Gynecological Conditions and Procedures, Exams of Nursing

Download Gynecological Conditions and Procedures and more Exams Nursing in PDF only on Docsity!

NR602 Final Exam

Colposcopy exam- - ANS procedure that visualizes vaginal, vulvar, or cervical epithelium w/ magnification to id abnormal area to be bx painful menstruation that prevents normal activity and requires medication 3 types: primary (no organic cause), secondary (pathologic cause) and membranous - causes intense cramping pain due to passage of a cast of endometrium through undilated cervix - ANS Dysmenorrhea Dysmenorrhea treatment - ANS Tx- NSAIDs/tyelnol, heat, antiprostaglandins, OCP w/ increased estrogen- pain relief r/t absence of ovulation, decreased prostaglandin production; surgery Dysmenorrhea mechanism - ANS prostaglandin activity -vaginal wall weakens and stretches and allows the bladder to bulge into the vagina - ANS Cystocele Sx-felling of fullness or pressure in vagina, increased discomfort when you strain/cough/bear down, feeling of incomplete empty, repeated bladder infection, pain or urinary leak during sex, bulge of tissue into vaginal opening - ANS Cystocele Cystocele prevention - ANS kegels, prevent constipation, avoid heavy lifting, avoid wt gain Rectocele - ANS -When thin tissue of vagina separates the vaginal and rectum allowing vaginal wall to bulge Sx- soft bulge of tissue in vaginal, difficult BM, sensation of rectal pressure, incomplete emptying after BM, sexual concerns - ANS Rectocele Causes of rectocele - ANS Causes- constipation/strain, chronic cough, heavy lifting, overweight, childbirth, age Retocele prevention - ANS Prevention- kegels, prevent constipation, avoid heavy lifting, cough, avoid wt gain

-pelvic floor muscles and ligaments stretch and weaken and no longer provide support for uterus and protrude into vagina. - ANS Uterine Prolapse Uterine Prolapse causes - ANS Causes- pregnancy, large baby delivery, lower estrogen level after menopause, obesity Common in postmenopausal and one or more childbirth Uterine Prolapse symptom - ANS Sx- heaviness or pulling into pelvis, tissue protruding from vagina, urinary probs (leakage, retention), trouble having BM, feeling of sitting on small ball, sexual concerns Uterine Prolapse prevention - ANS Prevention- kegels, treat constipation, correct lifting, avoid wt gain uterine prolapse treatment - ANS Tx- pessary chronic viral infection caused by HSV1 or HSV2, relapsing - ANS Herpes Simplex Herpes Simplex prevention - ANS Prevention: consistent condom use b/c viral shedding can occur in asymptomatic periods and can lead to transmission. W/ symptoms- Valacyclovir 500 mg daily Herpes Simplex sign and symptoms - ANS Sx-multiple painful vesicular or ulcerative lesion on genitals, can be absent. Virus lays dormant and can be reactivated Herpes Simplex diagnosis - ANS lays dormant and can be reactivated Dx-cell culture and PCR Herpes Simplex treatment - ANS Tx- systemic antiviral. Acyclovir 7-10 days for 1st episode, suppressive 200 mg daily BID Chancroid - ANS -Transmitted via sexual contact or on hands that have touched lesion. Caused by Haemophillus ducreyi -Reportable disease

