• Common, benign
• Most common in 30-50 year olds
• S/S:
• Pain, tenderness, swelling
• Cyclical
• More intense before menses and improves 1-2 days into menstrual cycle

• Often subsides on its own after menopause
• Decreased sodium and low dose diuretic in week prior to menses
• Should do BSE one week after menses

• Common, benign tumor
• Solid, slowly enlarging mass
• Most common in adolescence, decreases in size with age

• Family or personal hx of breast, endometrium, ovary, or colon cancer; genetic factors
• Older age
• Pregnancy later in life (>30) or no pregnancies
• Early menstruation or late menopause
• Never breastfed a child
• Postmenopausal obesity
• Alcohol intake

• Left-skin dimpling
• Right- peau d' orange
• Lymph edema of arm

• Excision of mass-- reduces risk for local recurrence
• Dissection or removal of axillary lymph nodes
• Sentinel lymph node biopsy

Nursing Interventions: Post-op Care

Surgical Management of Breast Cancer

• No BP measurement, injections, or blood draws in affected arm
• Vital signs
• Care of wound drainage
• Comfort measures
• Mobility, diet, and exercise of affected arm
• Support and education

• Treatment given after the primary or initial cancer treatment
• Purpose:
• Increases possibility of a cure
• Decreases risk of cancer recurrence

• Radiation therapy
• Chemotherapy
• Hormonal therapy
• Stem cell transplantation

• BSE (breast self-examination)
• Clinical breast exam
• Breast ultrasound
• Mammography
• Biopsy
• Cytology
• BRCA serum testing

• Monthly BSE
• Annual clinical breast exam
• Mammogram screening
• Every 1-2 years starting at age 40
• Annually starting at age 50
• More frequent if high risk
• Fine needle aspiration (confirms diagnosis)

• Pelvic inflammatory disease (PID)
• Endometriosis
• Vaginitis
• Toxic shock syndrome (TSS)

• Cervical cancer
• Endometrial cancer
• Ovarian cancer

• Dysmenorrea
• Amenorrea
• Premenstrual syndrome

• Ovarian cysts
• Polycystic ovarian syndrome (PCOS)

• Inflammatory/ infectious process
• Pathogenic invasion of the fallopian tubes, ovaries, or both as well as any vascular/ supporting structures w/in the pelvis (except the uterus)
• Future infertility may develop (complications)

• Multiple sexual partners
• Frequent intercourse
• IUDs
• Childbirth

• Low-grade fever
• Pelvic pain
• Abdominal pain
• "Bearing down" backache 
• Foul-smelling vaginal discharge
• Nausea

• Irreversible scarring or strictures
• Sterility
• Ectopic pregnancies

• Delayed fertility
• Early menarche
• Menstrual cycles <27 days
• Menses >7 days
• Family hx
• Painful menstruation

• Dysmenorrhea
• Rectal pressure
• Dyspareunia (painful sex)
• Infertility
• Dysfunctional uterine bleeding

• Client hx
• Pelvic ultrasound
• Exploratory laproscopy
• CBC

• NSAIDs
• Contraceptives (OCPs, Depo Provera)
• Danazol (causes masculinization)
• Teaching

• Infections caused by bacteria, protozoa, viruses, and yeasts
• Common types:
• Cnadidiasis, Chlamydia, etc.

• Wear cotton-crotch underwear
• Avoid sitting in a wet bathing suit
• Seek prompt medical attention @ 1st sign of infection
• Eat an 8 oz container of yogurt w/ active cultures daily while taking antibiotics

• Most often associated w/ Staphylococcus aureus
• Staph enters through the bloodstream
• Associated with use of tampons 

• Fever
• Vomiting
• Diarrhea
• Progressive hypotension

• Most preventable gynecological cancer
• Diagnosed by Pap smear
• Dysplasia wil be seen on Pap smear (change in size and shape of cervical cells)
• Most common cause is HPV (human papilloma virus)
• Risk of death 2x higher in African Americans than Caucasians

• Young age at first coitus (<16 y.o.)
• HIV infection
• Hx of multiple partners
• Hx of STI's
• HPV infection
• Hx of smoking
• DES exposure
• Family hx

• Virus that causes genital warts
• Causes 90% of all cervical cancers
• Subtypes 16 and 18 mostly to cause cancer
• Can be prevented by Gardisil

• Protects against HPV subtypes 6, 11, 16, and 18
• Recommended at 11-12 y.o. check up
• Can be given b/w 9-26 years of age
• Series of 3 vaccines over 6 months
• Still need regular pap smears

