NURS 330

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NURS 330

• November 18, 2010

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Announcements

• Final Exam
• Thurs, December 9, 2010
• 730pm 10pm
• Last Lecture Dec 2, 2010
• There is no class on Thurs, 11/25/10
• No essays will be accepted after 11/18/10
• If essay not submitted to Turnitin and hard copy
  in class, it will not be graded

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Review In-Class Assignments

• 10/28/10 Sexual Response Cycle
• 11/4/10 - Contraception

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• Abortion

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Abortion

• Spontaneous abortion
• aka miscarriage
• Loss of baby before 20 weeks of pregnancy
• Induced abortion
• Surgical
• Drug-based

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Surgical Method

• Vacuum Aspiration
• First trimester method
• Dilation and Extraction (D X)
• Late surgical method

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Drug-Based Methods

• Mifepristone (RU 486) Injection, 0rally
• An anti-progesterone
• prevents progesterone from making uterine lining
  hospitable for implantation
• If fetus is already implanted, causes the uterus
  to shed its lining and, along with it, the
  fertilized fetus
• Approved by FDA in September 2000 for abortion
• As an alternative to surgical procedure
• Effectiveness is increased if used with another
  drug, Misoprostol (95-98)
• Most effective within 7 weeks of fertilization

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Drug-Based Methods (cont)

• Methotrexate Injection orally (rarely)
• Prevents cell division and multiplication
• Can be used to induce an abortion
• Effectiveness is increased if used with another
  drug, Misoprostol (95)
• Approved by FDA for treatment of cancer,
  arthritis and psoriasis
• Most effective within 7 weeks of fertilization
• Misoprostol orally or vaginally
• Legal Drug used in conjunction with above drugs
• The second drug used to complete the abortion
  procedure
• Taken a day or two after administration of the
  first drug
• Causes the uterus to contract and expel its
  contents
• Approved in the US for coating the stomach of
  people who take stomach-irritating
  anti-inflammatory drugs.

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Abortifacient

• A method or substance that causes a fertilized
  egg that has implanted in the uterine wall or
  fetus to be expelled.
• Which of the drug-based methods is an
  abortifacient?

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Incidence of Abortions

• Nearly half of pregnancies among American women
  are unintended, and four in 10 of these are
  terminated by abortion.
• Twenty-two percent of all pregnancies (excluding
  miscarriages) end in abortion.
• In 2005, 1.21 million abortions were performed,
  down from 1.31 million in 2000. From 1973 through
  2005, more than 45 million legal abortions
  occurred.
• Each year, about two percent of women aged 15-44
  have an abortion 47 of them have had at least
  one previous abortion.

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When women have abortions
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Cost

• Surgical
• In 2005, the cost of a non-hospital abortion with
  local anesthesia at 10 weeks gestation ranged
  from 90 to 1,800 the average amount paid was
  413
• (Source Perspectives on Sexual and
  Reproductive Health)
• Drug-based
• most providers do charge more for this method

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Abortion and the Law

• Roe v. Wade
• 1973 Supreme Court decision stating
• 1st trimester abortions cannot be regulated by
  states and the decision to abort is between woman
  and physician
• 2nd trimester abortions permitted when mental or
  physical health of mother at risk
• 3rd trimester abortions allowed when life of
  mother at risk

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California Law

• California does not have any of the major types
  of abortion restrictions such as waiting
  period, mandated parental involvement or
  limitations on publicly funded abortions often
  found in other states.

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The Pro-Life and Pro-Choice Controversy

• Anti-abortion (Pro-life) position
• Pro-choice position

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• The following presentation on Cancer is from the
• American Cancer Society. It has been authorized
• for use in this class by Chrissy Kim,
• Manager, Healthcare/Corporate Initiatives

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What is Cancer?

• Cancer occurs when cells in a part of the body
  begin to grow out of control. Normal cells divide
  and grow in an orderly fashion, but cancer cells
  do not. They continue to grow and crowd out
  normal cells.
• Although there are many kinds of cancer, they all
  have in common this out-of-control growth of
  cells.

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Cancer (cont)

• Sometimes cancer cells break away from a tumor
  and spread to other parts of the body through the
  blood or lymph system. They can settle in new
  places and form new tumors. When this happens, it
  is called metastasis. Cancer that has spread in
  this way is called metastatic cancer.
• Even when cancer has spread to a new place in the
  body, it is still named after the part of the
  body where it started. For example, if prostate
  cancer spreads to the bones, it is still called
  prostate cancer. If breast cancer spreads to the
  lungs, it is still breast cancer. When cancer
  comes back in a person who appeared to be free of
  the disease after treatment, it is called a
  recurrence.

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Survival Rates

• 5-year localized survival rate
• Localized cancer is cancer that, at the time of
  diagnosis, had not spread to additional sites
  within the body. Typically, the earlier a cancer
  is detected and diagnosed, the more successful
  the treatment, thus enhancing the survival rate.

