Term
| Hypothalamic – Pituitary Cycle: Basics |
|
Definition
| Estrogen/progesterone levels drop at end of cycle • Hypothalamus stimulated/secretes GnRH • GnRH stimulates anterior pituitary to secrete FSH • FSH stimulates development of follicle • Then GnRH stimulates ant pituitary to secrete LH • LH causes expulsion of ovum from graafian follicle • If fertilization doesn’t occur, corpus luteum disintegrates, estrogen/progesterone levels fall and menses begins |
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Term
|
Definition
|
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Term
|
Definition
| Absence of menses by age 16 years or within 4 years of breast development |
|
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Term
|
Definition
| Cessation of menses for @ least 3-6 months. This is a classic symptom of what psychiatric disorder primarily seen in younger women? |
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Term
| Hypogonadotropic Amenorrhea |
|
Definition
Hypothalamic suppression from stress, weight loss, eating disorders, strenuous exercise and mental illness may lead to amenorrhea.
Rare cases linked to pituitary disease or genetics |
|
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Term
Hypogonadotropic Amenorrhea
Treatment |
|
Definition
| address the underlying issues |
|
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Term
| Exercise Associated Amenorrhea #1 |
|
Definition
| At risk: > 20% under weight Excessive/rapid weight loss Engaging in rigorous exercise |
|
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Term
| Exercise Associated Amenorrhea #2 |
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Definition
| Focus on decreasing activity and improving nutrition: Intake of 1500mg Ca+/D plus weight gain as needed to support physiological processes |
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Term
|
Definition
Painful menstruation
• Onset 1 to 2 days before menses and generally lasts several days after menses begins
• Primary form occurs within 3 years of menarche
• R/T uterine cramping and associated with ovulation and changes in progestin levels. May ease after pregnancy
• Secondary dysmenorrhea r/t pathology, treat underlying problem |
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Term
| Treatment for Primary Dysmenorrhea |
|
Definition
NSAIDS • Oral Contraceptives (inhibits ovulation) • Supplemental vitamins E and B6 may help, but
best forms are naturally occuring • Low fat, lower Na, well balanced diet
• Heating pad • TENS |
|
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Term
| Premenstrual Syndrome - PMS |
|
Definition
Cyclic and predictable not well understood
• Late in luteal phase of the cycle(after ovulation) and ends soon after menstruation begins
• 85% of women experience some mood and somatic complaints
• ~ 9% report physical, mood and behavioral symptoms as disabling |
|
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Term
|
Definition
Symptoms range from irritability, depression, HA and GI disturbances to urinary retention, breast tenderness and acne flair-ups.
• Treatment is discussed in next slide, but a brief word about YAZ *(drospirenone) first. It is associated with increased risk for clots so use with caution!!! |
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Term
|
Definition
Rarer form of PMS is Premenstrual Dysphoric Disorder (~5% of women affected) that entails meeting very specific criteria for diagnosis. Multifactorial etiology.
• Management of PMS & PMDD includes diet with additional calcium, magnesium, vitamin B6 and E, exercise, medications (possibly SSRI’s) and counseling. OC’s may help* |
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Term
|
Definition
Presence of endometrial tissue implanted outside uterine cavity, primarily in pelvis
• Common signs: pelvic pain r/t menses and abnormal uterine bleeding (may be asymptomatic)
• Peak incidence between 20 and 45 years • Affects > 10% childbearing aged women in US
• ~ 30% of women with severe menstrual cramping have endometriosis |
|
|
Term
| Endometriosis is also found? |
|
Definition
| Pelvic area is primary site, but found in other areas including lung, abdomen or bladder |
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Term
| Endometriosis is diagnosed by |
|
Definition
|
|
Term
| Endometriosis Etiology and Pathophysiology |
|
Definition
Multifactorial disorder with probable autoimmune component
Implanted tissue responds to hormones and leads to cyclic bleeding.
