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128 Cards in this Set
- Front
- Back
Dysmenorrhea
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painful menstrual flow
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pathogenesis of dysmenorrhea
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decrease uterine blood flow
increase contractility peripheral nerve hypersensitivity |
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Primary dysmenorrhea
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cramps without underlying disease
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treatment of primary dysmenorrhea
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treat symptoms:
narcotics and sedatives contraceptives NSAIDS-ibuprofen heat exercises and massage help with cramps |
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diagnosis of primary dysmenorrhea
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sx immediately before or at onset of menstrual bleeding
pain not present at other times of the cycle most severe on first and/or second day of menses |
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OTC NSAIDS and dysmenorrhea
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use preventative dose of NSAIDS
strong loading does maintanence dose routinely |
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How oral contraceptives improve primary dysmenorrhea
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by inhibiting ovulation, progesterone-stimulating endometrial prostaglandin production is reduced
by reducing menstrual flow, which contains prostaglandins |
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cause of Secondary dysmenorrhea
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associated with underlying disease:
pelvic inflammatory disease endometriosis others |
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characteristics of secondary dysmenorrhea
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low anterior-pelvic pain
may begin before onset of menses and last through the end of menstration may be noncyclic may be accompanied by pelvic tenderness or a pelvic mass |
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treatment of secondary dysmenorrhea
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find the cause and treat cause
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Premenstrual Syndrome (PMS)
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collection of symptoms that are cyclic (emotional behavioral and somatic
occur at luteal phase or menstrual cycle 20-40% have severe symptoms |
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PMS treatment
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symptomatic:
limit sodium for bloating diuretics, eliminate caffeine support groups |
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PMS occurs more often in women who:
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are between their late 20's and early 40's
have atleast one child family history of depression Major life crisis |
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Life style changes that may help PMS
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take a multivitamin that includes 400 micrograms of folic acid
exercise regularly eat healthy foods avoid salty, sugary foods, caffeine and alcohol try to get 8 hrs of sleep each night find healthy ways to cope with stress don't smoke |
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Amenorrhea
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absence of menstrual periods
primary and secondary |
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primary amenorrhea
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menstration fails to occur by age 16
Does she have pubic hair? |
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secondary amenorrhea
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menstraton started, but stopped without recurrence for atleast 3 months
must rule out pregnancy possibly from weight gain/loss, exercise, stress |
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Post menopausal bleeding
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vaginal bleeding occurring after menopause
1st thought- cancer? |
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treatment of post menopausal bleeding
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endometrial biopsy, D and C, hysterectomy, progesterone with estrogen
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endometriosis
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symptoms of underlying cause
implantation of endometrial tissue outside the uterine cavity: benign can be planted outside the uterine body |
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symptoms of endometriosis
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pain-starting several days before period
pain during intercourse (dyspareunia) goes away with period |
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common sites of endometriosis
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uterine sacral ligaments
increase incidence of infertility |
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Treatment of endometriosis
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analgesics, heating pad, oral contraceptives- suppress estrogen, laser treatment, and/or hysterectomy
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dysfunctional uterine bleeding (DUB)
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bleeding that is excessive or abnormal in amount or frequency
bleeding throughout month |
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medical treatment of (DUB)
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depo-provera, oral contraceptives
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surgical treatment of (DUB)
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D & C, laser endometrial, ablation, hysterectomy
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anovulatory DUB during reproductive years
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endocrine disturbances
polycystic ovary disease stress obesity or underweight long term drug use anatomic abnormalities |
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ovulatory causes of DUB
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Rare
related to dysfunctional corpus luteum |
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polycystic ovarian syndrome (PCOS)
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most common hormonal disorder of woman of reproductive age
ovaries often enlarged, containing small cysts outer edge of ovary |
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PCOS manifestations
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menstrual abnormality
excessive androgen acne polycistic ovaries obesity infertility often heavy, facial hair, diabetic possibly |
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PCOS treatment
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life style changes
regular menstrual cycle reduce glucose levels reduce excessive hair growth use meds to induce ovulation possible surgery |
