during sexual contact
• Box 22-4 Pt education for STIs
• Best prevention is a mutually monogamous
  relationship with an uninfected partner
• If that is not possible use safer sex practices
• Table 22-3