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Survival Rates

• 5-year overall survival rate
• The 5-year survival rates represent persons who
  are living 5 years after diagnosis, whether
  disease-free, in remission, or under treatment.
  They do not imply that 5-year survivors have been
  permanently cured of cancer.

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The Breast

• Main function is to produce milk for
  breastfeeding
• 2 main types of tissues
• glandular tissues
• Lobules milk production
• Ducts milk passages to the nipples
• supporting (stromal) tissues
• Fatty Fibrous connective tissue
• Give breast their size, shape and support

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Breast Changes

• Changes in the breasts may be caused either by
  benign conditions or cancer
• Benign Breast Conditions
• Never life threatening very common
• Some may increase the risk of developing
• breast cancer
• fibrocystic changes
• benign breast tumors
• breast inflammation
• Breast Cancer - Life threatening

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Breast Changes

• It is often not possible to tell the difference
  between benign and cancerous conditions based on
  symptoms alone
• More tests will be needed
• Some benign breast conditions may not cause any
  symptoms and may be found during a mammogram or a
  breast biopsy.

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What Is Breast Cancer?

• Breast cancer is a malignant (cancerous) tumor
  that develops from cells in the breast.
• Most breast lumps are benign (not cancerous).
• Early detection is very important because the
  cancer can spread if not treated at its earliest
  stages.

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The American Cancer Societys Estimates

• The American Cancer Society's most recent
  estimates for breast cancer in the United States
  are for 2010
• About 207,090 new cases of invasive breast
  cancer will be diagnosed in women.
• About 54,010 new cases of carcinoma in situ (CIS)
  will be diagnosed (CIS is non-invasive and is the
  earliest form of breast cancer).
• About 39,840 women will die from breast cancer

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Who Is At Risk?

• Two factors greatly influence the risk of
  developing breast cancer
• 1. Being a woman
• The disease is over 100 times more common in
  women than in men.
• 2. Age
• Approximately 77 of women with breast cancer
  are age 50 or older at the time of diagnosis.

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Why Are Older Women More At Risk?

• Exposure to reproductive hormones, like estrogen,
  over a lifetime may increase the risk. This is
  influenced by
• Age
• Age of first menstrual period
• Number of pregnancies
• Age at menopause
• History of taking medication that contains
  estrogen

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Other Risk Factors

• Family history of breast cancer
• Having a first-degree relative (mother, sister,
  or daughter) with breast cancer approximately
  doublesa womans risk.
• Most women with breast cancer do not have a
  first-degree relative with the disease.
• History of noncancerous breast disease
• Never having children or having first live birth
  after age 30

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Other Risk Factors

• Starting monthly periods before age 12
• Starting menopause after age 55
• More than 5 years of postmenopausal estrogen
  replacement therapy
• Use of alcohol, especially two or more drinks
  daily
• Obesity, especially excessive weight gain
• Physical inactivity

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Reducing Your Risk

• Limit alcohol use.
• Engage in regular physical activity.
• Maintain a healthy weight.
• Eat a healthy, balanced diet that includes at
  least five servings of fruits and vegetables
  every day.

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Symptoms

• The most common sign of breast cancer is a new
  lump or mass.
• Other signs include
• Generalized swelling of part of a breast (even if
  no distinct lump is felt)
• Skin irritation or dimpling

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Symptoms other signs (cont)

• Nipple pain or retraction (turning inward)
• Redness or scaliness of the nipple or breast skin
• Discharge other than breast milk

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Detection Methods

• Nearly all breast cancers can be successfully
  treated if detected early.
• A mammogram is the best method for detecting
  breast cancer because often it can identify
  cancer before physical symptoms develop.
• All women should have regular breast examinations
  by a health provider.

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The American Cancer Societys Screening
Recommendations

• Clinical Breast Exam should be part of a periodic
  health exam, about every three years for women in
  their 20s and 30s, and every year for women 40
  and older.
• Women should know how their breasts normally feel
  and report any breast change promptly to their
  health care provider. Breast Self Examination is
  an option for women starting in their 20s.

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The American Cancer Societys Screening
Recommendations

• Yearly mammograms are recommended starting at age
  40 and continuing for as long as a woman is in
  good health.
• Women at increased risk (e.g., family history,
  genetic tendency, past breast cancer) should talk
  with their doctors about the benefits and
  limitations of starting mammography screening
  earlier, having additional tests (i.e., breast
  ultrasound and MRI), or having more frequent
  exams.

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Breast Self Exam

• Beginning in their 20s, women should be told
  about the benefits and limitations of BSE. Women
  should be aware of how their breasts normally
  feel and report any new breast changes to a
  health professional as soon as they are found.
  Finding a breast change does not mean that a
  cancer is present.

