Women

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Womens Health

• Fibrocystic Breasts
• Endometriosis
• Polycystic Ovary Syndrome
• Vaginal Infections
• Uterine Tumors/Fibroids
• Gynecological Cancers
• Breast Cancer
• Pelvic Relaxation/Hysterectomy
• Female Circumcision

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Fibrocystic Breasts

• Thickening of breast tissue due to imbalance in
  estrogen and progesterone
• Cyst formation is a late change in breasts
• Most common benign breast disorder
• Ages 30 50 years
• May or may not increase risk of breast cancer
  depends on type of cellular changes

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Fibrocystic Breasts

• Symptoms increase approaching menopause and
  decrease after menopause
• Pain, tenderness, swelling before menses, lumpy
  feel to breasts
• May have serosanguineous discharge

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Fibrocystic Breasts

• Diagnostic studies
• Mammography, sonography, palpation
• Fine needle aspiration
• Biopsy

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Fibrocystic Breasts

• Treatment
• Restrict sodium intake
• Limit caffeine
• Mild diuretic
• Mild analgesic
• Hormone inhibitor danazol
• Oral contraceptives
• Antiestrogen tamoxifen
• Oil of evening primrose

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Endometriosis

• Endometrial tissue outside the endometrial cavity
• Endometrial tissue bleeds cyclically like a
  menstrual period
• Causes inflammation, scarring, adhesions
• Occurs between 20 and 45 years of age

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Endometriosis

• Pelvic pain - related to menstrual cycle
• Dyspareunia - painful intercourse
• Abnormal uterine bleeding
• Bimanual examination
• Fixed, tender, retroverted uterus
• Palpable nodules in cul-de-sac
• Diagnosis confirmed by laparoscopy

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Endometriosis Treatment

• Surgical removal of visible endometrial tissue
• Excision, endocoagulation, electrocautery, or
  laser vaporization
• Surgery is effective in relieving pain
• Surgical removal of uterus, ovaries, tubes
• Hormonal therapy, OCs
• Women with minimal symptoms - observation,
  analgesics, nonsteroidal anti-inflammatory drugs

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Polycystic Ovary Syndrome

• Imbalance of hormones
• Higher levels of androgens
• Enlarged ovaries with many fluid-filled cysts
• Egg-containing cysts in ovaries grow but do not
  release the egg
• Not cancerous
• Runs in families

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Polycystic Ovary Syndrome

• Irregular, decreased or no periods
• Less frequent ovulation
• Excess growth of hair on face, chest, abdomen,
  back, pubic area
• Acne or oily skin
• Weight gain, esp. waist area
• Patches of thickened, dark colored skin

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Polycystic Ovary Syndrome

• Less common features
• Male-pattern baldness
• Skin tags in armpits or neck
• High total cholesterol, low HDL chol.
• High blood pressure
• Diabetes

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Polycystic Ovary Syndrome

• Diagnosis
• Pelvic ultrasound, hormone levels
• Treatment
• Oral contraceptives
• Exercise
• Low calorie diet
• Electrolysis, hair removal creams
• Medicate to cause ovulation in infertility

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Vaginal Infections

• Bacterial Vaginosis
• Alteration of vaginal pH allowing bacteria to
  grow (Gardnerella, mycoplasmas)
• Not an STI
• Thin, watery white or gray discharge with fishy
  smell
• Treat with metronidazole (Flagyl)

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Vaginal Infections

• Candidiasis monilial yeast infection
• Vaginal cottage cheese discharge, itching,
  dysuria, dyspareunia
• Treatment - Clotrimazole

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Sexually Transmitted Infections (STIs)

• Trichomoniasis
• Protozoal infection
• Toilet seats, wet bathing suits, wet towels
• Yellow-green frothy odorous discharge
• Treatment
• Metronidazole (Flagyl)
• Treat both partners

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STI

• Chlamydia
• Bacterial infection
• Treatment
• Azithromycin, doxycycline

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STI

• Gonorrhea
• Treatment
• Ciprofloxacin with doxycycline

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STI

• Herpes
• Treatment
• Acyclovir

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STI

• Syphilis
• Can be transmitted transplacentally
• Treatment
• Penicillin G

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STI

• Human Papilloma Virus (HPV)
• Venereal warts
• Soft, grayish-pink, cauliflower-like lesions
• Treatment
• Cryotherapy, laser surgery
• Linked to cervical cancer

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STI

• Pediculosis Pubis

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Abnormal Pap Smear Results

• Detects variety of abnormalities
• Greatest impact on detection of cervical cancer
• Bethesda system most widely used Pap Smear
  reporting system Early detection allows changes
  to be treated before precancerous or cancerous
  cells develop
• Deliver results in a caring way

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Ovarian Masses

• May be palpated during a pelvic exam
• Between 70 and 80 of ovarian masses are benign
• More than 50 are functional cysts
• Occurs most commonly in women 20 to 40 years of
  age
• May be asymptomatic or symptomatic
• Symptoms Cramping, dyspareunia, irregular
  bleeding, delayed menses

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Ovarian Masses
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Ovarian Masses (contd)

• Treatment Oral contraceptives, surgery
  considered for large masses
• Most ovarian cysts resolve on their own
• Ovarian cancer is the most fatal of all cancers
  in women
• Difficult to diagnose
• Often spread throughout the pelvis before it is
  detected

