Disorders of the Female Reproductive System
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Questions and Answers

What is defined as the absence of menstrual flow?

  • Menarche
  • Amenorrhea (correct)
  • Menopause
  • Dysmenorrhea

    • Which of the following is a condition that could lead to secondary amenorrhea?

  • Menopause
  • Normal pregnancy
  • Polycystic ovarian syndrome (correct)
  • Primary ovarian insufficiency

    • What is a common symptom of primary dysmenorrhea?

  • Pain unrelated to pelvic disorders (correct)
  • Weight loss
  • Heavy bleeding
  • Delayed onset of menstruation

    • What is the first step in the diagnostic process for amenorrhea?

    <p>Confirm absence of pregnancy</p> Signup and view all the answers

    Which hormonal condition could be associated with secondary dysmenorrhea?

    <p>Intrauterine contraceptive device</p> Signup and view all the answers

    Which treatment is commonly used to address underlying causes in amenorrhea?

    <p>Hormone replacement therapy (HRT)</p> Signup and view all the answers

    Which stage of tumor classification includes tumors that have metastasized to distant organs?

    <p>Stage IV</p> Signup and view all the answers

    What type of surgical intervention conserves breast tissue while removing a tumor?

    <p>Lumpectomy</p> Signup and view all the answers

    Which option is NOT a risk factor for primary dysmenorrhea?

    <p>Age over 30 years</p> Signup and view all the answers

    What does a simple mastectomy involve?

    <p>Removal of surrounding tissue and skin flap maintenance</p> Signup and view all the answers

    What is the primary goal of breast reconstruction after mastectomy?

    <p>To match the opposite breast in size and shape.</p> Signup and view all the answers

    Which reconstruction method involves using tissue from another part of the body?

    <p>Musculocutaneous flap procedure.</p> Signup and view all the answers

    What complication may arise from the musculocutaneous flap procedure?

    <p>Bleeding, hernia, and infection.</p> Signup and view all the answers

    When is nipple reconstruction typically performed?

    <p>After breast reconstruction as a separate procedure.</p> Signup and view all the answers

    What should a nurse include in discharge teaching for a client who had a modified radical mastectomy?

    <p>Instructions on caring for the surgical site.</p> Signup and view all the answers

    What is the 5-year survival rate for localized breast cancer?

    <p>Close to 100%.</p> Signup and view all the answers

    What intervention should a nurse delegate to unlicensed assistive personnel for a client with a right modified radical mastectomy?

    <p>Tell the UAP to place a sign to avoid using the right arm for blood pressure.</p> Signup and view all the answers

    Which option describes a possible breast reconstruction method after mastectomy?

    <p>Musculocutaneous flap procedure as an option.</p> Signup and view all the answers

    What might happen to the survival rate once breast cancer metastasizes?

    <p>It drops to 22%.</p> Signup and view all the answers

    What technique may be employed for areola reconstruction?

    <p>Tattooing for the areola.</p> Signup and view all the answers

    What is typically required for patients with lymph node involvement after a mastectomy?

    <p>Chemotherapy</p> Signup and view all the answers

    Which treatment option involves inserting radioactive seeds into the breast after tumor removal?

    <p>Brachytherapy</p> Signup and view all the answers

    What is a common adverse effect associated with chemotherapy?

    <p>Bone marrow suppression</p> Signup and view all the answers

    What is the primary role of nursing interventions post-mastectomy?

    <p>To support the patient emotionally and physically</p> Signup and view all the answers

    Which of the following is NOT a recommended patient teaching point after a mastectomy?

    <p>Lift heavy objects to strengthen the arm</p> Signup and view all the answers

    What is the purpose of hormonal therapy in the treatment of breast cancer?

    <p>To block or remove the source of estrogen</p> Signup and view all the answers

    What is the appropriate timing for starting external beam radiation after surgery?

    <p>2-3 weeks post-surgery</p> Signup and view all the answers

    Which aspect of care is important to help prevent lymphedema after a mastectomy?

    <p>Regular elevation of the affected arm</p> Signup and view all the answers

    Trastuzumab (Herceptin) is used for patients with which specific condition?