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Treatment

• Treatment is most successful when breast cancer
  is detected early.
• Often two or more treatment methods are used.
• Patients should thoroughlydiscuss treatment
  optionswith their doctors.

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Treatment Options

• Breast conservation surgery
• Mastectomy
• In both cases, the lymph nodes under the arm
  may also be removed.

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Treatment Options

• Chemotherapy
• Uses anticancer drugs that attack cancer cells
  and normal cells.
• These drugs usually are given by injection or by
  mouth.
• Hormone therapy
• Uses hormones (chemicals made in the body that
  affect cell activity) or drugs that interfere
  with hormone production.

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Treatment Options

• Monoclonal antibody therapy
• Uses substances that locate and bind to cancer
  cells.
• Can be used alone or to deliver drugs, toxins, or
  radioactive material directly to tumor cells.
• Radiation therapy
• Uses high-energy rays to shrink or kill cancer
  cells.

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Survival Rates

• 5-year localized survival rate is 98
• 5-year overall survival rate is 80

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Hope For The Future

• Scientists are continually learning more about
  breast cancer, including how lifestyle,
  environment, and other factors affect risk.
• Examining the role of physical activity, weight
  gain or loss, diet, hormone replacement therapy,
  and environment on breast cancer risks.
• Determining the best use of genetic testing to
  find gene mutations (BRCA1 and BRCA2) that may
  increase breast cancer risks.

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Hope For The Future

• Scientists are also finding better ways to detect
  and treat breast cancer, such as
• Developing new screening methods and improving
  existing ones.
• Testing chemotherapy drugs and drug combinations
  to find those that attack breast cancer cells but
  cause less damage to normal cells.
• Testing hormone therapies, such as raloxifene and
  tamoxifen, that have been shown to greatly
  reduce the risks among women at high risk for
  this disease.

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The Bottom Line

• Nearly all breast cancers can be treated
  successfully if found early.
• The key is early detection!
• Breast cancer risk may be reduced by being
  physically active, maintaining a healthy weight,
  and reducing alcohol use.

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Conditions of the Scrotum

• Epididymitis
• an inflammation or infection of the epididymis
• Caused by bacterial infections
• Sometimes caused by gonorrhea and chlamydia
• Incidence is less than 1 in 1,000 males per year
• Epididymitis is primarily a disease of adults,
  most commonly affecting males aged 19-40 years.

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Testicular Cancer
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What Is Testicular Cancer?

• Testicular cancer can develop in one or both
  testicles in men and boys.
• Contained in a sac of skin called the scrotum,
  the testicles are the part of the male
  reproductive system that produces sperm and male
  hormones (like testosterone).
• Very rare cancer but is the most common cancer
  found in men ages 15 - 35

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The American Cancer Societys Estimates

• In the United States during 2008
• 8,090 new cases of testicular cancer
• Deaths per year 380 men
• Testicular cancer is not common about 1 in 300
  men will develop testicular cancer in their
  lifetime.

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Risk Factors

• The main risk factors for testicular cancer
  include
• Race
• Family history
• Being born with an undescended testicle
• Cryptorchidism
• Because these risks cannot be avoided, it is not
  currently known how to prevent most cases of
  testicular cancer.

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Risk Factors (cont)

• Although testicular cancers usually occur in
  patients between the ages of 15 and 40, they can
  affect males of any age, including infants and
  elderly men.
• The risk among White men is about five times
  higher than among African American men.
• Men who have had cancer in one testicle are at
  increased risk for developing cancer in the other
  testicle.

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What Are Other Risk Factors?

• If a mans close family members have had
  testicular cancer, he is at greater risk.
• Men who had an undescended testicle as a baby are
  at increased risk (3 out of every 100 male
  infants).
• Men who have had cancer in one testicle are at
  increased risk for developing cancer in the other
  testicle.

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Other Risk Factors

• Some jobs may put men at increased risk for
  testicular cancer. Examples include being one
  of the following
• Miner
• Oil or gas worker
• Janitor
• Leather worker
• Recent studies found no evidence that having a
  vasectomy increases a mans risk of
  developingthe disease.

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Reducing Your Risk

• The main risk factors for testicular cancer
  include
• Race
• Family history
• Being born with an undescended testicle
• Because these risks cannot be avoided, it is not
  currently known how to prevent most cases of
  testicular cancer.

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Risk Factors (cont)

• Since none of these risks can be prevented, the
  best protection is awareness of risks and
  symptoms, early detection, and prompt treatment.
• Men at risk may want to perform a monthly
  self-exam
• Testicular Self Exam (TSE)

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Testicular Self Exam (TSE)

• The best time to perform the self-exam is during
  or after a
• bath or shower, when the skin of the scrotum is
  relaxed. To
• perform a testicular self exam
• Hold the penis out of the way and examine each
  testicle separately.
• Hold the testicle between the thumbs and fingers
  with both hands and roll it gently between the
  fingers.
• Look and feel for any hard lumps or nodules
  (smooth rounded masses) or any change in the
  size, shape, or consistency of the testes.

