Nursing Management of Female

Physiologic Processes:
Menstruation, Premenopausal, and
Menopause
PREPARED AND PRESENTED BY:
MRS. HAJAR HIJAZI_NURS 374_OBSTETRICS AND GYNECOLOGY NC_FALL
2023- 2024
 Nursing Management of female physiologic
processes

 Nursing Management of female physiologic processes:

1. Menstruation
2. Premenopausal
3. Menopause

 Differentiate between presumptive, probable, and positive signs of pregnancy (signs of pregnancy).
 Nursing Management of female physiologic
processes

1- Menstruation:

 Girls who are approaching menarche (the onset of menstruation) should be educated about the normal
process of the menstrual cycle before it occurs.

 Regular exercise and a healthy diet, and rest have been found to decrease discomfort for some women.

 Heating pads or nonsteroidal anti-inflammatory drugs (NSAIDs) may be very effective for cramps.
 Nursing Management of female physiologic
processes

2. Perimenopause:

 Perimenopause has been described as an opportune time for educating women about health promotion
and disease prevention strategies.

• When discussing health related concerns with women who

are in midlife, nurses should consider the following issues:
Sexuality, Fertility, Contraception, STIs
 Nursing Management of female physiologic
processes

2. Perimenopause:

 Breast health. About 16% of cases of breast cancer occur in

women who are perimenopausal, so breast self-examination,
routine physical examinations, and mammograms are
essential.
 Nursing Management of female physiologic
processes

3. Menopause:

 The nurse explains to the patient that cessation of menses is a normal

occurrence that is rarely accompanied by nervous symptoms or
illness.

 Patient education and counseling regarding healthy lifestyles, health

promotion, and health screening are of paramount importance.
 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Strategies for Women Approaching Menopause

1. An annual physical examination can help screen for problems and promote general health.

2. A nutritious diet (decrease fat and calories, increase fiber and whole grains) and weight control will enhance physical and
emotional well-being.

3. Exercise for at least 30 minutes 3 or 4 times a week to maintain good health.

4. Safer sex is important at any age.

5. Hot flashes: See primary provider to discuss hormone replacement therapy (HRT) indications.

6. Decreased perineal muscle tone and bladder control: Practice Kegel exercises daily (contract the perineal muscles as though
 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Strategies for Women Approaching Menopause

7. Risk for urinary tract infection (UTI): Drink 6–8 glasses of water daily as a possible way to reduce the incidence
of UTI related to atrophic changes of the urethra.

8. Vaginal bleeding: Report any bleeding after 1 year of no menses to the primary provider immediately, no matter
how minimal.
 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Medical Management:

1. Hormone Therapy

2. Alternative Therapy for Hot Flashes

3. Maintaining Bone Health

4. Maintaining Cardiovascular Health

5. Behavioral Strategies

6. Nutritional Therapy
 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Medical Management:

1. Hormone Therapy

 Menopausal hormonal therapy (hormone replacement therapy [HRT]) is medication that contains estrogen or

estrogen and progestin together, to replace the ones the body is no longer making.

 HT is contraindicated in women with a history of breast cancer, vascular thrombosis, impaired liver function,

uterine cancer, and undiagnosed abnormal vaginal bleeding.

 Women who take HT need to be informed about the importance of regular follow-up care.
 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Medical Management:

2. Alternative Therapy for Hot Flashes

 A few studies have shown some improvement in vasomotor symptoms (hot flashes and night sweats) with the use

of complementary therapies (reflexology, aromatherapy, yoga, meditation).

 When taking a medical history, the nurse should always address their use of complementary and alternative

therapies and supplements.

 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Medical Management:

3. Maintaining Bone Health

 Observe recommended calcium and vitamin D intake, including calcium supplements, if indicated, to slow

the process of osteoporosis; avoid smoking, alcohol, and excessive caffeine, all of which increase bone loss.
Perform weight-bearing exercises.

 Undergo bone density testing when appropriate.

 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Medical Management:

4. Maintaining Cardiovascular Health

 Lifestyle changes and behavioral strategies

 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Medical Management:

5. Behavioral Strategies

 Regular physical exercise, It may reduce stress, enhance well-being, and improve self-image.

 Weight-bearing exercise may prevent loss of muscle tissue and bone tissue.

 Regular health screening recommended for women at the time of menopause: gynecologic examinations,

mammograms, colonoscopy, fecal occult blood testing, and bone mineral density testing if at risk for
osteoporosis.
 NURSING MANAGEMENT OF FEMALE PHYSIOLOGIC
PROCESSES

 Menopause:

 Medical Management:

6. Nutritional Therapy

 Women are encouraged to decrease their fat and caloric intake and

increase their intake of whole grains, fiber, fruit, and vegetables.

SIGNS AND SYMPTOMS OF PREGNANCY
 SIGNS AND SYMPTOMS OF PREGNANCY
Presumptive, Probable & Positive Signs of Pregnancy

 General Objective:

 Diagnosis of pregnancy

 Specific Objective:

 Differentiate between Presumptive, Probable and Positive Signs of Pregnancy.

 Presumptive, Probable and Positive Signs of
Pregnancy

 It's important to understand the meanings of presumptive,

probable, and positive signs of pregnancy.

 And to know what is included in each category, to confirm a

pregnancy.
 1. Presumptive Signs of Pregnancy

 Presumptive signs and symptoms of pregnancy are usually noted by the client.

 These signs and symptoms are not proof of pregnancy, and may be caused by something else.

