Professional Documents
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Routine Gyn Screening Class Presentation
Routine Gyn Screening Class Presentation
Group C
Morgan Frank, Jenny Garred, Alyssa Hall, Rachel Lima,
Lauren Powell, Clay Sensibaugh, Leah Silver, Emily St.
Germain, Holly Zuehlke-Frazelle
NURS368
Mammography
Current Screening
Recommendations
Holly Zuehlke-Frazelle
What is mammography?
They may also be done as follow up testing on women who have had a
history of breast cancer.
Current recommendations on
mammography testing.
Women aged 55 and older should transition to biennial screening or have the
opportunity to continue with annual screening.
The American Cancer Society does not recommend clinical breast examination for
breast cancer screening among average-risk women at any age.
Current recommendations on
mammography testing.
Recommendations for women with a higher risk for breast cancer.
Women at a higher risk for breast cancer based on certain factors
should have a yearly mammogram and MRI.
Risk factors include
Have a lifetime risk of breast cancer of about 20-25%, based mainly
on family history of breast cancer.
Have a known BRCA1 or BRCA2 mutation.
(American Cancer Society, 2015d).
Current recommendations on
mammography testing.
Performing a BSE
Although breast self-exam is no longer
recommended as part of breast cancer screening,
it is still important to be familiar with the way
your breasts normally look and feel.
Knowing what is normal for your body can help you see or feel any changes
in your breasts.
A self breast exam should be performed monthly, and should be performed
in the shower, in front of a mirror, and laying down.
Look for changes in contour, swelling, dimpling of the skin, or changes in nipples.
Lying down (in a supine position) allows the breast tissue to spread out evenly along the chest
wall.
2.
Place a pillow under right shoulder and put right arm behind head.
3.
Use left hand and feel with pads of fingers around your right breast in small, gentle, circular
motions.
4.
5.
6.
7.
Patient Teaching
BSE is NOT recommended for breast cancer screening
However, when combined with regular medical care and appropriate
guideline-recommended mammography, BSEs can help patients know what
is normal for their body so changes or lumps can be promptly reported to a
healthcare provider.
Women should perform a BSE at the same time each month because of
hormonal changes that affect breast tissue
Patients should be educated about proper technique and positioning for
performing a BSE.
Sources: National Breast Cancer Foundation, INC, 2015b
Johns Hopkins Medicine, 2015
Pap Smear
Cervical Cancer
Risk factors, Signs, and
Symptoms
Lauren Powell
Cervical Cancer
Pregnancy: women who have had three or more full-term pregnancies, or who had their first full-term
pregnancy before age 17, are twice as likely to get cervical cancer.
Family History:
Women with a sister or mother who had cervical cancer are two to three times more likely
Sexual History: HPV infection (most important risk factor). Sex before age 16, sex with multiple partners
and sex with someone who has had multiple partners. Studies also show a link between chlamydia infection
and cervical cancer.
Smoking:
Oral Contraceptive Use: Women who take oral contraceptives for 5 or more years has an increased risk
of cervical cancer, but this risk returns to normal within a few years after the pills are stopped.
Other Conditions
HPV: Though infection of the cervix with human papillomavirus
(HPV) is the most common cause of cervical cancer, having
HPV does not mean you will get cancer.
The majority of women who contract HPV clear the virus or
have treatment so the abnormal cells are removed.
Routine Pap screening is important to check for abnormal cells
in the cervix, so they can be monitored and treated as early as
possible.
Weight loss
Loss of appetite
Fatigue
Back pain
Bone fractures
Classification of
Abnormal Pap Smear
Results
Clay Sensibaugh
Quick Refresher
The Pap test is a screening test for malignant and
premalignant changes of the cervix. A positive result
indicates that there may be a problem and that
further diagnostic procedures must be done. The Pap
test is not a diagnostic test. It cannot be used to
exclude a cancer of the cervix for a person who has
symptoms that could be due to a cervical cancer
(Pfenninger, 2011).
Normal
Class II (Atypical)
Carcinoma-in-situ
Class V (Cancer)
Negative (Class I)
Indicates that there are no abnormal cells
present.
The smear is clean and clear of any
inflammatory cells.
Signs of infection with yeast, herpes or
Trichomonas vaginalis.
High-grade squamous
intraepithelial lesion (Class IV)
High degree of precancerous change.
Colposcopy is mandated.
Warrants cryotherapy treatment or removal of
area of concern.
Cancer (Class V)
Treatment/Follow-Up of
Abnormal Pap Smear
Results
Alyssa Hall
Colposcopy
Will be needed if:
Biopsy
Treatment
If a colposcopy and biopsy show a high grade abnormality, your specialist will recommend
that you have treatment.