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Symptoms

• Lump or swelling in either testicle
• 90 of cases
• Often painless or slightly uncomfortable
• Enlargement of a testicle
• Feeling of heaviness in the scrotum
• Dull ache in the lower abdomen or groin
• Sudden collection of fluid in the scrotum
• Enlargement or tenderness of the breasts

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Detection Methods

• In 90 of cases, men have a lump or swelling in a
  testicle.
• Any swelling or aching in the testicles should
  be examined by a doctor without delay.
• Men at risk may want to perform a monthly
  self-exam.

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Diagnosis

• Medical History and Physical Exam
• Ultrasound
• Blood Tests

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Treatment

• Testicular cancer is highly treatable, usually
  curable, and relatively rare.
• Treatment is most successful when cancer is
  detected early.
• Often two or more treatment methods are used.
• Patients should thoroughly discuss treatment
  options with their doctors.

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Treatment Options

• There are three main treatment options
• Surgery
• An operation to remove cancer cells.
• Radiation therapy
• Uses high-energy rays to shrink or kill cancer
  cells.
• Chemotherapy
• Uses anticancer drugs that attack cancer cells
  and normal cells. The drugs are usually given by
  injection or by mouth.

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Survival Rates

• 5-year localized survival rate is 99
• 5-year overall survival rate is 95
• Survival rates drop to 76 when cancerhas spread
  to distant organs, which underlines the need for
  early action.

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Prostate Cancer
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What Is Prostate Cancer?

• In American men, prostate cancer is the most
  common cancer and the second leading cause of
  cancer death.
• The prostate gland is walnut-sized and is located
  in front of the rectum, behind the penis, and
  under the bladder.
• Most prostate cancers grow very slowly, but when
  they spread, they can do so quickly.

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The American Cancer Societys Estimates

• In the United States during 2008
• 186,320 new cases of prostate cancer
• Deaths per year 28,660

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Three Greatest Risk Factors

• Being a man
• Only men develop prostate cancer, typically those
  ages 50 and older.
• Age
• More than 70 of prostate cancers are diagnosed
  in men over 65.
• Race African American men have the highest
  prostate cancer incidence rates in the world. The
  rates of prostate cancer death for African
  American men are more than twice the rates for
  White men.

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Other Risk Factors

• About 5 to 10 of prostate cancers may be
  inherited.
• Eating a high-fat diet
• especially a diet high in saturated fat, found
  primarily in animal sources, such as red meat and
  dairy productsmay play a part in causing
  prostate cancer.

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Symptoms

• Most early cases of prostate cancer cause no
  symptoms, but some early signs may be
• Frequent urination, especially at night.
• Difficulty starting urinationor inability to
  urinate.
• Weak or painful urination.

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Diagnosis

• Prostate-Specific Antigen (PSA)
• blood test
• Digital Rectal Exam (DRE)
• rectal exam
• All men 50 years of age and older should ask
  their physicians about having the PSA test and a
  DRE every year.
• At a younger age if at high risk

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Treatment

• Treatment is most successful when prostate cancer
  is detected early.
• Often two or more treatment methods are used.
• Patients should thoroughly discuss treatment
  options with their doctors.

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Treatment

• If prostate cancer is detected early, is slow
  growing, and is not causing symptoms, watchful
  waiting may be chosen initially, especially for
  older men.
• Active treatment is started if the cancer begins
  to grow more quickly or symptoms appear.

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Treatment (active) Options

• Surgery
• Removal of the prostate, called prostatectomy, is
  
• the most commonly chosen surgical treatment.
• Radiation therapy
• Uses high-energy rays to shrink or kill cancer
  cells.

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Treatment Options (cont)

• Chemotherapy
• Uses anticancer drugs that attack cancer cells
  and normal cells. The drugs are usually given by
  injection or by mouth.
• Hormone therapy
• Treatment with hormones or drugs that interfere
  with hormone production or action, or the
  surgical removal of hormone producing glands.

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Survival Rates

• 5-year localized survival rate is 100
• 5-year overall survival rate is 99

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Prevention

• All men 50 and older should talk to their doctors
  about having annual DRE and PSA tests to help
  find prostate cancer early.
• Men who are at high risk for prostate cancer
  (African Americans or men with a first-degree
  relative diagnosed with prostate cancer at a
  young age) should begin testing at age 45.
• Prostate cancer is less likely to be curable once
  it has spread however, with annual screening,
  prostate cancer can be detected before this
  occurs.

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December 9, 2010

• Final Exam
• 730PM 1000PM
• 100 Questions
• Cumulative
• Study guide will be posted on course website by
  12/2/10.