 But they will make the health provider and woman suspicious of pregnancy.
 1. Presumptive Signs of Pregnancy

 Presumptive signs of pregnancy are:

1. Amenorrhea (Cessation of Menstruation)
 Is one of the earliest clues of pregnancy. The majority of clients have no periodic bleeding after the onset of
pregnancy.

 Other causes for amenorrhea must be ruled out, such as:

A. Menopause
B. Stress (severe emotional shock, tension, fear, or a strong desire for pregnancy).
C. Chronic illness (endocrine disorders, or central nervous system abnormality).
D. Anemia.
 1. Presumptive Signs of Pregnancy

2. Nausea or vomiting (MORNING SICKNESS)

 Usually occurs in early morning during the first weeks of pregnancy.

 Usually spontaneous and subsides in 6 to 8 weeks or by the twelfth to sixteenth week of pregnancy.

 These are unreliable signs of pregnancy since they may result from other conditions such as:

A. Gastrointestinal disorders (ulcers, and appendicitis).

B. Infection (influenza, food poisoning).

C. Emotional stress, upset (anxiety and anorexia nervosa).

 1. Presumptive Signs of Pregnancy

3. Frequent urination
 Frequent urination is caused by pressure of the expanding uterus on the
bladder.

 In the last weeks of pregnancy the head of the fetus press against the bladder.

 But frequent urination can be apparent (diabetes, urinary tract infection, or

tumors).
 1. Presumptive Signs of Pregnancy

4. Breast changes

 In early pregnancy, changes start with a slight, temporary enlargement of the breasts causing a sensation
of weight.

 As pregnancy continues the patient may notice:

A. Increased firmness of the breasts.

B. More visible veins due to the increased blood supply.

 1. Presumptive Signs of Pregnancy

5. QUICKENING (FEELING OF LIFE)

 This is the first perception of fetal movement.

 It usually occurs toward the end of the fifth month because of spasmodic flutter.

• A multigravida can feel quickening as early as 16 weeks.

• A primigravida usually cannot feel quickening until after 18 weeks.

 Fetal movement early in pregnancy is frequently thought to be gas.

 2. Probable Signs of Pregnancy

 Probable signs of pregnancy indicate pregnancy the majority of the time.

 However, there is still the chance they can be false or caused by something other than pregnancy, like
presumptive signs.

 These signs include:

1. Uterine changes

2. Cervical changes

3. Abdominal changes

4. Positive pregnancy test

 2. Probable Signs of Pregnancy

1. UTERINE CHANGES
 POSITION: By the 12 week, the uterus rises above the symphysis pubis and it should reach the xiphoid process
by the 36th week of pregnancy.

 These guidelines are fairly accurate only as long as pregnancy is normal and
there are no twins, tumors, or excessive amniotic fluid.

 SIZE: The uterus increases in width and length approximately five times its
normal size. Its weight increases from 50 grams to 1,000 grams.
 2. Probable Signs of Pregnancy

1. UTERINE CHANGES
 Hegar’s sign: This is softening of the lower uterine segment just above the cervix.

 hegar's sign is noted by the sixth to eighth week of pregnancy.

Soft
 2. Probable Signs of Pregnancy

2. Cervical Changes

 Goodell’s sign:

 The cervix is normally firm, like the cartilage at the end of the nose.

 Goodell’s sign occurs when there is marked softening of the cervix. This is present at the 6th week of pregnancy.

 Chadwick’s sign:

 Bluish color to the cervix, vagina, and labia resulting from increased blood flow happens around 4 weeks gestation.
 2. Probable Signs of Pregnancy

2. Cervical Changes
 BRAXTON-HICK'S CONTRACTIONS:
 This involves painless uterine contractions occurring throughout pregnancy.
 It usually begins at about the 20 week of pregnancy and becomes progressively stronger.
 Braxton-Hick's contractions are distinct from labour contractions that they do not cause cervix dilatation.

 Vaginal Changes
 Vagina: Violet, moist, warm with increased acidity.
 2. Probable Signs of Pregnancy

3. ABDOMINAL CHANGES
 This corresponds to changes that occur in the uterus. As the uterus grows, the abdomen gets larger.

 Abdominal enlargement alone is not a sign of pregnancy.

 Enlargement may be due to uterine or ovarian tumors, or edema.

 2. Probable Signs of Pregnancy

4. POSITIVE PREGNANCY TEST (HUMAN CHORIONIC GONADOTROPHIN HORMONE

BHCG):
 Detection of BHCG in maternal serum and urine is evident on 8 -10 days after conception

 Even if the test is positive, it could be the result of ectopic pregnancy or a hydatidiform mole (an abnormal
growth of a fertilized ovum).
 3. Positive Signs of Pregnancy

 Positive signs of pregnancy are definitely confirmed as a pregnancy. They include:

 Fetal heart sounds:

 The fetal heart is audible with a doppler ultra sound by 10 -12 weeks of pregnancy .

 Ultrasound scanning of the fetus:

 Pregnancy ultrasound is a method of imaging the fetus and the female pelvic organs during pregnancy.

 The gestation sac can be detected by 8 weeks of pregnancy .

 3. Positive Signs of Pregnancy

 Fetal movements:

 It can be palpated or observed through abdomen by examiner or the mother at 20 weeks.

 Detection of fetal skeleton by X-Ray

 References

 Myles textbook for midwives. Sixteenth edition / edited by Jayne E. Marshall, Maureen D. Raynor ;
foreword by Diane M. Fraser. 2014.