• 1st pap smear w/in 3 years of onset of sexual activity or by age 21
• Subsequent pap smears annually until age 29 y.o.
• At age 30 and after 3 normal smears in a row, may get pap smear every 2-3 years
• At age 70 and after 3 norm. smears in a row and no abnormal smears in past 10 years, may stop

• HPV reflex testing
• If HPV reflex is positive--> colopscopy done

• May be asymptomatic (esp. preinvasive cancer)
• Post-coital bleeding
• Dyspareunia
• Referred pain (thighs, upper legs, back)
• Hematochezia (passing blood through the anus, esp. w/ stools)
• Anemia, weight loss (metastasis)

• Greatest risk: postmenopausal women who have taken estrogen for >5 years
• Late menopause (>50 y.o.)
• Early menarche (<12 y.o.)
• Infertility
• Obesity and disease that cause obesity (like DM)

• Asymptomatic until relatively advanced
• Unexplained vaginal bleeding (esp. after menopause)
• Weight loss
• Pelvic pain or mass
• Lymph node enlargement, pleural effusion, abdominal masses, ascites (late stage)

• Depends on stage of cancer and clients goals
• D&C
• Hysterectomy
• Total abdominal hysterectomy w/ lymph node removal
• Pelvic radiation or brachytherapy (local radiation)
• Progestin therapy (to maintain fertility)
• Chemotherapy

• AKA the silent killer
• Incidence greatest in women b/w 45 and 65
• Cancer begins in the cells of the ovary and a tumor grows

• Nulliparity
• Smoking
• Alcohol
• Infertility
• High-fat diet

• Abdominal bloating/ feeling of fullness
• Enlarged abdomen, waist of clothes tight
• Pelvic discomfort or pain
• Dyspareunia
• Urinary symptoms (frequency, urgency)
• Constipation, gas, bloating
• Loss of appetite
• Unexplained weight loss or gain
• Loss of energy
• Lower back pain

Onset of menstruation (first period)

Average age = 12 years old

Permanent cessation of menstruation

End of reproductive years

Average age = 45-50 years old

Absence of menstruation

Primary or secondary

Menstrual periods <21 days in frequency

Short cycles

White discharge

Don't confuse with lochia alba or candida infection !

Uterine pain during menstruation

Menstrual cramps

More common in nulliparous women and in women not having sex

Absence of menstruation by age 17

Related to anatomical or genetic abnormalities

When a woman w/ normal menstrual cycle stops getting her periods for >6 months

• Result of:
• Anatomic abnormalities, nutrition deficits, excessive exercise, emotional disturbances, endocrine dysfunction, med side effects, pregnancy, and lactation

• Complex of symptoms:
• Mood swings, fatigue, irritability, breast tenderness, food cravings, depression
• Occurs 3-14 days before menstruation starts, alleviated by start of menstruation
• Affects 25-40% of women w/ mild to moderate symptoms

• Age >30
• Depression
• Stress

• Pharmacological interventions
• Diet 
• Exercise

• An abnormal amount of uterine bleeding
• Occurs at various times during the month
• Also describes excessively light or excessively heavy menses

May contain fluid and tissue

Occur spontaneously or as a result of hyperstimulation of the ovaries

• Any ovulating female
• Excessive amounts of luteinizing hormone (endogenous or exogenous)
• Hx of STIs

• Abdominal pain (unilateral or bilateral)
• Fullness or bloating
• Amenorrhea
• May be asymptomatic

• Physical exam
• Client hx
• Pelvic ultrasound
• Exploratory laparotomy

• OCP's
• Analgesics
• Antibiotics
• Surgery

• Enlarged cystic ovaries
• Amennorrhea
• Oligomenorrhea
• Obesity
• Acne/ oily skin
• Hirsuitism
• Hyperlipidemia
• Infertility

• Risk:
• Obesity and hyperandrogenism
• Affects 6-10% of women
• Increased risk of breast and enometrial cancer
• Possible increased risk of CVD

• Education and emotional support
• Initial treatment:
• Weight loss of at least 10% (if overweight)
• Other treatments to follow

• Cessation of menstruation & end of natural reproductive ability
• Decreased ovarian functioning--> decreased estrogen adn progesterone--> menopause
• Average age = 50 years
• Treatment:
• Pharmacological intervention, diet, and exercise

• Absence of menses for 1 full year
• Depression, nervousness, insomnia
• Hot flashes
• Decreased fertility
• Vaginal changes (increased pH)
• Changes in fat distribution and appearance
• FSH > 30 mIu/m
• Skin dryness, hair thinning, decreased breast fullness, shrinkage of ovaries, uterus, cervix, and vagina