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Menopause
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normal biologic event for woman
marked by the end of menstrual periods Marked by 6-12 months of amenorrhea event really takes months or years |
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menopause management
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hormonal replacement therapy
HRT (Hormonal Replacement Therapy) combination of estrogen and progestin HRT previously thought to avoid problems with osteoporosis, coronary heart disease, breast and endometrial cancer (wrong) |
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Menopause problems
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osteoporosis esp. in petite women, increase numbers of coronary artery disease, breast cancer, endometrial cancer, vaginal dryness
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treatment of menopause
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need to weigh risk of HRT with benefits
estrogen available as oral, transdermal, intravaginal, and IM preparations Herbal therapy increase soy diet, decrease problems |
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Simple vaginitis
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inflammation of the vagina
very common yeast infection |
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causes of vaginitis
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changes in normal flora
alkaline ph insertion of foreign bodies chemical irritants medications bacterial STDS |
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preventative measures of simple vaginitis
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wipe front to back
cotton no douching no tight pants |
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Bacterial vaginitis
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heampohilus vaginitis- most common cause
cause unknown associated with preterm labor and birth |
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Symptoms of bacterial vaginitis
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fishy odor
not all have odor-most apparent after sex discharge- profuse, white, gray, milky |
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PCOS treatment
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life style changes
regular menstrual cycle reduce glucose levels reduce excessive hair growth use meds to induce ovulation possible surgery |
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Menopause
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normal biologic event for woman
marked by the end of menstrual periods Marked by 6-12 months of amenorrhea event really takes months or years |
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menopause management
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hormonal replacement therapy
HRT (Hormonal Replacement Therapy) combination of estrogen and progestin HRT previously thought to avoid problems with osteoporosis, coronary heart disease, breast and endometrial cancer (wrong) |
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Menopause problems
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osteoporosis esp. in petite women, increase numbers of coronary artery disease, breast cancer, endometrial cancer, vaginal dryness
|
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treatment of menopause
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need to weigh risk of HRT with benefits
estrogen available as oral, transdermal, intravaginal, and IM preparations Herbal therapy increase soy diet, decrease problems |
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Simple vaginitis
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inflammation of the vagina
very common yeast infection |
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causes of vaginitis
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changes in normal flora
alkaline ph insertion of foreign bodies chemical irritants medications bacterial STDS |
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preventative measures of simple vaginitis
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wipe front to back
cotton no douching no tight pants |
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Bacterial vaginitis
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heampohilus vaginitis- most common cause
cause unknown associated with preterm labor and birth |
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Symptoms of bacterial vaginitis
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fishy odor
not all have odor-most apparent after sex discharge- profuse, white, gray, milky |
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bacterial vaginitis
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heamphilus vaginitis
most common cause assoc. with preterm labor and birth |
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symptoms of bacterial vaginitis
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fishy odor
not all have odor odor must apparent after sex discharge-profuse, white, gray, milky |
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candidasis
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yeast infection
caused by candida albincans- 80-95% of yeast infections caused by this organism cheasy spotty looking cervix |
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risk factors of candidasis
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antibiotic therapy
diabetes obesity diets in high sugar/artificial sweeteners steriods immunosuppressed states tight fitting clothing non absorbent underwear |
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vulvitis
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inflammation of the vulva
causes: direct or by extension of irritation from vagina to vulva |
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symptoms of vulvitis
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itching and pruritis, burning during urination
|
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treatment of vulvitis
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methods to reduce itching
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Toxic Shock Syndrome
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systemic infection caused by the toxin of staph aureus
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causes of toxic shock syndrome
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menstruation and tampon use, nose packing, surgical wound infection, pastpartum conditions, diaphragm, cervical cap and vaginal contraceptive sponge use
Recommend not using tampon during night |
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Toxic Shock Symptoms
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2-3 period of mild symptoms
low grade fever, muscle aches, chills, malaise |
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body systems affected by toxic shock
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skin, lungs, liver, blood, pancreas
