Women’s Health

1. Women’s Health Fibrocystic Breasts Endometriosis Polycystic Ovary Syndrome Vaginal Infections Uterine Tumors/Fibroids Gynecological Cancers Breast Cancer Pelvic Relaxation/Hysterectomy Female Circumcision

2. 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

3. Fibrocystic Breasts • Symptoms increase approaching menopause and decrease after menopause • Pain, tenderness, swelling before menses, “lumpy” feel to breasts • May have serosanguineous discharge

4. Fibrocystic Breasts • Diagnostic studies: • Mammography, sonography, palpation • Fine needle aspiration • Biopsy

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

6. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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)

15. Vaginal Infections • Candidiasis – monilial yeast infection • Vaginal “cottage cheese” discharge, itching, dysuria, dyspareunia • Treatment - Clotrimazole

16. 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

17. STI • Chlamydia • Bacterial infection • Treatment • Azithromycin, doxycycline

18. STI • Gonorrhea • Treatment • Ciprofloxacin with doxycycline

19. STI • Herpes • Treatment • Acyclovir

20. STI • Syphilis • Can be transmitted transplacentally • Treatment • Penicillin G

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

22. STI • Pediculosis Pubis

23. 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

24. 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

25. Ovarian Masses

26. Ovarian Masses (cont’d) • 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

27. 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

28. Uterine Fibroids

29. Uterine Masses (cont’d) • 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

30. 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

31. Endometrial Cancer

32. Endometrial Cancer (cont’d) • 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

33. 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

34. 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

35. Diagnostic Tests for Breast Cancer • Breast examination • Mammogram • Needle biopsy • Excisional biopsy • Ductal lavage and nipple aspiration

36. Treatment for Breast Cancer • Mastectomy • Lumpectomy • Simple • Modified radical • Radiation therapy • Chemotherapy • Breast Reconstruction

38. Pelvic Relaxation • Cystocele • Relaxation of anterior vaginal wall with prolapse of bladder

39. Pelvic Relaxation • Rectocele • Relaxation of posterior vaginal wall with prolapse of rectum

40. Pelvic Relaxation • Uterine Prolapse • Downward displacement of uterus

41. 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.

42. 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

43. 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

44. 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

45. 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.

46. 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

47. 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

48. NICU Nurse’s Prayer Help me to remember to care for the littlest of children with tenderness and compassion. Keep me ever mindful that babies can’t 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.

49. NICU Nurse’s 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.