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Menstrual Cycle, Ovulation, and Related Conditions: Pain, Endometriosis, and IPV, Exams of Nursing

A.T. Still University of Health Sciences (ATSU)Nursing

An overview of various aspects of the menstrual cycle, including primary dysmenorrhea, ovulation induction, endometriosis, and intimate partner violence. Topics covered include causes, symptoms, treatments, and related university topics. Students may find this document useful for understanding the complexities of these conditions and their implications for women's health.

Typology: Exams

2023/2024

Available from 02/22/2024

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Exam 1 Spring Study Guide 2024
Rated A+
1. Women’s Health/ Non-pregnant
Dysmenorrhea (painful menstruation)
- Pain shortly before or during menstruation
- Primary dysmenorrhea
oRelated to ovulation
▪Due to the presence of estrogen & progesterone
oArises from the excessive release of prostaglandin
▪Abnormally increased uterine activity (strength & frequency of uterine contraction)
oAlleviating discomfort
▪Medications (NSAIDs – ibuprofen, naproxen)
▪Heat
▪Alternative methods (exercise, yoga, relaxation training, hypnotherapy, etc.)
- Secondary dysmenorrhea
oMenstrual pain associated w/ pelvic pathology
▪Endometriosis, PID, fibroids, etc.
oDiagnosis & Tx
▪Pelvic examination
▪Ultrasound examination, dilation & curettage (scraping), endometrial biopsy, laparoscopy
▪Tx directed to removal of underlying pathology
Premenstrual syndrome (PMS)
- Cyclic symptoms occurring in luteal phase (begins around day 15 of a 28 day-cycle & ends when you
get period) of menstrual cycle
oPMS
▪30% - 80% of women experience symptoms
▪Cluster of symptoms (physical, psychological, behavioral)
▪Poorly understood
▪Tx includes diet, exercise, & herbal therapies
STIs and vaginitis
-
-
- Gonorrhea & chlamydia can cause:
oWomen: pelvic inflammatory disease (Major cause of tubal infertility) & cervicitis
oMen: urethritis, epididymitis, accessory gland infection
oMumps, leading to orchitis, may cause secondary testicular atrophy
oOther infections that may affect fertility include tuberculosis, toxoplasmosis,
malaria, schistosomiasis & leprosy
-
Conception counseling: nutrition
- Healthy diet ensures adequate nutrients for developing fetus
- 1st trimester critical in terms of embryonic & fetal development
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Download Menstrual Cycle, Ovulation, and Related Conditions: Pain, Endometriosis, and IPV and more Exams Nursing in PDF only on Docsity!

Exam 1 Spring Study Guide 2024

Rated A+

1. Women’s Health/ Non-pregnant Dysmenorrhea (painful menstruation) - Pain shortly before or during menstruation - Primary dysmenorrhea o Related to ovulation ▪ Due to the presence of estrogen & progesterone o Arises from the excessive release of prostaglandin ▪ Abnormally increased uterine activity (strength & frequency of uterine contraction) o Alleviating discomfort ▪ Medications (NSAIDs – ibuprofen, naproxen) ▪ Heat ▪ Alternative methods (exercise, yoga, relaxation training, hypnotherapy, etc.) - Secondary dysmenorrhea o Menstrual pain associated w/ pelvic pathology ▪ Endometriosis, PID, fibroids, etc. o Diagnosis & Tx ▪ Pelvic examination ▪ Ultrasound examination, dilation & curettage (scraping), endometrial biopsy, laparoscopy ▪ Tx directed to removal of underlying pathology Premenstrual syndrome (PMS) - Cyclic symptoms occurring in luteal phase (begins around day 15 of a 28 day-cycle & ends when you get period) of menstrual cycle o PMS ▪ 30% - 80% of women experience symptoms ▪ Cluster of symptoms (physical, psychological, behavioral) ▪ Poorly understood ▪ Tx includes diet, exercise, & herbal therapies STIs and vaginitis - - - Gonorrhea & chlamydia can cause: o Women: pelvic inflammatory disease (Major cause of tubal infertility) & cervicitis o Men: urethritis, epididymitis, accessory gland infection o Mumps, leading to orchitis, may cause secondary testicular atrophy o Other infections that may affect fertility include tuberculosis, toxoplasmosis, malaria, schistosomiasis & leprosy - Conception counseling: nutrition - Healthy diet ensures adequate nutrients for developing fetus - 1 st^ trimester critical in terms of embryonic & fetal development