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Toxic shock manifestations
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atleast 102, rash, HA, sore throat, cough, N/V, perfuse diarrhea, abd. pain, fainting/lightheadedness, low bp <90
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treatment of toxic shock
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fluid replacement, antibiotics, transfusions if low platelets, corticosteroids, prevention should be taught
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uterine displacement
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abnormal positioning of the uterine body
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uterine prolapse
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decent of uterus into vagina
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Pessary
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placed below cervix to hold in place
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treatment of uterine prolapse
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knee-chest postition, vaginal pessary, hysterectomy
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cystocele
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protrusion of bladder through the vaginal wall due to weakened pelvic structures
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symptoms of cystocele
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painful sex, uti, urinary dysfuntion
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treatment of cystocele
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anterior repair
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Rectocele
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prolapse of rectum through a weakened vaginal wall
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symptoms of rectocele
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constipation, uncomfortable sex
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treatment of rectocele
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posterior repair
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leiomyomas (fibroids)
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benign
slow-growing tumors of the uterus most common pelvic tumor develop from the uterine myometrium, attatched by a pedicle classified according to a position in layers of uterus |
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etiology of leiomyomas
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cause unknown
may be related to estrogen simulation often enlarge during pregnancy and diminish after menopause-due to estrogen |
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Signs and Symptoms of Leiomyomas
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pain- not all have it
pelvic pressure constipation urinary frequency or retention abdominal girth increases painful intercourse infertility |
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Incidence of leiomyomas
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occur in 20-30% women older than 30
many women are asymptomatic african american and premenopausal women are at greatest risk |
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diagnosis of leiomyomas
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cbc
pregnancy test endometrial biopsy US laposcopy |
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non surgical management of leiomyomas
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reassess q4-6 mo- may shrink during menopause
Uterine artery embolization (UAE)- occludes blood flow to tumors |
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Surgical management of leiomyomas
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myomectomy
total abdominal hysterectomy total vaginal hysterectomy |
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Pre-op nursing care of hysterectomy
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lab tests for baselein
prophylactic antibiotics teach post-op expectations (turn, cough, deep breath) explore significance of loss of uterus identify misconceptions so that they can be dealt with |
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what happens if ovaries are included in hysterectomy
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immediate menopause
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post op nursing care of hysterectomy
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VS
urinary output (Foley) assess dressing and drains assess vag bleeding monitor po intake and bowel sounds assess for thrombophlebitis pain meds sitz baths, heat or cold |
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hysterectomy postop complications
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paralytic ilius
wound infection embolism, hemorrhage atelectasis, pneumonia UTI, urinary retention |
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atelectasis
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the collapse of part or (much less commonly) all of a lung
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Bartholin's cyst
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occlusion of the bartholin gland of the vulva
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patho of bartholin's cyst
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obstruction of the duct of the bartholin gland and fills with fluid
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what causes a bartholins cyst
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infection, thickened mucus near ductal opening
trauma such as an episiotomy or laceration |
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Barholin cyst treatment
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only if symptomatic
simple incision and drainage may produce temp. relief infection usually causes rupture spontaneously within 72 hours moist heat, antibiotics |
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Endometrial cancer
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one of the most commonly occuring reproductive cancers
good prognosis 80-90% of the time |
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Risks for endometrial cancer
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obesity
DM Hypertension infertility nulliparity polycystic ovary disease late menopause history of uterine cancer |
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symptoms of endometrial cancer
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post menopausal bleeding
low back or abdominal pain low pelvic pain |
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diagnosis of endometrial cancer
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D & C
endometrial biopsy |
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managment of endometrial cancer
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progestational therapy- Tomoxifen
TAH and BSO or radical hysterectomy |
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TAH
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Total abdominal Hysterectomy