Chancroid symptoms - ANS -Sx- erythematous papule that evolves into pustule and degenerates into saucer shaped ragged ulcer that is circumscribed by inflammatory wheal. Tender, heavy foul discharge that is contagious Chancroid diagnosis - ANS Dx-culture that grows H ducreyi Chancroid treatment - ANS Tx- Abx azithromycin 1 g PO one time, ceftriaxone 250 mg IM 1 x, cipro 500 mg PO BID x3 days erythromycin 500 mg PO TID x7 days. Personal hygiene, clean w/ soap and water, sitz bath Syphilis - ANS -chronic, systemic disease caused by a sphirochete transmitted via contact with infectious moist lesion. Sexually acquired or vertically transmitted from infected mom. Reportable disease Syphilis transmitted - ANS -Transmitted in primary and secondary stages Primary-mucus mem 10-90 days later. Secondary- 2 wks-6mo after primary lesion then generalized cutaneous eruption of secondary may appear. Latent- may last a lifetime Syphilis prevention - ANS Prevention- condom, wash w/ soap and water after sex, screen ppl @ high risk (men that have sex with men, drug trafficers, correctional facilities) Syphilis symptoms - ANS Sx- [Primary]- Chancre- indurated firm painless papule or ulcer w/ raised borders, women can have cervical or vaginal lesion....on any mucus mem. [Secondary}-viral syndrome w/ diffuse lymphadenopathy AEB dermatitis, papulosquamous lesion on palms and soles. Lesions on trunk will be macular or maculopapular popular or pustular other systemic include patchy alopecia, hepatitis, nephritis. [Latent]- resolution of lesion of primary and secondary or finding of serologic test w/o therapy Syphilis Diagnosis - ANS Dx- T pallidum sphirochetes on dark field exam of cutaneous lesion, serologic testsing antibody titers Syphilis treatment - ANS Penicillin G Chlamydia trachomatis gold standard test - ANS. Gold standard test is NAT, not culture Chlamydia trachomatis - ANS negative whiff w/ mucupurulent d/c and + clue

cells. Chlamydia trachomatis symtoms - ANS Sx- dyspuria, intramenstrural spotting, postcoital bleeding, pain w/ sex, vag d/c purulent d/c reddened congested cervix or can be asymptomatic. Chlamydia trachomatis diagnoses - ANS Dx-Urine or endocervix/vaginal swab Chlamydia trachomatis tx - ANS Tx- 1 gm Azithromycin OR doxy, erythro PLUS rocephin 250 or cefixime Complications- salpingitis and PID, perihepatitis, Gonorrhea - ANS STI, first causes cervical infection and ascend to endometrium and fallopian tube. Reportable Gonorrhea prevention - ANS Prevention: Screen all high risk ppl sexually active women age 25 or less. Use condoms. Sex partner w/ in 60 days evaluate to tx that sex partner, > 60 days tx most recent sex partner, NB receive erythro ointment after delivery Gonorrhea symptoms - ANS Sx-many are asymptomatic. inflamed and edematous cervix with d/c coming from cervical os. Vag d/c urinary frequency, dysuria, unilateral swelling of intoitus, anal itching, pain, pharyngitis, conjunctivitis, systematic triad (polyarthalgia, tenosynovitis, and dermatitis) Gonorrhea diagnosis - ANS Dx- endocervical vaginal or urine specimens Complications- salpingitis- tubal scarring, infertility Gonorrhea treatment - ANS Tx- Rocephin 125 mg, cefixime OR azithromycin No sex 7 days after therapy. Tx for chlamydia as well. HSV-type 1 or 2. - ANS Type 2 most common cause of genital herpes. Produces cervical lesion, first vesicular then ulcers. After initial infection, virus continues to reside in nerve cells for life. HPV- spread - ANS spread via skin to skin (genital warts) Prevention- abstinence, condom use, treating affected partner @ same time

Trich - ANS Caused by flagellated protozoan, mobile Trich prevention - ANS Prevention: condoms, decrease # of sex partners, vulvular hygiene Trich symptoms - ANS Sx- purulent malodorous d/c w/ burning itching, dysuria, frequency, and painful sexl. Postcoital bleeding may occur foamy white green d/c, strawberry appearing cervix trich diagnosis - ANS Dx- motile flagellated organisms on saline wet smear, Affirm Trich treatment - ANS Tx-Metronidazole 2g PO single dose OR tinidazole 2 gm in single dose Candida - ANS white curd like d/c Candida diagnosis - ANS Dx- potassium hydroxide prep---distinct presence of hyphae Candida treatment - ANS Tx- topical azole drugs or PO fluconazole bacterial vaginosis - ANS most prevalent vaginal infection. * Loss of lactobacilii and increase in vaginal pH fishy odor bacterial vaginosis risk factor - ANS Risk factors: multiple sex partner, douching, lack of condom use, lack of vag lactobacilli Bacterial vaginosis prevention - ANS condom use, no douching bacterial vaginosis treatment - ANS Tx- metronidazole 500 mg PO x7 days, metronidazole gel 0. %x5 days, clinda cream 2% x3 nights OR tinidazole PO x2 days Bacterial vaginosis symtoms - ANS Sx-3 of 4 Amsel criteria Bacterial vaginosis diagnosis - ANS Dx- Gram stain is gold standard, saline wet mount with "clue cells", Amsel criteria: thin homogenous white/yellow d/c, "clue cells on microscopy, fishy odor w/ k hydroxide solution, pH of 4.5 or >-----need 3 of 4 to be dx.

