PRESENTED BY, Suby Annu, First year M.

Sc nursing

During her life ,a woman undergoes a lot of changes in her reproductive system which finally ends in a condition called menopause.It is a natural life change that can be very distressing for someone and not so for others.The word menopause originates from the Greek words men meaning month and pauses meaning cessation.

1.Menopause is the permanent phy siologic cessation of menstruation, associated with decreased ovarian function; reproductive function dimini shes and ends. 2.Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries i.e the ripening and release of ova and the release of hormones that cause the creation of the uterine lining and the subsequent shedding of the same.

3.Menopause refers to all the transition years.Also known aschange of life or climacteric or as perimenopause.Meno pause is medically declared in a woman who has had amenorrhoea for one year. Though menopause is often referred to as cessation of menstruation it is seen that women whose uterus is removed but ovaries are preserved do not go into menopause but women whose ovaries are removed, go into immediate menopause.

The term refers to the years when menstruation starts becoming irregular to the time when it stops.It can begin as early as 35 years of age and can last for a few years to ten years or more.During this period, the production of estrogen and progesterone by the ovaries becomes irregular.The fertility diminishes but is not zero.F.S.H levels are high.

Natural menopause:mean age in Indian women is 44 years and that in Westerners is 54 years. Premature menopause: it is due to premature ovarian failure secondary to systemic diseases like autoimmune disorders,thyroid diseases,chemo therapy,radiotherapy e.t.c.

Surgical menopause:due to surgical remo val of ovaries or injury to the blood vessels supplying them or due to chemotherapy or radiotherapy.

Increased F.S.H from pituitary

Decreased estrogen and progesterone

1.Vasomotor instability: Hot flashes:sudden involuntary waves of heat beginning in the chest or neck and passing to the head and face. - Lasts for a few seconds to one hour. - Increases with anything that increases the body temperature. Hot flushes:measurable changes in the body temperature of the skin with a pink to red change in skin colour.

Night sweats-a hot flash with or without a hot flush.Followed by mild to severe sweating followed by chills Increased risk of atherosclerosis. Migraine. Irregular and rapid heart beat. 2. Menstrual irregularities:The amount of flow may increase ,decrease become irregular and finally stops.The interval between periods becomes longer,maybe a few months.

3.Urogenital changes: Urogenital atrophy. Thinning of the membranes of the vulva, vagina ,cervix and outer urinary tract. Thinning of pubic hair. Shrinking of labia. Vaginal irritation and dryness. Pruritis. Increased leucorrhoea. Urinary frequency and incontinence. Vaginal and urinary infections.

4.Psychological effects: Anxiety Depression Forgetfulness Mood swings Memory loss

Osteoporosis and spontaneous fractures. High levels of circulating cholestrol levels. Cystocele,rectocele. Uterine prolapse.

Hormone replacement therapy(H.R.T, H.T) Estrogen and progesterone in a woman with a uterus. Estrogen only for women with hysterectomy. Although beneficial in many ways H.T increases the risk of breast cancer,stroke,heart attacks e.t.c.

Started in women who have recently had menopause. Should not be used for more than five years. Lower dose of estrogens preferred. Frequent and regular pelvic examinations and Pap smears should be done

Medicines used: Estrogen only e.g conjugated equine estrogen (premarin) Estrogen-progestin combination e.g (premarin plus provera). Methods of administration: -Tablets -Dermal patches -Vaginal creams rings, suppositories.

Other medicines: -Selective estrogen receptor modulators. Act as agonists on bones and as antagonists on breasts and uterus.eg.Raloxifene,Tamoxifene. -Antidepressants. -Antihypertensives. -Gabapentin. -Vitamins B6 andvit:E.

Weight bearing exercises. Avoid alcohol and smoking. Diet rich in calcium,low in saturated fat .

Regular gynaecologic examinations. Mammograms. Colonoscopy Fecal occult blood testing Bone mineral density.

Low fat ,low caloric diet. Calcium-1200-1500 mg, vit.D-800 IU Adequate intake of whole grains, fibre, fruits and vegetables.

Herbal preparations like soya products to be taken under medical supervision. Accupuncture. Meditation.

Provide education,support and assistance to cope with the phase. Accurate information is given to increase adjustability. Educate about risks and benefits of H.R.T. Advise use of topical estrogen preparations to relieve vaginal discomfort. Stress on importance of weight bearing exercises,cessation of smoking and alcohol. Good perineal hygiene and increased fluid intake helps prevent UTIs. Kegels exercises.

Though menopause is a difficult phase in a womans life, proper nursing management and client participation in health care planning can help improve the life quality in menopausal women.

Sexual assault has become very common and the victims need sensitive and proper management.Nurses in the emergency department are required to have skill in handling such cases. MEANING Sexual assault or RAPE is forced sexual acts especially when it involves vaginal or anal penetration.

Crisis intervention starts when the client enters the emergency department. Specially trained nurses called sexual assault nurse examiners(SANE) manage these cases. They are trained with special skills:forensic evidence collection,history taking,documenting and ways of approaching the patient. She also needs skills in photography,videography,colposcopy and microscopy.

Characterised by: An acute disorganisation phaseshock,disbelief,fear,guilt,humiliation which are expressed or hidden. A phase of denial-unwilling to talk,anxiety,flashbacks,sleep disturbances, hyperalertness and psychosomatic disorders. Phase of reorganization-recovers or develops chronic stress disorders and phobias.

The goals of management are: To give sympathetic support and counselling. To reduce the patients emotional trauma. To gather available evidence for legal proceedings. Encourage patient to gain control over her life.

Written and informed consent for physical examination,photography and revealing findings to the police. History taking if it was not taken by police or counsellor. Record history in the patients own words. Ask if the patient has bathed brushed,changed clothes or passed urine or faeces.

Document the time of admission,date and time of alleged rape,patients condition ,evidence of trauma. Head to toe examination for injuries especially to the head ,neck,breasts ,thighs,buttocks etc. Look for: -evidence of trauma -dried semen stains -broken finger nails,body tissues and foreign materials Oral examination

Pelvic and rectal examination SPECIMEN COLLECTION Vaginal discharge for presence of sperms Swab specimens of vaginal secretions Oral,anal and vaginal smears Culture for gonorrhoea Blood serum for syphilis and HIV Pregnancy tests Any foreign material Pubic hair samples

TREATING POTENTIAL PROBLEMS Prophylactic antibiotics Antipregnancy measures FOLLOW UP CARE Counselling services Refferal to the help organizations Follow up for surveillance of pregnancy,STDs and HIVtesting Rehabilitation

Physical examination and collection of evidence Provide support and counselling Never leave the client alone Encourage talking Show empathy and honest listening Be available Promote physical comfort and sense of security Explain every procedure

Tell her what to expect immediately and afterwards Maintain eye contact. CONCLUSION Recovery of a client from sexual assault is along term process that can be facilitated by constant support from care givers,family and friends.

THANK YOU