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Cervical cancer
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abnormal cells develop in lining of cervix
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Risk factors of cervical cancer
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AA and Native american women
Multiparity- <18 at 1st intercourse multiple sex parnters infections- HIV, HPV, CMV, HSV |
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Prevention of cervical cancer
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gardasil vaccine-recomeneded for all femails up to age 26
not recommended for pregnant women |
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Gardasil vaccine
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3 injections usually in deltoid
Dose 1- at choosen date Dose 2- 2 months later Dose 3- 6 months after dose 1 |
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symptoms of cervical cancer
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Early- no symptoms
Late- vaginal discharge and bleeding post menopausal bleeding fistualas |
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Diagnostics of cervical cancer
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PAP smear
cytologic pelvic exams |
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PAP smear
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recommended at 20 years old or when sexually active
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Medical management of cervical cancer
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laser therapy
cryosurgery radiation therapy chemotherapy |
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Surgical management of cervical cancer
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conization- biopsy of cervix
hysterectomy pelvic exoneration |
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pelvic exoneration
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very radical procedure
anterior and posterior total- both |
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anterior pelvic exoneration
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removal of cervix, ovaries, fallopian tube, vagina, bladder, urethra, and pelvic lymph nodes
|
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posterior pelvic exoneration
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cervix, ovaries, fallopian tube, vagina, descending colon, rectum and anal canal
|
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ovarian cancer
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leading cause of death from female reproductive malignancies
1 out of 70 women will develop |
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risks of ovarian cancer
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family history
nulliparity increased incidence with menopause diets high in fats |
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symptoms of ovarian cancer
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asymptomatic in early phase
abdominal distention urinary urgency and frequency urinary and bowel obstruction feeling of being full very quickly |
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Hint to ovarian cancer
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women who have vague abdominal or GI symptoms lasting several weeks
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Ovarian cancer diagnosis
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palpation of ovary in postmenopausal women
IV urography transvaginal US Lab values definitive diagnosis based on surgical exploration |
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Lab values that may indicate ovarian cancer, also used for breast cancer
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BRCA 1
BRCA 2 CA 125 |
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management of ovarian cancer
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chemo and radiation
|
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surgical mangament of ovarian cancer
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TAH & BSO
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BSO
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bilateral salpingo-oophorectomy
the surgical removal of one or both ovaries |
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post surgical standard of care for TAH and BSO of ovarian cancer
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periodic CA125
vaginal US chest x-ray |
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non surgical management of ovarian cancer
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chemo
monoclonal antibiotics- hormones and agents that target cell growth external radiation therapy |
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prevention of Ovarian cancer
|
maintain normal weight
well balanced diet low in fat, high in fiber decreased risks- have had children, used contraception for atleast 5 years, and breast fed |
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Vulvar cancer
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primarily disease of older women
slow growing stays localized for long time relationship with herpes simplex 2, HPV, and other STD's |
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Vulvar cancer symptoms
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itching and irritation of perineal area
a sore taht won't heal bleeding-late symptom |
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management of vulvar cancer
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Premalignant- laser therapy (healing for several weeks)
Invasive cancer- surgery, reconstructive surgery |
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surgical managment of vulvar cancer
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skinning vulvectomy- remove superficial skin
simple vulvectomy- removal of vulva radical vulvectomy- clit, subcu, and lymph nodes |
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vulvectomy post-op care
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multiple drains for 7-10 days
pressure reducing mattress bed cradle to keep linens off SCD's catheter for 7-10 days Major concern-wound healing and pain management |
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vaginal cancer
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rare
90% menopausal |
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risks factors for vaginal cancer
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repeated vaginal injury (multipara)
STD's prior radiation |
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vaginal cancer symptoms
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asymptomatic
abnormal PAP Late symptoms- foul smelling discharge, painless vaginal bleeding |
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management of vaginal cancer
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laser therapy
close follow-up (PAP, colposcopic exam q 4 months for 1 year) partial or total vaginectomy radical or pelvic exeneration topicla chemo radiation therapy |