The purpose of treatment is to remove the abnormal cells
One of the following methods will be recommended:
Wire loop excision
Cone biopsy
Laser
Diathermy
After treatment
A Pap smear and colposcopy should be done four to six months later.
Yearly Pap smear and an HPV test until both tests are negative two years in a row.
These follow ups are done to make sure the treatment has worked.
(Cancer Institute NSW,
2015)
Cervical Cancer
It is rare that a Pap smear result will show cells suggestive of cervical
cancer, because cervical cancer is a rare disease. If this does happen,
your doctor will recommend you see a specialist who will perform a
colposcopy and further tests to determine how serious the changes are.
If a biopsy shows that cancer is present, your doctor may order certain
tests to see how far the cancer has spread including:
Cystoscopy, proctoscopy, and examination under anesthesia
Imaging studies
Chest x-ray, CT, MRI, PET scans
Radiation
External beam radiation and brachytherapy
Chemotherapy
(American Cancer Society,
Other Components of
Routine Gynecologic
Exam
Emily St. Germain
Gynecological History
A routine gynecological exam begins with a complete gynecological
history.
This consists of:
Presenting problem
Medical and surgical history
Medications & allergies
Menstrual history
Sexual history
Obstetric history
Last pap smear
Intimate partner violence screening
Family history
Urologic history
(Lentz, 2012)
Physical Exam
A complete physical exam may be performed for every patient at the
first visit and at each check up
Breast exam
Pelvic exam
external examination
speculum examination
bimanual examination
(Lentz, 2012)
Pelvic Exam
External Examination
Visual inspection of external
genitalia for any lesions,
discoloration, or abnormalities
(Lentz, 2012)
Speculum Examination
Pelvic Exam
Bimanual Examination
References
American Cancer Society (2015a). Breast cancer prevention and early detection. Retrieved from
http://www.cancer.org/acs/groups/cid/documents/webcontent/003165-pdf.pdf
American Cancer Society (2014b). Cervical cancer prevention and early detection. Retrieved from
http://www.cancer.org/acs/groups/cid/documents/webcontent/003167-pdf.pdf.
American Cancer Society (2015c). How is cervical cancer treated? Retrieved from
http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-treating-general-information
American Cancer Society (2015d). Mammograms and other breast imaging tests. Retrieved from
http://www.cancer.org/acs/groups/cid/documents/webcontent/003178-pdf.pdf
Cancer Institute NSW (2015). What is an abnormal Pap smear test? Retrieved from
https://www.csp.nsw.gov.au/understanding-your-results/what-is-an-abnormal-result/
References
Chapman, L. & Durham, R. F. (2014a). Alterations in womens health. In R. Durham & L. Chapman (Eds)., Maternal-newborn
nursing: The critical components of nursing care (2nd ed.) (pp. 527-529). Philadelphia, PA: F.A. Davis Company.
Chapman, L., & Durham, R. F. (2014b). Well womens health. Maternal-newborn nursing: The critical components of
nursing care
(2nd ed., pp. 492-493). Philadelphia, PA: F. A. Davis Company.
Johns Hopkins Medicine (2015). Breast self-exams. Retrieved from
http://www.hopkinsmedicine.org/breast_center/treatments_services/breast_cancer_screening/breast_self_exam.
html.
Lentz, G.M. (2012). History, physical examination, and preventative health care. In G.M. Lentz, R.A. Lobo, D.M. Gershenson,
&
V.L. Katz (Eds.), Comprehensive gynecology (6th ed.) (pp. 113-128). Philadelphia, PA: Elsevier Mosby.
National Breast Cancer Foundation, INC (2015a). Breast self-exam. Retrieved from
References
MD Anderson Cancer Center. (2011, April 14). Patient education pap smear. Retrieved from
https://www4.mdanderson.org/pe/index.cfm?pageName=opendoc&docid=3451
National Breast Cancer Foundation, INC (2015b). Breast self-exam. Retrieved from
http://www.nationalbreastcancer.org/breast-self-exam
Oeffinger, K.C., Fontham, E.T., Etzioni, R., Herzig, A., Michaelson, J.S., Shih, Y.T., Wender, R. (2015). Breast cancer
screening for
women at average risk 2015 guideline update from the American Cancer Society. The Journal of the American
Medical Association.
314(15). 1599-1614.
Pfenninger, J. (2011). Pap smear information. Retrieved November 15, 2015 from
http://www.mpcenter.net/patient_ed/pap_smear_info.html