PID - ANS -inflamm of upper femal genital tract w/ combo of endometritis, salpingitis, tubo- ovarian abscess, and pelvic peritonitis. PID prevention - ANS Prevention- screening and tx sexually active women and sex partners for gonorrhea and chlamydia PID symptoms - ANS Sx- insidious or acute lower abd/pelvic pain usually bilateral. Pelvic pressure/back pain ass w/ purulent vag d/c. N, HA, fever is NOT necessary. Abd tenderness, may be distended bowel sounds hypo or absent. Bimanual= extreme tenderness or cervix ****CDC says empiric tx should be initiated in sex active young women and those @ risk for STD and if 1 or more of following criteria- cervix motion tenderness, uterine tenderness, and adnexal tenderness. PID diagnosis - ANS DX-+endocervical swabs...but all may be normal. PID treatment - ANS Tx- empirically with presumptive dx. Rocephin 250 IM +doxycycline 100 mg BID x14 + metronidazole 500 mg BID x HEP B - ANS -caused by Hep B virus, transmitted via blood with other concentration in wound exudate, semen vag secretions, and saliva. Transmitted via percutaneous or mucous mem w/exposure to blood or body fluid. Reportable disease. Can cause liver failure and death Risk factors- unprotected sex w/ infected partner, hx of STD, illegal injection drug use. Hep B prevention - ANS Prevention: Hep B immune globulin-provides 3-6 mo protection and used post exposure prophylaxis in adjunct to vaccine or in unvaccinated person and Hep B vaccine. Hep B Vaccine- contains HBsAg provides protection from pre and post exposure, require series. Routinely screen ALL preg women. Unvaccinated or those ho do not respond to Hep b vaccine series should be given HBIG and vaccine if exposed. Hep B diagnosis - ANS Dx-presence of igM antibody is dx Hep B symptoms - ANS Sx- asymptomatic. Constitutional @ first- anorexia, N, jaundice, RUQ pain HEP TX - ANS Tx- supportive care. No effective antiviral drugs Hep C - ANS -Caused by Hep C virus through parenteral exposure of contaminated blood

Hep C prevention - ANS Prevention-no vaccine, reducing transmission and chronic liver disease. + pt do not donate blood, , don't use razors or toothbrushes Hep C symptoms - ANS Sx- asymptomatic or mild illness. Hep C diagnosis - ANS Dx-nucleic acid PCR Hep C treatment - ANS Tx- interferon and ribavirin HIV - ANS -wide spectrum of disease that begins w/ acute viral illness and transitions to chronic and latent illness. Will progress to AIDS. It depletes CD4 lypmphocyetes which maintains immunity and when falls below 200 pts are @ risk for lifethreatening infections HIV transmission - ANS Transmitted- sexual contact, parenteral exposure to blood or body fluid infected woman to fetus. Heterosexual HIV prevention - ANS Prevention- condom use, avoid sharing needles, universal precautions w/ jobs, good prenatal care, Screen high risk populations HIV symptoms - ANS Sx-wt loss, fever, night sweats, pharyngitis, lymphadenopathy, reddened maculopapular rash, extragenital lymphadenopathy HIV diagnosis - ANS Dx-HIV-1 antibody. Ppl develop detectable levels after 12 wks of exposure. ELISA. Viral load/CD4 count is useful in determining activity of disease HIV treatment - ANS Tx-managed by specialist. Use high active antiretroviral therapy (HAART) -maternal transmission of HIV can occur transplacentally before birth, peripartum via blood and bodily fluid exposure or thru BF. Lichen Sclerosus - ANS severe itching -Dryness/irritation, labia adhered -benign chronic inflamm process.

