Professional Documents
Culture Documents
Ch 46, 47
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uterus vagina
Assessment
Health Hx. past illnesses, STDs, treatments, hx sexual/physical abuse, Sexual Hx. PE findings, lab results Female genital mutilation
Cutting, partial/total removal of external genitalia Cultural passage to womanhood: Africa, Middle East. Crime in the U.S. Type I, II, III, IV p 1620
Assessment
Domestic violence
Physical: for child, elderly; men & women Emotional degradation, coercive control, threats, intimidation. Sexual assaults
The need to maintain control of a partner is rooted in sex role inequality. Sensitive care is required if a woman states that she is being hurt. Report & provide safety for pt. (p.1621)
Physical Assessment
Periodic examination/ pelvic & breast Routine cancer screening Positioning: supine lithotomy, upright lithotomy vs. Sims position (left side) Proper equipment Inspection : lesions of the labia majora/minora (venereal warts, melanoma lesions) trauma to the vaginal wall, cystocele, rectocele, presence of a hymen
Assessment
Women with disabilities experience increase risk for abuse Inquire about barriers to health care Any healthcare limitations Cognitive or developmental changes affecting understanding Gerontology considerations Facing health disparities or end-of-life issues
Physical Assessment
Speculum Examination: Cervix 2-3 cm, smooth vs. laceration Malignant changes cysts, polyps Discoloration Cauliflower-like growth (cancer) Vaginal discharge
Diagnostic Testing
PAP Smear cytology for detecting cervical cancer
Atypical cells: Human papillomavirus (HPV)
Colposocpy visual examination with a portable microscope Cervical biopsy analysis of cervical tissue Cryotherapy/laser therapy freezing cervical tissue with nitrous oxide Cone Bx Loop Electrosurgical Excision Procedure (LEEP) surgical procedure using laser beam
Diagnostic Testing
Endometrial Aspiration Bx. allows for detection of cellular changes in the endometrium Dilation & Curettage (D&C) surgery; dilation if cervical canal and scraping of endometrial/endocervical tissue for cytology Endoscopic laparoscopy visualization of the pelvic structures
Diagnostic Testing
Hysteroscopy visualization of all the parts of the uterine cavity Hysterosalpingography or Uterotubography x-ray of uterus & fallopian tubes. Computed Tomography (CT) transverse radiographic images Ultrasonography ultra sound images. Magnetic Resonance Images (MRI) definitive images using magnetic waves
Perimenopause 1st sign of menopause: hot flashes, vaginal dryness, irregular menses.
Consider issues in sexuality, fertility, STD,oral contraceptives, breast cancer,
Menstrual Disorders
Dysmenorrhea: painful menstruation, severe crampings Tx: relieve discomfort, A.S.A. NSAIDs, low level local heat
Contraindicated with peptic ulcers Amenorrhea absence of menstrual cycle
Allow pt to express concerns, PE, medical hx., stress level, pregnancy, eating disorders, anorexia & bulimia
Menstrual Disorders
Menorrhagie excessive menstruation; profuse, prolong flow during regular periods Related to endocrine distrubances, inflammatory disturbances, uterine tumors Can result in anemia; need to see MD
Count # pads, & saturation (absorbency)
Menstrual Disorders
Metrorrhagie heavy uterine bleeding between periods; irregular May signal cancer, benign tumors of the uterus Health hx., taking oral contraceptives or HR? Hypomenorrhea scanty flow Oligomenrrhea reduced frequency of periods
Contraception
Abstinenece practice celibacy; only effective method Sterilization Bilateral tubal ligation: laparoscopy procedure Fellopian tubes are coagulated, sutured, or ligated with bands/clips. Transcervical tubal occlusion Vasectomy excision of the vas deferens
Contraception
More than half of pregnancies in the U.S. are unintended Nurses can assist in providing information and support Family planning resources Listen, educate and take time to answer questions Be unbiased and nonjudgmental Understand the risks & benefits
Contraception
Hormonal use of estrogens & progestins by women. Block ovarian stimulation, prevent release of FSH from the anterior pituitary gland. Benefits: reduce incidence of benign breast disease, uterine & ovarian cancers, anemia, pelvic infections; Improves acne. Risks: DVT, breast soreness, HA, nausea, leg cramps ** Inform pts that hormonal contraception protects
against pregnancy but not from STD of HIV
Contraception
Intrauterine device (IUD) a plastic, t-shaped device inserted into the uterine cavity to prevent pregnancy. Causes local inflammation, which is toxic to sperm & blastocysts; therefore prevents fertilization May cause excessive bleeding, cramps, backaches, slight risk of tubal pregnancy, perforation of cervix and uterus is rare
Contraception
Mechanical barriers diaphragm Cervical cap Contraceptive spong Female condom (p1645) Male condom Spermicides Coitus interruptus (withdrawal) Rhythm & natural method safe period Emergency contraception morning after pill
Contraception
Abortion Spontaneous abortion Habitual (recurrent) abortion
After 2 consecutive abortion, pt is referred to genetic counseling and testing
Nursing management
For spontaneous abortion - provide bed rest, sexual abstinence, no straining on defecation Allow expression of feelings: listen Pt education: available forms of contraception, community resources Counseling Pelvic exam, lab studies, RhoGAM, STD screening
Infertility
The couples inability to achieve pregnancy after 1 yr. of unprotected intercourse. Ovarian/ovulation factors Tubal factors Uterine factors Semen & other male factors
Artificial Insemination
Deposit of semen into the female genital tract by artificial means
Sperm cannot penetrate the cervical canal Donor or partner/husband semen is frozen Written consent Safeguards set in place for legal, ethical, emotional & religious issues
Must meet certain condition: the women should have no genital abnormalities, require patent fallopian tubes, available ovum. Viable sperm: normal shape, amount, motility and endurance
Ectopic Pregnancy
Decreasing in rate, but remains the leading cause of pregnancy related dealth in 1st trimester Acute condition require surgery Relieve acute pain Monitor potential complications prevent hemorrhage, shock. Provide emotional support