Results include inflammation, scarring, adhesion formation in the peritoneum and generally pelvic pain
Delaying childbearing increases risk for endometriosis and infertility |
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Term
| Medical Treatment of Endometriosis |
|
Definition
NSAIDS
• Medications include: Oral contraceptives that may decrease bleeding/amenorrhea), progestin's (Depo) or other agents that suppress endometrial growth, ovulation and bleeding (GnRH agonist such as Lupron) |
|
|
Term
| Surgical Treatment of Endometriosis |
|
Definition
| Laparoscopy either abdominal or vaginal resection or ablation with or without concurrent use of hormones |
|
|
Term
|
Definition
Pain r/t peritoneal irritation of endometriosis
• Ineffective coping r/t depression regarding infertility or pain |
|
|
Term
| Outcomes of Care Evaluation |
|
Definition
Patient reports approaches that effectively decrease pain
• Patient able to discuss condition and treatment options |
|
|
Term
|
Definition
Patient assessment, care and teaching regarding pain issues and desire for fertility.
Mild pain: NSAID’s ModeratePain:OC’s Severe Pain: GnRH agonists or Lupron Debilitating Pain: TAH with BSO |
|
|
Term
| Management Plan continuation |
|
Definition
Reinforce practitioners explanation of pharmacological care and surgical options so patient can make an informed choice.
• www.endometriosis.org |
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|
Term
| Uterine Fibroids aka myomas |
|
Definition
Benign tumors of smooth muscle Symptoms may include heavy bleeding - menorrhagia.
Urinary urgency, frequency or retention Bowel complaints, pain Occasionally infertility or recurrent pregnancy loss |
|
|
Term
| Medical Management of Fibroids |
|
Definition
OCs reduce heavy bleeding • IUD’s reduce bleeding, minimize pain • NSAIDs such as ibuprofen or naprosyn for
cramps or pain
• Short-term hormonal therapy injections to help shrink the fibroids -GnRH agonists
• Iron supplements to prevent or treat anemia due to heavy periods |
|
|
Term
| Surgical Treatment for fibroids |
|
Definition
• Uterine Artery Embolization • If childbearing is important, myomectomy • Severe cases may require hysterectomy or
endometrial ablation |
|
|
Term
| Pelvic Inflammatory Disease “PID” |
|
Definition
May result from untreated Chlamydia trachomatis or Neisseria gonorrhea or both
• Up to 85% of women with chlamydia or GC have no obvious symptoms.
• Symptoms of PID (always symptomatic!) include fever, pain, N/V, muco-purulent cervical or vaginal discharge, cervical motion/adenexal tenderness and bleeding.
• Risk factors include age 15 – 24 yrs, early onset of sexual activity, multiple partners, history of PID, and recent GYN procedures |
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Term
Consider the Impact Primary Prevention has on Women’s Health
Prevent |
|
Definition
Pain
Anxiety
Depression
Ineffective coping |
|
|
Term
Consider the Impact Primary Prevention has on Women’s Health
Promote |
|
Definition
Wellness
Centeredness
Joy
Assertivenes |
|
|
Term
|
Definition
Nursing focuses on prevention • Primary: Teaching “safe sex” • Secondary: Screening a high risk client • Tertiary: Treating infection and it’s
complications
Medical Management stresses eradication of infection in order to prevent complications |
|
|
Term
|
Definition
| May Require Hospitalization • Labs • IV fluids • Antibiotics intravenous or PO • Management of pain • General comfort measures • Teaching • IUD if present, is removed after ~48 hours of ABX |
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Term
| Effects on Patient and Baby |
|
Definition
Closely associated with infertility, ectopic pregnancy and chronic pain in women.
• Neonates at risk for conjunctivitis and pneumonia with latter requiring mother to be treated prior to birth with antibiotics like erythromycin.
• What is the most common SE of erythromycin?
• With what should you reconstitute Rocephin powder? |
|
|
Term
| Human Papilloma Virus “HPV” |
|
Definition
Most common STD caused by a virus
• Many types of genital warts
• Leading cause of cervical and penis cancer
• Picture shows 7 month old born to mother with HPV who was successfully treated with Imiquimod cream |
|
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Term
|
Definition
Treatment consists of
cryotherapy or topical agents (Imiquimod aka Aldara).