Lichen Sclerosus causes - ANS Causes- vit A deficiency, autoimmune, excess enzyme elastase, decreased activity of 5-alpha reductase Lichen Sclerosus symptoms - ANS Sx- itching, vulvar pain, pain w/ sex, or white lesions. Starts as erythema and edema over vulvar skin, then white plaques and hyperkeratosis, then uniting of plaques, and itching Lichen Sclerosus diagnosis - ANS Dx- fixed labia, adhesions, vulvar biopsy to confirm Lichen Sclerosus Treatment - ANS Tx- stop itch scratch cycle and minimize inflamm. General hygiene avoid tight undies, cleanse daily w/ soap and dry. Oral antihistamine @ HS, clobetasole (Dermovate) potent topical steroid twice daily x2 wks then once daily x2 wks, taper down ****Can progress to vulvar carcinoma Lichen Simplex Chronicus - ANS -chronic eczematous disease characterized by intense and unrelenting itching and scratching Lichen Simplex Chronicus symtoms - ANS Sx- benign epithelial thickening and hyperkeratosis from chronic irritation EX- perfume pads, chronic vulvovaginal infect. Itching leads to rubbing and scratching Lichen Simplex Chronicus Treatment - ANS Tx- vulvar hygiene, sitz bath, lubricants, oral antihistamine for itching, medium potency steroids. Should resolve in 4-6 wks to heal Vulvodynia - ANS persistent pain/burning Vulvodynia Symptoms - ANS Sx- introital pain on vestibular or vag entry (entry dyspareunia) vestibular tenderness -Commonly affects 20-30 yr Vulvodynia Tx - ANS Tx- pelvic floor PT, maintain vulvar hygiene, avoid constricting clothes and irritating agents. 5% lido cream for pain relief, topical estrogen prep, after 3 months and no relief tx w/ TCA

Amenorrhea Primary - ANS Primary (no menses by 13 w/o 2ndary sex characteristics OR 15 w/ secondary sex; Amenorrhea Primary Causes - ANS causes- chromosomal defect, anatomic anomalies, hormone imbalance, tumor, trauma) Amenorrhea Secondary - ANS No menses x6 mo, pelvic pathology, most common cause=pregnancy --- eating disorder most frequent etiology no menses for 3 or more cycles OR 6 consecutive months in previous menstruation. Amenorrhea Secondary causes - ANS Causes- pregnancy (most common), hypothalamic amenorrhea, pit amenorrhea, androgen disorders (PCOS, adult onset adrenal hyperplasia), galactorrhea- amenorrhea syndrome.---female athlete triad (anorexia, amenorrhea, osteoporosis) ASCUS/HSIL results from Paper Test Report- - ANS CDC--- Amenorrhea Primary (no menses by 13 w/o 2ndary sex characteristics OR 15 w/ secondary sex; causes- chromosomal defect, anatomic anomalies, hormone imbalance, tumor, trauma) For non-pregnant women between 25 and 65 years of age with ASCUS cytology who have not had HPV co-testing already, HPV testing is the preferred next step (high-risk HPV testing only). With a negative HPV test (either on co-test or after cytology), repeat co-testing Vulvar Carcinoma - ANS post menopausal women, pruitus 4th most common gyn malignancy -90% of tumors are squamous cell carcinoma -disease in postmenopausal women 60-70 yrs Vulvar Carcinoma symptoms - ANS Sx- vulvar itching, mass, vulvar bleeding/pain and tumor found incidentally during pelvic