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Uterine Masses

• Fibroid tumors/leiomyomas
• Most common benign disease entities in women
• Most common reason for gynecologic surgery
• Between 20 and 50 of women develop leiomyomas
  by age 40
• Common in women of African heritage

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Uterine Fibroids
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Uterine Masses (contd)

• Frequently asymptomatic
• Symptoms include Lower abdominal pain, fullness
  or pressure, menorrhagia, dysmenorrhea
• Diagnosis Ultrasonography revealing masses or
  nodules
• Masses or nodules involving the uterus palpated
  on pelvic examination
• Treatment None, embolization (plug artery
  supplying blood), U/S, or surgery

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Endometrial Cancer

• Most common disease of postmenopausal women
• High rate of cure if detected early
• Hallmark sign is vaginal bleeding in
  postmenopausal women not treated with hormone
  replacement therapy
• Diagnosis Endometrial biopsy, transvaginal
  ultrasound, posthysterectomy pathology of uterus

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Endometrial Cancer
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Endometrial Cancer (contd)

• Treatment Total abdominal hysterectomy (TAH) and
  bilateral salpingo-oophorectomy (BSO)
• Radiation therapy may also be indicated
• Nursing management
• Reinforce knowledge of etiology, symptoms, and
  treatment options
• Schedule follow-up appointments
• Provide emotional support and counseling

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Breast Cancer

• Unregulated growth of abnormal cells in breast
  tissue
• Most common cancer in women
• Second leading cause of death in women
• Can metastasize to bone, brain, lung, liver,
  skin, lymph nodes
• Staging 0, I, II, III, IV

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Manifestations of Breast Cancer

• Breast mass or thickening
• Unusual lump in underarm or above the collarbone
• Persistent skin rash near the nipple area
• Flaking or eruption near the nipple
• Dimpling, pulling, or retraction in an area of
  the breast
• Nipple discharge
• Change in nipple position
• Burning, stinging, or pricking sensation

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Diagnostic Tests for Breast Cancer

• Breast examination
• Mammogram
• Needle biopsy
• Excisional biopsy
• Ductal lavage and nipple aspiration

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Treatment for Breast Cancer

• Mastectomy
• Lumpectomy
• Simple
• Modified radical
• Radiation therapy
• Chemotherapy
• Breast Reconstruction

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Pelvic Relaxation

• Cystocele
• Relaxation of anterior vaginal wall with prolapse
  of bladder

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Pelvic Relaxation

• Rectocele
• Relaxation of posterior vaginal wall with
  prolapse of rectum

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Pelvic Relaxation

• Uterine Prolapse
• Downward displacement of uterus

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Pessaries
The GELLHORN pessary provides support for a
second to third degree uterine prolapse or
procidentia.
The DONUT pessary provides support for a
third-degree uterine prolapse as well as
cystocele and rectocele.
RING pessaries, with or without support, provide
relief for first and second-degree uterine
prolapse or cystocele.
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Hysterectomy

• Surgical removal of uterus
• TAH or TVH w/ BSO
• TAH preferred for cancer, large fibroids,
  endometriosis
• TVH preferred for small fibroids, abnormal
  uterine bleeding

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Female Circumcision

• Female genital mutilation performed on 2 million
  girls/year in African and Asia countries
• Cultural practice of womanhood
• Sunna excision of clitoris
• Excision removal of entire clitoris and part or
  all of labia
• Infibulation excision of clitoris, labia minora
  and scraping out labia majora

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Female Circumcision

• Provide privacy
• Create environment of trust where patient can
  talk openly
• Use warmed pediatric speculum for exams
• Provide health education about reproductive care
  and pregnancy care
• Develop birth plan to meet cultural needs

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NCLEX Question

• The nurse is planning to teach couples factors
  that influence fertility. What should not be
  included in the teaching plan?
• Sexual intercourse should occur 4 times a week.
• Wait one hour to urinate after intercourse.
• Do not douch.
• Use stress reduction techniques.

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NCLEX Question

• A menopausal woman tells the nurse that she
  experiences discomfort from vaginal dryness
  during sexual intercourse, and asks, What should
  I use as a lubricant? What should the nurse
  recommend?
• Petroleum jelly
• Water-soluble lubricant
• Body cream or lotion
• Less-frequent intercourse

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NCLEX Question

• A nursing tech is assisting with nursing care of
  a postmastectomy client. What information does
  the nurse reinforce with the nursing tech?
• Maintain strict Intake and Output
• No BP on the mastectomy side
• Begin arm exercises immediately
• Elevate proximal joint higher than distal joint

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NICU Nurses Prayer

• Help me to remember to care for the littlest of
  children with tenderness and compassion.
• Keep me ever mindful that babies cant tell me of
  their needs, so I must use every one of my senses
  in taking care of them.
• Walk with me in every task of my day so that I
  will stay alert to any changes that need my
  attention.

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NICU Nurses Prayer

• Let me encourage the parents as they learn how to
  care for their babies.
• Give me the grace to teach them with patience and
  show them unconditional love.
• Help us to care for each other when the shift is
  long and the work is stressful. Remind us to be
  thankful and to celebrate this healing ministry.

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