• Cryo-therapy if pregnant
• No treatment is completely effective
• Women need regular PAP exams even after lesions have disappeared
• Associated with oral and rectal cancer
• Non judgmental
• Vaccine available for some strains – see next slide |
|
|
Term
| Gardasil or Cervarix for Prevention of HPV |
|
Definition
Available to women and girls aged 9-26 yrs.
• 3 shot series
• Approved for use in boys and men.
Protects against HPV types 16 – 18 which cause ~70% of cervical cancers.
• Also protects against strains 6 and 11. |
|
|
Term
| Herpes Simplex Virus - HSV |
|
Definition
1 in 6 Americans infected (Reuter’s 2010)
• HSV-1 or HSV-2 with type 2 causing more outbreaks than type 1.
• Following primary infection clearing, viral shedding continues for up to 3 months. Subsequent outbreaks vary thereafter.
• 50% risk of fetal transmission with presence of lesion and primary infection
• 60-90% of infections are truly asymptomatic or unrecognized |
|
|
Term
Herpes Simplex Virus - HSV
Diagnosis |
|
Definition
More than one in five pregnant women have antibodies in their blood to HSV, indicating a past or present infection. (WebMD-2010)
• Viral culture primary test in most clinics. Confirm diagnosis by PCR
• Lesions begin as small macules that progress to vesicles on an erythematous base that eventually ulcerate. Very painful |
|
|
Term
| Treatment of New Onset HSV |
|
Definition
Acyclovir or a similar antiviral agent • Hygiene measures to avoid secondary infection • Pain management with an NSAIDs or a lidocaine
based topical if needed • Diet rich in B vitamins, Vit C, zinc and calcium • amino acid L-lysine reduces replication during
active phase and can use for prevention (FYI) • Education and emotional support |
|
|
Term
|
Definition
Acyclovir reduces length of time of outbreak and severity and asymptomatic viral shedding (AVS). Use as suppressive Rx to reduce transmission and @ 36 weeks gestation to protect fetus.
• Teach clients about AVS
• Condoms not 100% protective, but reduce spread
• Most important STD in enhancing HIV transmission
• Psychosocial support. Need to empower client |
|
|
Term
|
Definition
Infant may be asymptomatic at birth, but 2-12 days later may develop fever or hypothermia, jaundice, seizures and poor feeding and half develop vesicular lesions.
• Herpes encephalitis untreated is fatal • Anti-virals tremendously helpful. • Best treatment is primary prevention. Treat
mom when symptoms present and consider C/S. Acyclovir does not appear to harm fetus but best avoided in 1st trimester |
|
|
Term
| Effects on Client - Nursing Diagnosis |
|
Definition
Nursing Diagnoses
• Pain r/t lesions secondary to HSV • Sexual Dysfunction • Pre-natal visit includes assessing for history of
HSV in woman and partner
Nursing Diagnoses
• Pain r/t lesions secondary to HSV • Sexual Dysfunction |
|
|
Term
| Infectious diseases can be contracted in a variety of ways. |
|
Definition
Infections of Pregnancy
• T - Toxoplasmosis • O – other like hepatitis • R - Rubella • C – CMV • H - Herpes Simplex
Symptoms of some may appear in mother as flu-like, while effects on developing fetus are more serious. Most of these are not STD’s |
|
|
Term
| Sexually Transmitted Infections con’t |
|
Definition
The following can lead to preterm birth
• Syphilis
• HIV
• Chlamydia: Fastest spreading STD in US women ~1 in 20 girls between 14-19 yrs. has had it
• Trichomoniasis
• Bacteria Vaginosis “BV” (Technically not an STD) |
|
|
Term
| Effects of Syphilis on Pregnant Women |
|
Definition
• 25% will have stillbirth or neonatal death
40-70% will have syphilis-infected babies
if untreated |
|
|
Term
| Syphilis is divided into four stages: |
|
Definition
1. Primary
2. Secondary
3. Latent
4. Tertiary (late)
• An untreated infected person may infect others during the first 2 stages (1-2 years).