  • Folic acid intake o 0.4 mg in fortified foods recommended o Neural tube defects can occur with poor intake
  • Desirable body weight reduces maternal & fetal risks Ovulation
  • Inducing Drugs o Clomiphene ▪ Chemically stimulate pituitary gland to produce hormones that trigger ovulation process ▪ Numerous side effects ▪ May not be appropriate for pts w/:
  • Large fibroid tumors
  • Ovarian cysts
  • Liver problems o Bromocriptine ▪ Reduces production of prolactin hormone ▪ Some side effects ▪ May not be appropriate for pts w/ pituitary tumors > 1 cm o Human Menopausal Gonadotropins (hMG) o Follicle-stimulating Hormone (FSH) ▪ Stimulate ovary to develop follicles ▪ 75-150 IU/day (w/ hCG) ▪ 20-40% possibility of multiple births ▪ May not be appropriate in cases of pituitary tumor, ovarian cysts o Gonadotropin-Releasing Hormone (GnRH) ▪ Triggers normal pituitary hormonal activity so ovulation can occur ▪ Effective in women w/ hypothalamic amenorrhea ▪ No known physical side effects ▪ Ovulation pump administers injections every 90 mins ▪ User must carry pump w/ attach IV tubing for 1-2 weeks or until ovulation occurs Endometriosis
  • Presence & growth of endometrial tissue outside of uterus o Still responds to hormone/menstrual cycle o May worsen or be undetectable until it clears up during menopause
  • Theories o Familial tendencies o Tissue travels during menstruation & remains ▪ Retrograde menstruation
  • Major symptoms o Dysmenorrhea o Deep pelvic dyspareunia (painful intercourse)
  • Drug therapies o GnRH agonists (Synarel, Zoladex) o Birth control pills o NSAIDs o FSH/LH suppression (Danazol) o Surgical Intervention Risks for benign breast lumps and breast cancer
  • Anatomic variances

o Blood-tinged discharge present o Surgical excision recommended because of risk of malignancy

  • Infections of the breast o Cellulitis ▪ Occurs at a time while the women is not lactating (that is different diagnosis) ▪ With or without abscess formation ▪ Most common pathogen is staph aureus (MRSA may be possible, but rare) Family types
  • Nuclear families – two parents & children
  • Extended families – compose of uncles, aunts, nieces, nephews & grandparents
  • Multigenerational families – two or more adults generations – ex. grandparents & children
  • No-parent families – child/children not living with parents – e.g. divorce, mental problems, unemployment, alcoholism
  • Married-blended families – single parent marries another person who may or may not have children
  • Cohabitating-parent families – child/children into cohabiting parent family (2 biological parent family – e.g. cousin) & born single parent living w/ romantic partner but not married
  • Single-parent families – mother or father alone raises child/children ( most socially vulnerable )
  • Homosexual families – couple of the same sex who adopt or one is the biological parent of child/children Menstrual cycle
  • ~ 28 days o Starts w/ onset of bleeding o ~ 5 days o ~ 50 mL total blood loss
  • Endometrial cycle
  • Hypothalamic-pituitary cycle o End of cycle, estrogen/progesterone fall stimulating the secretion of Gonadotropin Releasing Hormone (GnRH) o Pituitary release of Luteinizing hormone (LH) + small peak of estrogen (~ day 12) proceed ovulation
  • Ovarian cycle o Lifecycle of the ovary o After ovulation estrogen drops, small blood released o For 10% of women this blood is visible o ~1 in 100 cycles, more than 1 ovum is released o At peak luteal functioning (hormone levels high), the fertilized ovum implants in the endometrium of the uterus o If no implantation occurs, the corpus luteum regresses, steroid levels drop & menstruation occurs
  • Other cyclic changes Intimate Partner Violence (IPV)/Abuse*
  • Most common form of violence against women o Behavior by an intimate partner or ex-partner that causes physical, sexual, or psychological harm, including physical aggression, sexual coercion, psychological abuse & controlling behaviors o Not exclusive to women
  • Complex, stigmatizing problem involving issues of emotional distress, personal safety, & social isolation
  • IPV has been tolerated or ignored
  • National Intimate Partner & Sexual Violence Survey (NISVS) collect data
  • Mandatory reporting varies state to state
  • Women Experiencing IPV

▪ Migraines w/ aura ▪ Prolonged immobility (surgery, MS, etc.) ▪ Diabetes w/ vascular complications ▪ Gallbladder disease ▪ Hepatic disease or disorder o Warning Signs ▪ Pregnancy ▪ Use of fosamprenavier, rifampin, or rifabutin ▪ Use of some anticonvulsants ▪ Less than 6 week PP ▪ Smoker over 35 ▪ A : abdominal pain may indicate a problem w/ the liver or gallbladder ▪ C : chest pain or shortness of breath may indicate clot problem w/in the lungs or heart ▪ H : headaches (sudden or persistent) may be cause by cardiovascular accident or HTN ▪ E : eye problems may indicate vascular accident or HTN ▪ S : severe leg pain may indicate a thromboembolic pressure Breast cancer risks

  • At least 15% of cases are related to a genetic mutation
  • Etiology of breast cancer & risk factors o Gender, age, time of menarche, menopause & time of first live birth o Personal hx of breast cancer o Breast cancer affects predominantly women, but 1% of all breast cancer occur in men o Geographic differences (diet, weight, lifestyle, heredity) o 1 st^ pregnancy after age 40
  • Genetic considerations o 85% chance of developing breast cancer in a woman’s lifetime with either genetic mutation: ▪ BRCA1/BRCA o The Breast Cancer Risk Assessment Tool (Gail Model): rick calculator o Chemoprevention ▪ Tamoxifen or raloxifene - Consider side effects 2. Pregnancy Pelvic anatomy