Pap recommends - ANS Vulvar Carcinoma treatment - ANS Tx- surgery, removal of tumor Vulvar Carcinoma diagnosis - ANS Dx- biopsy Molluscum contagiosum - ANS -viral skin infection, benign epithelial poxvirus-induced tumor Molluscum contagiosum symptoms - ANS Sx- round firm painless bumps that size from pinhead to eraser, have small indentation (umbilication), itchy, may be seen on genitals, lower abd and iner thighs if was spread sexually Molluscum contagiosum transmission - ANS Transmit- direct person-to-person contact, sexual contact w/ affected Molluscum contagiosum prevention - ANS Prevent- wash hands, avoid touching bumps, avoid sexual contact, cover bumps Molluscum contagiosum treatment - ANS Tx- self limited, can be treated with desiccation, freezing, chemical caut Condyloma acumiate - ANS Condyloma acumiate causes - ANS (genital warts)- pg 628— Caused by HPV, high risk ages 16- Condyloma acumiate prevention - ANS Prevention- vaccine Condyloma acumiate symptom - ANS Sx-white, papillary growth w/ fingerlike projections containing capillaries, hyperkeratotic lesion Condyloma acumiate diagnosis - ANS Dx- clinical, biopsy

Condyloma acumiate treatment - ANS Tx- bichloracetic acid, podophyllin in tincture, cryo, electrosurgery, surgical excision,pt can do podofilox soltion gel Condyloma lata - ANS Associated w/ secondary syphilis Generalized maculopapular rash on trunk and proximal extremities and spreads to entire body including palms, soles and scalp. Condyloma lata symptoms - ANS Sx- wart-like lesions found in genital area Androgen insensitivity/ resistance syndrome - ANS Inability of body to respond properly to male sex hormone, produced during pregnancy Androgen insensitivity/ resistance syndrome symptoms - ANS Sx- genetic make up is male but physical traits of woman Vagina but no cervix, inguinal hernia w/ testes, normal female breasts, testes in abd or other place of body Turner's Syndrome - ANS Disorder of females by absence of all/part of 2nd sex chromosome. 1 of 2 X chromosomes. Infertile Turner's syndrome symptoms - ANS Sx- congenital lymphedema, short stature, gondal dysgenesis, broad chest, small nipples, webbed neck, coarctation of aorta, renal abdnormalities, epicanthal folds, nevi, short 4th metacarpal --Need gondal hormone therapy for sex dev., enhancement of growth, & maintenance of sex reprod tissue Turner's Syndrome treatment - ANS Need gondal hormone therapy for sex dev., enhancement of growth, & maintenance of sex reprod tissue CDC recommendations chlamyida - ANS annual screen < UTI causes - ANS Can be complicated OR uncomplicated. E.Coli is primary cause

UTI risk factors - ANS Risk factors- preg, DM, no void after sex, UTI - UA dipstick results - ANS +WBC, + Nitrates + = (E.coli converts nitrate to nitrite), RBC cast (pylonephritis), WBC cast (glomeruloarnephritis inflamm) UTI treatment uncomplicated - ANS [healthy 18-65 yr- 3 day tx] not necessary for C&S . Check for previous Abx. Tx w/ Bactrim BID, Macrobid x5 days. If sx persist then do culture. Pyrdium for pain. UTI treatment complicated - ANS [elderly, recurrent, children] Tx for 7 days or longer; Cipro 500 mg BID x7-10 days OR Macrobid 7-10 days, if allergy Keflex Interstitial Cystitis - ANS not STD chronic condition causing bladder pressure, pain, and sometimes-pelvic pain Interstitial Cystitis symptom - ANS Sx- pelvic pain, persisitent urge to urinate, frequenct, pain as bladder fills, pain w/ sex Interstitial Cystitis risk factors - ANS Risk factors- female, > Interstitial Cystitis treatment - ANS Tx- pelvic PT, NSAIDs, TCA (relax bladder and block pain), antihistamine, pentosan polysulfate sodium Pyelonephritis - ANS -bacteria in urine culture/ bacterial infection of kidney Pyelonephritis symptoms - ANS Sx- fever, shaking, chills, CVA tenderness N/V, HA, increased urinary frequency, and dysuria. -pyuria on UA w/ WBC casts....absence of pyuria should raise suspicion for other dx.

