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Chapter 22

Women’s Health Issues

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Chapter 22
Lesson 22.1

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Objectives
1. 2.

3.

4.

5.

6.

Define key terms listed. Describe toxic shock syndrome and list four of its symptoms. Explain three measures that women should be taught to prevent toxic shock syndrome. Define endometriosis and state one typical symptom. Describe premenstrual syndrome and list potential ways to reduce it. Identify potential causes of dysmenorrhea and explain how it can be relieved.

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Women’s Health Care
 

Culturally competent communication Healthy People 2010 goals

Curb rise in breast cancer  Increase number of women over 40 receiving mammograms  Reduce number of deaths related to cervical cancer  Increase number women over 18 receiving Pap tests

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Physiologic Changes

Nurse must be aware of normal physiologic changes associated with aging, especially when assessing an older woman

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Smoking and Health

 

Smoking during pregnancy places woman at risk for preterm delivery Fetus at risk for intrauterine growth restriction Stress often associated with smoking

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Toxic Shock Syndrome (TSS)
 

Multisystem infection Response of body to toxins produced by Staphylococcus aureus and group A streptococci


  

Alters capillary permeability Allows intravascular fluid to leak from vessels Results in hypovolemia, hypotension, and shock Direct tissue damage to organs Precipitates serious defects in blood coagulation

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Causes and Prevention of TSS

Caused by
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Use of high-absorbency tampons Barrier method contraception

Prevented by

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Changing tampons every 4 hours Using peripads during sleep Not using diaphragms or cervical caps during menstruation Washing hands before and after inserting anything into vagina

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Symptoms of TSS
 

Sudden spiking fever Flulike symptoms

Headache, muscles aches, vomiting, diarrhea, sore throat

 

Hypotension Generalized rash resembling sunburn Skin peeling from palms and soles

1 to 2 weeks after onset of illness Elevated BUN and creatinine levels Low platelets

Laboratory tests showing

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Premenstrual Syndrome (PMS)
 

Aka ovarian cycle syndrome Physical, psychologic, or behavioral symptoms that regularly recur with luteal phase of menstrual cycle
 

Significantly disappear during remainder of cycle Completely disappear week after menstrual period

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Symptoms of PMS

Occur between ovulation and beginning of menses

    

Weight gain Bloating Irritability Loss of concentration Headaches Constipation


   

Acne Breast tenderness Anger Fatigue Feeling out of control

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Premenstrual Dysphoric Disorder (PMDD)
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More severe form of PMS Involves
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Irritability Dysphoria Mood swings Fatigue Appetite changes Sense of being overwhelmed

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Treatments for PMS
   

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Vitamin B6 Calcium and multivitamins with E Diuretics Selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine [Prozac] and sertraline [Zoloft]) Gonadotropin-releasing hormone (GnRH) agonists do not show strong evidence in comprehensive treatment of PMS Diet modifications Avoiding high salt intake Reducing caffeine Low-fat, high−complex carbohydrate diet

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Dysmenorrhea
 

Painful menstrual cramps Primary

  

Caused by prostaglandins Increases uterine contractility Decreases uterine blood flow Results in painful ischemia Pathologic condition Appears after menstruation has been established Caused by endometriosis, pelvic inflammatory disease, ovarian cysts Treatment • Vitamin E, mild prostaglandin inhibitor • Warmth, massage, daily exercise

Secondary

  

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Menstrual Irregularities (Dysfunctional Bleeding)

Menorrhagia: excessive bleeding during menses Metrorrhagia: bleeding from uterus between menstrual cycles Postmenopausal vaginal bleeding: occurs at least 1 year following cessation of spontaneous menstruation Dysfunctional uterine bleeding: bleeding that occurs with abnormal frequency Amenorrhea: absence of menstrual bleeding

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Leiomyomas (Uterine Fibroids)

Benign uterine tumors
 

Majority diagnosed during pelvic examination Detectable fibroids present as a pelvic mass, excessive bleeding, or both

Pregnant women with fibroids at risk for

Antepartum bleeding, dystocia, potential cesarean, early pregnancy loss  Most pregnancies end favorably

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Pelvic Floor Dysfunction

Supporting structures to pelvic organs are damaged or weakened Vaginal wall prolapse
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Uterus can protrude through vagina Cystocele Enterocele Rectocele

Uterine prolapse

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Treatment and Nursing Care

Management of pelvic floor dysfunction also considers

Age  Physical condition  Sexual activity

May involve
  

Surgical repair Pessary Kegel exercises

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Osteoporosis

Degenerative musculoskeletal disorder Decrease in bone density leads to porosity in bones More vulnerable to fractures

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Risk Factors for Osteoporosis
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Asian descent Small boned Fair-skinned whites of Northern European descent Early menopause Sedentary lifestyle Inadequate calcium intake Caffeine Alcohol Smoking Long-term use of steroids

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Chapter 22
Lesson 22.2

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Objectives
7.

8.

9.

10.

State two screening techniques for early detection of breast cancer. Explain the technique of breast selfexamination. Describe two options in the management of breast cancer. Explain the physiologic factor that initiates menopause.