    <p>HER2-positive breast cancer</p> Signup and view all the answers

    What nursing action is vital for post-mastectomy patients regarding body image?

    <p>Encourage dressing changes to increase acceptance</p> Signup and view all the answers

    Which of the following can lead to secondary amenorrhea?

    <p>Pituitary tumors</p> Signup and view all the answers

    Match the following types of dysmenorrhea with their characteristics:

    <p>Primary = Pain not related to pelvic disorders Secondary = Pain linked to pelvic disorders Menarche = First occurrence of menstruation Adenomyosis = Endometrial tissue grows into the uterine muscle</p> Signup and view all the answers

    What is the primary purpose of chemotherapy in breast cancer treatment?

    <p>To interfere with cell replication and reduce the size of the tumor</p> Signup and view all the answers

    Match the following types of breast cancer treatments with their descriptions:

    <p>Radiation Therapy = Used to destroy the tumor or prevent recurrence Chemotherapy = Interferes with cell replication and targets rapidly dividing cells Hormonal Therapy = Blocks estrogen to reduce tumor growth Monoclonal Antibody Therapy = Targets HER2 positive breast cancer with trastuzumab</p> Signup and view all the answers

    Study Notes

    Amenorrhea

    • Absence of menstrual flow
    • Normal before puberty, after menopause, during pregnancy, and sometimes during lactation
    • Primary amenorrhea: Menarche has not occurred by age 17-18 years old
    • Secondary amenorrhea: Menarche has occurred, but flow has ceased for at least 6 months, excluding normal conditions like pregnancy
      • Caused by frequent exercise, low body fat, emotional disorders, pituitary tumors, hyperactive thyroid gland, polycystic ovarian syndrome, and medications (hormones, chemotherapy)
    • Other symptoms include weight gain or loss, hormonal changes (breast discharge, increased hair growth, etc.)
    • Diagnostics involve confirming the absence of pregnancy, pelvic exams, serum hormonal levels, imaging studies (CT/MRI/US), and genetic testing if indicated
    • Medical management focuses on treating the underlying cause. Hormone replacement therapy (HRT) may be needed.

    Dysmenorrhea

    • Uterine pain with menstruation, also known as "menstrual cramps"
    • Primary dysmenorrhea: Pain is not related to pelvic disorders or diseases and begins when ovulatory function is established. Discomfort/pain usually starts at the time of menstruation or 1-2 days prior
    • Secondary dysmenorrhea: Painful menstruation linked to pelvic disorders, such as endometriosis, fibroids, STIs, PMS, adenomyosis, endometrial polyps, pelvic inflammatory disease, and the use of an intrauterine contraceptive device.

    Breast Cancer (Stages)

    • Stage 0: Carcinoma in situ, no spread to nearby tissue
    • Stage I: Tumor size less than 2 cm, no spread to lymph nodes, no metastasis to other organs
    • Stage IIA: Tumor size between 2 cm and 5 cm and involves 1-3 lymph nodes. No metastasis to other organs.
    • Stage IIB: Tumor size greater than 5 cm OR involves 4-9 lymph nodes. No metastasis to other organs
    • Stage IIIA: Tumor size greater than 5 cm and involves 3-10 lymph nodes. No metastasis to distant organs
    • Stage IIIB: Tumor regardless of size has spread to the chest wall or skin. Lymph node involvement but no distant organ involvement.
    • Stage IIIC: Same as IIIB, except more than 10 lymph nodes are involved.
    • Stage IV: Tumor of any size, with nodal involvement and metastasis to distant organs.

    Surgical Interventions for Breast Cancer

    • Lumpectomy: Conserves the breast by removing a circumscribed area along with the tumor. Usually performed when the tumor is small and located on the peripheral area of the breast (Stage 1 tumor). Includes removal of axillary lymph nodes and preservation of the nipple.
    • Simple Mastectomy: Removal of the entire breast with skin flap retained to cover the area. Both pectoralis major and minor muscles remain intact. Option of breast reconstruction afterward.
    • Modified Radical Mastectomy: Performed if tumor is 4 cm or larger, invasive, or in the patient's best interest. Overlying skin, nipple, and pectoralis minor muscle are removed. Samples of axillary lymph nodes and fascia are also removed. Pectoralis major remains intact.