Supine positioning

Development of the placenta

  • Maternal-placental-embryonic circulation in place by day 17
  • Structure: starts to form at implantation. Forms from trophoblast – as soon as the fertilized ovum implants, we begin to make the placenta, connection to mom’s blood
  • Functions: exchange of waste & nutrients. Early function of an endocrine gland. Produces 4 hormones necessary to maintain pregnancy. Most common is HCG.
  • Assess all of the placenta is present or no present of abnormalities b/c if lobe left behind, the body will think she is pregnant  resulting in hemorrhage Anemia
  • Maternal blood loss decreases oxygen – carrying capacity & increases risk for anemia
  • Molar pregnancy clinical manifestation is anemia from blood loss
  • Pregnant woman with anemia need additional iron & should be instructed about how best to prevent & manage side effects Elevated blood pressure in pregnancy
  • Gestational hypertension o Onset of hypertension w/out proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy o SBP > 140, DBP > 90 o Resolves after birth
  • Preeclampsia o Pregnancy-specific condition in which hypertension and proteinuria develops after 20 weeks of gestation in a previously normotensive woman o Can also develop for the first time during the postpartum period o In the absence of proteinuria, preeclampsia may be defined as hypertension along with the following: ▪ Thrombocytopenia ▪ Impaired liver function ▪ New-onset renal insufficiency ▪ Pulmonary edema ▪ New-onset cerebral or visual disturbances
  • Chronic essential hypertension o Hypertension present before pregnancy or diagnosed before week 20 of gestation o Chronic hypertension with superimposed preeclampsia ▪ Women with chronic hypertension may acquire preeclampsia or eclampsia ▪ Can be difficult to diagnose Determining gestational age/ due date
  • Formulas for calculating EDB but none infalliable
  • Nagele rule o Determine 1 st^ day of last menstrual period (LMP), subtract 3 months, add 7 days plus 1 year o Alternatively add 7 days to LMP & count forward 9 months o Most women give birth from 7 days before to 7 days after EDB Ex: June 25 July 4 March 25 + 7 April 4 + 7 April 2, 2022 April 11, 2022 Hormones of pregnancy
  • hCG o Human chorionic gonadotropin is earliest biochemical marker of pregnancy o Pregnancy tests based on recognition of hCG or B subunit of hCG o Can be detected in serum or urine as early as 7 to 8 days after ovulation GTPAL
  • Gravidity – how pregnancies you’ve had
  • Term – pregnancies, here 37 weeks +
  • Preterm – pregnancies, here 20-36 weeks + 6 week
  • Abortion – elective or spontaneous, here before 20 weeks
  • Living children *Twins count as 1 pregnancy Early Function of the placenta
  • Functions: exchange of waste & nutrients. Early function of an endocrine gland. Produces 4 hormones necessary to maintain pregnancy. Most common is HCG. Signs of pregnancy
  • Presumptive (subjective) o Those changes felt by the women
  • Placenta implanted in lower uterine segment near or over internal cervical
  • Degree to which the internal cervical is covered by placenta used to classify 3 types o Complete placenta previa o Marginal placenta previa o Low-lying placenta
  • Incidence & etiology o 1 in 200 pregnancies o Risk factors include: previous c-birth, advanced maternal age (more than 35 to 40 years of age), multiparity (multiple birth?), Hx of prior suction curettage, living at a higher altitude & smoking
  • Clinical Manifestations o Painless bright red vaginal bleeding during second or third trimester o Now, most cases are diagnosed by ultrasound before significant vaginal bleeding occurs o Abdominal examination usually reveals a soft, relaxed, nontender uterus w/ normal tone
  • Maternal & fetal outcomes o Major complication is hemorrhage o Morbidly adherent placenta, an abnormally firm placental attachment o Surgery-related trauma (most delivered by c-section) o Preterm birth: IUGR
  • Dx o Initial transabdominal ultrasound examination o Transvaginal ultrasound is better than a transabdominal scan from accurately determining placental location
  • Interprofessional Care Management o Expectant management o Home care o Active management Diabetes

Appendicitis

Invasive diagnostic testing during pregnancy

Normal findings for each trimester

  • 1 st^ trimester: week 1-13+
  • 2 nd^ trimester: week 14-27+
  • 3 rd^ trimester: week 28+ Effects of High risk pregnancy on pt/fam
  • Psychologic Considerations o Label of high risk often increases the patient’s sense of vulnerability o May exhibit anxiety, low self-esteem, guilt, frustration, & inability to function o May affect parental attachment, accomplishment of the tasks of pregnancy, & family adaptation to the pregnancy Diabetes in pregnancy