Pyelonephritis diagnosis - ANS Dx- UA w/ culture Pyelonephritis treatment - ANS Tx- (outpt) Bactrim 14-21 days, antipyretics for fever Cervical cancer screening - ANS age 21 - 29 every 3 years age 30 - 65 every 5 years with HPV co-test or 3 yrs with cytology when not to screen for cervical cancer - ANS 21 or younger past 65 with 3 neg cytology or 2 neg HPV within 10 years of stopping when breast exams should be done? - ANS age 50 - 74 age 40 - 49 with strong family hx / abdnorm mammo Cervix/ Uterus Exam - ANS Normally mobile can be moved 2-4cm w/o pain-restricted movement could mean inflammation Friable cervix - ANS easily irritated, prone to bleeding esp after intercourse---suspicious for cervical ca firm and easily friable Uterus - ANS 1/2 size of pt's fist. Pear shaped thick walled organ between base of bladder and rectum. 2 portions. The body and smaller cervix below. Mammogram - ANS screening method for breast ca. Cancer may be id 2 yr b4 size detected via palpation.

Breast ultrasound - ANS not recommended for screening in general population. IS AN ADJUNCT TO ABNORMAL MAMMO. May be added to high-risk woman. Can help decrease false- neg rate of mammo and eval mammographically occult palpable breast mass Bartholin's Cyst - ANS obstruction of main duct of Bartholin's gland that results in retention of secretions/ cyst formation. Gland and duct are located in deep posterior third of labia major with duct opening to vestibule Bartholin's Cyst diagnosis - ANS Dx- clinical exam Bartholin's Cyst symptoms - ANS Sx- generally result from infection such as pain, tenderness, dyspareunia, difficulty walking, tissue around is edematous and inflamed, firm, mass, cyst, induration, erythema Bartholin's Cyst treatment - ANS Tx- Drainage of infected cyst, abx , sitz bath, warm compress Nabothian Cyst - ANS -mucus filled cyst on surface of cervix. Develop when tunnel of columnar endocervical epithelium is covered by squamous metaplasia. Small white raised bump Tx- no tx necessary spermicidal, interferes w/ normal dev of ova or fertilization., causes cervical mucus to thicken T shaped frame. Can cause anovulation - ANS IUD 3 yr usage, placed in upper arm, contains 68 mg of etonogesterl Can be inserted anytime after no pregnancy. +high efficacy, long term, can use w/ lactation -bleeding irregularities, wt gain, emotions, acne, depression - ANS Implant - Nexplanon OCP- estrogen & progestin: - ANS reduction in ovarian & endometrial cancer risk, ectopic, PID, menses disorder, benign breast disease & acne. -: thromboembolism, stroke, MI

-cervical mucus is less permeable to sperms and endometrial activity goes out of [phase. Used for women w/ estrogen contraindication (smoke, older, sickle cell, MR, migraine HA, HTN, SLE, breastfeeding) - ANS Progestin only (mini pill) Removed after 7 days and new patch applied. 3 wks on, 1 week offApply anywhere but breasts. Break through bleeding and spotting with transdermal patch use is similar w/ OCP users. - ANS Transdermal Patch- Flexible unfitted ring placed in vagina that releases ethinyl estradiol etonogestrel. 3 wks in/1 wk out. Can still work w/ 3 hours out. - ANS Vaginal Ring- Nuvaring IM inject q3 months. Suppresses ovulation

• low risk of ectopic, reduced risk of endometrial ca,does not increase risk of DVT. May reduce bone mineral density, wt gain, return to baseline to get fertile may take 10 months. - ANS Injection/Long acting hormone contraception [Depo medroxyprogesterone acetate] Cimetidine - ANS H2 receptor agonist -acid reducer for heartburn and GERD safe in pregnancy, sit up 30 min after