    Radiation Therapy for Breast Cancer

    • Used to destroy the tumor.
    • Can be the primary treatment or used with surgery to prevent recurrence, shrink large tumors to an operable size, or as palliative treatment for pain caused by local recurrence and metastasis.
    • Usually started 2-3 weeks after surgery when the arm can be raised without harming the surgical wound.
    • External beam radiation: High-energy protons delivered externally, 5 days a week for 5-6 weeks. Potential side effects include fatigue, erythema, pruritus, dryness, infection, or pain.
    • Internal radiation (implant radiation or brachytherapy): Radioactive seeds are inserted into the breast after tumor removal, delivering concentrated radiation directly to the site where cancer is most likely to recur.

    Chemotherapy for Breast Cancer

    • Typically required for those with lymph node involvement or metastasis to distant organs.
    • Chemotherapy drugs reduce the size or slow the growth of cancer by interfering with the cell replication process.
    • Affects both malignant and normal cells, but rapidly multiplying cells (hematopoietic system, hair follicles, GI system) are most affected.
    • Common adverse effects include bone marrow suppression, nausea/vomiting, alopecia, weight gain, mucositis, and fatigue.

    Hormonal Therapy for Breast Cancer

    • Removes or blocks the source of estrogen, promoting tumor regression.
    • Requires determining the receptor status.
    • Achieved by inactivating hormone-secreting glands, surgical removal of ovaries, radiation therapy, or drug therapy to induce estrogen deprivation.
    • Used to treat recurrent or metastatic cancer and as an adjunct to primary treatment.
    • Other medications like bisphosphonates are being used to delay bone metastases and reduce skeletal problems in those with advanced breast cancer.

    Monoclonal Antibody Therapy for Breast Cancer

    • Trastuzumab (Herceptin) is used for metastatic breast cancer patients who are HER2 antigen positive.

    Ovarian Ablation for Breast Cancer

    • Achieved through bilateral oophorectomy combined with drug therapy.

    Bone Marrow & Stem Cell Transplantation for Breast Cancer

    • Used to treat patients with advanced metastatic breast cancer.
    • Autologous (self) bone marrow or stem cell transplantation combined with high-dose chemotherapy.

    Nursing Interventions for Breast Cancer Patients

    • Active role as a listener, reinforcing information from the health care provider (HCP), encouraging the patient to express concerns and feelings about surgery and treatment.
    • Provide emotional support and preparation for anticipatory grieving over the loss of a body part.
    • Assess and identify members of the patient's support system, referring to support groups (e.g., Reach for Recovery).
    • Build a therapeutic relationship with the patient and family, openly discussing fears.
    • Postoperative care for radical mastectomy patients includes:
      • Usual postoperative nursing care.
      • Maintenance of drains (JP or hemovac).
      • Monitoring for bleeding as large vessels were involved.
      • Positioning patient at 45-degree Fowler's to promote drainage when stable.
    • Monitor for incisional pain and during arm exercise. Patient may experience numbness and referred pain in the shoulder or back.
    • Provide pain management and wound care as indicated and ordered.
    • Instruct patients on isometric exercises or refer to physical therapy to increase circulation, prevent lymphedema, and prevent muscle contractures.
    • Provide interventions for body image acceptance, assisting patients in finding coping mechanisms and including them in dressing changes and incision cleaning to help them accept the changes.
    • Enable breast prosthesis if authorized by the HCP, ensuring a proper fit with assistance from a skilled fitter.