• Even though untreated syphilis is not contagious in the late stage serious complications can occur:
• blindness
• mental disorders or neurological problems
• serious heart abnormalities
• death |
|
|
Term
Syphilis is divided into four stages:
continuation |
|
Definition
Babies with congenital syphilis can have symptoms at birth or symptoms may take weeks to develop:
Anemia Fever Rashes and skin sores Moist sores of congenital syphilis are infectious
Liver and spleen and various deformities
• The rise in infant syphilis morbidity is a public health concern |
|
|
Term
| Factors That Increase Transmission |
|
Definition
Previous child with HIV
Chorioamnioitis
Preterm birth
Decreased maternal CD4
Firstborn twin
SVD
Chorioamnioitis Intrapartum blood exp. Failure to treat mom
and fetus/newborn during perinatal period with zidovudine “AZT” aka “ZDV |
|
|
Term
|
Definition
Screen all women
• Test HIV + women for other STD’s, CMV and Toxoplasmosis and offer PPD
• Check varicella and rubella titers • PAP • All positive pts. receive AZT throughout
pregnancy regardless of CD4 counts (watch for BM depression)
• CD4 counts < 200 get PCP prophylaxis • Immunize against Hep B, Hib, PCV, flu |
|
|
Term
|
Definition
Consider social, cultural & spiritual needs of the mother and confidentiality
• A disproportionate number of women are minorities • Identify family strengths and capitalize on them • Teaching includes “safe sex” throughout pregnancy • While pregnancy is discouraged in HIV positive
women, provide a hopeful milieu if the patient is pregnant |
|
|
Term
| HIV Case Management Continued |
|
Definition
Support for immune system by discussing importance of rest, diet, activity & stress reduction
• Treatment and teaching for substance abuse • Deliver within 4 hours of ruptured membranes • C/S if viral load high • Avoid internal fetal monitoring • Avoid vacuum and forceps delivery • Watch for postpartum bleeding and infection • Avoid breastfeeding |
|
|
Term
| Bacterial Vaginosis “BV” aka vaginitis gardenella |
|
Definition
The whiff test
• Very common in pregnant pts.
• Interruption of normal vaginal
bacterial flora
• Treat as it can lead to preterm labor, PROM or chorioamnionitis |
|
|
Term
Bacterial Vaginosis “BV”
Symptoms of BV and treatment |
|
Definition
Although more than 50% of women with Bacterial Vaginosis (BV) have no symptoms, when symptoms do occur they include:
• excessive, thin gray or white vaginal discharge that sticks to the vaginal walls
• fishy or musty, unpleasant vaginal odor, most noticeable after sexual intercourse
• vaginal itching and irritation
• Rx with metronidazole or clindamycin |
|
|
Term
|
Definition
Permanent cessation of menstrual flow.
• Just one event occurring over months when ovarian function & hormone production declines. Decreasing levels of estrogen and progesterone result in many of the classic symptoms.
• Labs: FSH and LH levels rise with menopause
• This transitional phase is known as climacteric |
|
|
Term
|
Definition
Vasomotor symptoms “hot flashes” r/t low levels of estrogen and increased levels of LH
• Sleep disturbances
• Urogenital Atrophy leading to vaginal thinning, incontinence (urge and stress), cystocele and rectoceles
• Osteoporosis
• Hair loss and hair growth |
|
|
Term
|
Definition
• Alt in thermoregulation
• Alteration in Comfort
• Trauma, Risk for r/t bone loss
• Sleep Pattern Disturbance
• Altered Urinary Elimination
• Knowledge Deficit |
|
|
Term
|
Definition
Hormone Replacement Therapy “HRT”
Heart, Estrogen, Progestin Replacement Study “HERS”
Women’s Health Initiative Study “WHI” |
|
|
Term
Women’s Health Initiative Study “WHI”
Best Candidate for HRT |
|
Definition
| • Dosing and Administration recommendations for estrogen and progesterone |
|
|
Term
| Menopause Management con’t |
|
Definition
Herbal remedies
Alternative approaches |
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|