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Benign Breast Disorders

Fibrocystic breast disease: mobile localized cyst that can be diagnosed and treated by needle aspiration Fibroadenoma: movable, well-defined solid breast mass, nontender; may require surgical removal Interductal papilloma: nonpalpable solitary nodule, usually found on mammography; excision treatment of choice

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Screening Tests for Cancer Detection


Breast self-examination (BSE): begin during adolescence, perform about 1 week after each period Mammography: soft-tissue radiographic image; can detect lesions before they are felt Papanicolaou (Pap) test: examines cells from cervix Vulvar self-examination: visual inspection and palpation of external genitalia

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Breast Cancer Risk Factors
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Genetic inheritance (BRCA-1 and BRCA-2) Age greater than 50 years Family history of premenopausal breast cancer Use of alcohol Smoking High-fat diet High caffeine intake Early menarche Late menopause Nulligravid status

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Treatment and Nursing Care

Surgical procedures
   

Lumpectomy Simple mastectomy Modified radical mastectomy Radical mastectomy

Education concerning diagnosis and treatment options is a nursing responsibility

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Adjuvant Therapy

Usually done after surgical intervention completed Some tumors are receptive to estrogen; therefore estrogen-blocking drugs such as tamoxifen and raloxifene may be given

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Discharge Planning After Breast Surgery

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Assist woman in understanding diagnosis, therapy, and long-term prognosis Encourage woman to participate in recovery program Teach to recognize complications that may occur Advise woman about planned exercises, activities, and follow-up care Encourage to attend Reach to Recovery group discussions

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Endometriosis

Endometrial tissue implanted predominantly in extrauterine sites Cells contain glands and stroma

Respond to cyclic hormonal stimulation in same way uterine endometrium does

Lesions build up and slough during menstrual cycle, causes pelvic pain, pressure, and inflammation to adjacent organs Inflammatory response can lead to adhesion formation

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Possible Causes and Management

Causes include

Retrograde menstrual flow that transplants endometrial tissue outside uterus  Hereditary tendency  Possible immunologic defect

Management varies with
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Severity of pain Extent of disease Desire for children Age Threat to GI or urinary tract

Management options include

NSAIDs  Surgery or laser therapy

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Pelvic Inflammatory Disease (PID)

Infection of upper genital tract involving fallopian tubes

Most common cause is from STIs, especially Chlamydia trachomatis and Neisseria gonorrhoeae

Early onset of sexual activity and multiple partners increase risk May cause infertility, ectopic pregnancy, pelvic abscess, and adhesions

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Criteria for Diagnosis of PID
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Pelvic pain Adnexal tenderness Cervical motion tenderness (CMT) Dyspareunia (painful intercourse) Fever Purulent vaginal discharge Positive ultrasound Elevated erythrocyte sedimentation rate

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Menopause

Menstruation that has ceased for at least 1 year; known as climacteric
 

Average age 52.5 years Pregnancy can still occur

Psychologic response affected by expectations, marital and financial stability, family views, and social or ethnic cultural values

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Physical Changes of Menopause
 

  

Result of lowered estrogen levels Uterine endometrium and myometrium atrophy Vaginal mucosa becomes smooth and thin Rugae disappear; loss of elasticity Hot flashes: feels burning sensation followed by perspiration

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Contraindications to Menopausal Estrogen Treatment
    

Pregnancy Unexplained vaginal bleeding Active or chronic impaired liver function Breast cancer Endometrial cancer, except in certain circumstances Recent vascular thrombosis (with or without emboli)

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Chapter 22
Lesson 22.3

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Objectives
11.

12.

13.

Describe the transmission, treatment, and prevention of common sexually transmitted infections. Explain methods to prevent transmission of infections acquired through blood and body fluids. Discuss the prevention of human papillomavirus infections.

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Violence Against Women

Known by variety of names
    

Domestic violence Intimate partner violence Spouse abuse Wife battering Marital rape

Single most common source of injury in women

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Abuse

Can be
    

Emotional: characterized by intimidation and assaults on selfesteem Physical Sexual Social Financial Violence is deliberate Can be severe Generally repeated Followed by “honeymoon period”

Abuser often does not perceive behavior as a problem
  

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Rape Trauma Syndrome

Is not a sexual experience for the woman
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Immediate response of victim is fear of death or mutilation After attack, woman may appear calm but focused inward May not be able to hear requests of medical personnel Anxiety and irritability are primary behaviors Changes to shock, disbelief, fear, guilt, and shame

Posttraumatic stress disorder (PTSD) may be a longterm complication

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Hepatitis
 

Inflammation of the liver from a virus Hepatitis A is transmitted by contaminated food and water or fecal-oral route Hepatitis B can be transmitted sexually, IV drug abuse, or intimate contact with blood or body fluids Immunizations available for A and B

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Sexually Transmitted Infections (STIs)

Infections are primarily transmitted during sexual contact

Spread by contact with bodily fluids from mouth, genitalia, rectum, and blood

STIs during pregnancy can cause spontaneous abortion, preterm birth, intrauterine growth restriction, prematurity, neonatal death, congenital infection, postpartum uterine infection

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Testing for STIs

Rapid tests available for
   

Human immunodeficiency virus (HIV) Herpes simplex virus 2 (HSV-2) Chlamydia Gonorrhea Syphilis Confirmation of HIV

Serum blood tests needed for
 

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Prevention of STIs

Identification of high-risk behaviors and education to address the issues Mutually monogamous relationship with uninfected partner Safer sex practices
  

Reduction in partners Avoiding exposure to blood and body fluids Condoms or barrier methods

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Question for Review

For the nurse to be an effective teacher about health behavior, the nurse must ___________________.

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Review Key Concepts of the Chapter

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