• Multiparity
• 3rd or 4th degree lacerations w/ childbirth
• Weakening of pelvic muscles (w/ age)

• Pessaries
• Surgery
• Colporrhaply (AP repair) 
• Marshall-Marchetti-Krantz
• Estrogen for post menopausal women (restores elasticity to tissues)
• Teaching

• Endometrial biopsy (detect tissue responses during both phases of menstrual cycle)
• Endocrine imbalance testing
• Laparoscopy (discover endometriosis, adhesions, or scar tissue)

The inability to conceive
Possibly related to anatomic or endocrine problems

Primary or secondary

• Increased age
• Disease (cancer, etc.)
• Congenital deformities
• Drugs/ smoking
• Sperm mobility
• Abnormal erections
• Abnormalities of seminal fluid

• Semen analysis (usually 1st test in men)
• Endometrial biopsy
• Postcoital test
• Basal body temp (chart entire cycle)

Done during luteal or secretory phase of menstrual cycle

Evaluation of infertility

Looks for normal motile sperm in cervical mucous

Evaluation of infertility

• Ovulation predictor kit
• Ultrasound
• Hysterosalpingogram
• Hysteroscopy

• Natural/ rhythm method
• Barrier methods
• Oral contraceptives
• Norplant
• Depo-Provera
• Intrauterine Device (IUD)
• Sterilization (tubal ligation, vasectomy)

6 small progestin-filled pellets inserted under the skin of the upper arm

Form of contraception

Form of contraception

Injected every 12 weeks

• Frequency of intercourse
• Motivation to prevent pregnancy
• Understanding use of the method chosen
• Adherence to method
• Provision of short/ long term protection
• Likelihood of pregnancy for the individual woman
• Consistent use of method

• Spermicides
• Condoms
• Diaphragm
• Cervical cap
• Contraceptive sponge

• Combined estrogen-progestin contraceptives
• Progestin-only contraception
• Emergency contraeption (Plan B)
• IUD
• Sterilization

• Caused by HPV
• Transmitted via genital contact or vaginal delivery
• Incubation period 2-3 months
• Occur on vagina, cervix, penis, scrotum, anus, and perineal areas
• Use condoms !!

• Often asymptomatic
• Visible genital warts
• Pre-cancerous changes in cervix, vulva, anus, or penis

• Visual inspection
• Abnormal pap tests
• Blood test

• No cure !
• Topical creams
• Cryosurgery/ freezing (liquid nitrogen)
• Electric or laser cauterization (burning the warts)
• Surgery

• Caused by Neisseria gonorrhoeae 
• Grows and multiplies easily in the cervix, uterus, fallopian tubes, urethra, throat, eyes, and anus
• Transmitted via contact w/ penis, vagina, mouth, blood, body fluids, or vaginal delivery of baby
• Incubation period 3-10 days

• May be asymptomatic
• Burning w/ urination
• White, yellow, or green discharge from penis
• Painful or swollen testicles

• Painful or burning sensation w/ urination
• Increased vaginal discharge
• Vaginal bleeding b/w periods

• Inspect for discharge
• Obtain specimen of the discharge for testing from parts of body likely to be infected (cervix, urethra, rectum, or throat)

Antibiotics (rocephin, cipro, floxin)

No sex until all meds completed

• Caused by Chlamydia trachomatis
• Incubation period = 1-3 weeks to months
• Modes of transmission:
• Vaginal, anal, oral, bodily fluids, vaginal delivery

• Women:
• Often asymptomatic
• Vaginal discharge
• Men:
• Urethritis
• Discharge from penis

• Assessment:
• Culture cells from cervix, urethra, or both
• Treatment:
• Antibiotics (azithromycin/ doxycycline)

• Women:
• PID--> ectopic pregnancy and infertility
• Salpingitis (inflammed fallopian tubes)
• Men:
• Epididymitis
• Prostatitis
• Infertility

• Protozoal infection of the vagina
• S/S:
• Copious, malodorous yellow/green discharge
• Itching/ burning

• Most common cause of vaginal discharge
• S/S:
• Thin, watery, gray/white discharge
• Fishy odor

• Yeast infection
• Risk factors:
• Meds-- antibiotics, immunosuppressants, corticosteroids
• DM
• Pregnancy
• Obesity
• High sugar diets

• Present in 9-23% of healthy women
• Positive GBS = poor pregnancy outcomes
• Give antibiotics once in labor/ ROM