    Patient Teaching for Breast Cancer Patients

    • Encourage coughing, deep breathing, and early ambulation.
    • Teach patients to elevate the affected arm on a pillow, ensuring the hand and wrist are higher than the elbow, and the elbow is higher than the shoulder joint. This facilitates lymphatic and venous fluid flow and prevents lymphedema.
    • Instruct patients to avoid procedures involving the arm on the affected side (BPs, IV infusions, blood draws) as these can cause edema or infection. Encourage the use of an ID bracelet on the affected arm.
    • Explain the lowered defense mechanisms due to lymph node removal and the need to guard against infections from burns, needle pricks, and gardening injuries.
    • Refer to physical therapy to control lymphedema if it develops.
    • For the affected arm:
      • Avoid lifting heavy objects for 6-8 weeks.
      • Avoid sleeping on the affected side.
      • Wear non-restrictive clothing.
      • Avoid wearing bracelets or watches.
    • Follow a low sodium diet, take diuretics if prescribed, and wear elastic stockinette if indicated to prevent edema.
    • For severe lymphedema, a knit compression sleeve or pneumomassage sleeve with automatic inflation/deflation can be ordered.

    Breast Reconstruction

    • Benefits include avoiding an external prosthesis, greater choice of clothing, loss of self-consciousness about appearance, improved self-esteem, and a renewed sense of wholeness.
    • Goals of reconstruction are to choose the simplest type that meets the patient's needs and expectations, and to match the opposite breast in size, shape, and contour.
    • Can be performed immediately after surgery or later.
    • Breast implants can be placed under the pectoralis major.
    • Musculocutaneous flap procedure: Used for patients who have had the pectoralis major removed. A musculocutaneous flap is removed from elsewhere in the body, and an implant may also be placed to reconstruct the breast. Potential complications include bleeding, hernia, and infection.
    • Nipple reconstruction: Usually performed as a separate procedure after breast reconstruction. Nipples can be constructed from available sites or harvested tissue. Newer procedures may use a sutured tuck and a tattoo for the areola.

    Prognosis for Breast Cancer

    • Metastasis occurs through the lymphatic system and bloodstream.
    • 5-year survival rate for localized breast cancer is close to 100%.
    • Once the cancer is metastatic, the survival rate drops to 22%.

    Amenorrhea

    • Absence of menstrual flow
    • Normal before puberty, after menopause, during pregnancy, and sometimes during lactation
    • Primary Amenorrhea: Menarche has not occurred by age 17-18 years old
    • Secondary Amenorrhea: Menarche has occurred, but flow has ceased for at least 6 months
      • Excludes normal conditions such as pregnancy
      • Can be caused by frequent exercise, low body fat, emotional disorders, pituitary tumors, hyperactive thyroid gland, polycystic ovarian syndrome, and medications (hormones, chemotherapy)
    • Other symptoms: weight gain or loss, hormonal changes – breast discharge, increased hair growth, etc.
    • Diagnostics: confirm absence of pregnancy first. Then pelvic exam, serum hormonal levels, imaging studies (CT/MRI/US), genetic testing if indicated.
    • Medical management: treat underlying cause. HRT may be needed.

    Dysmenorrhea

    • Uterine pain with menstruation; “menstrual cramps”
    • Primary Dysmenorrhea: pain is not related to pelvic disorders or diseases and begins when ovulatory function is established. The discomfort/pain begins at the time of menstruation or 1-2 days prior.
    • Secondary Dysmenorrhea: painful menstruation linked to pelvic disorders, such as endometriosis, fibroids STIs, PMS, adenomyosis, endometrial polyps, pelvic inflammatory disease, and maybe even the use of an intrauterine contraceptive device.

    Breast Cancer

    • Staging:

      • Stage 0: In situ carcinoma, cancer does not spread beyond the duct or lobule,
      • Stage I: Tumor <2cm and does not involve lymph nodes.No metastasis to distant organs.
      • Stage IIA: Tumor 2cm and involves 1-3 lymph nodes.No metastasis to distant organs.
      • Stage IIB: Tumor 2-5 cm and involves 1-3 lymph nodes.No metastasis to distant organs.
      • Stage IIIA: Tumor > 5 cm and involves 3-10 lymph nodes.No metastasis to distant organs.
      • Stage IIIB: Tumor regardless of size has spread to chest wall or the skin.Lymph node involvement, but no distant organ involvement.
      • Stage IIIC: Same as IIIB except more than 10 lymph node involvement.
      • Stage IV: Tumor of any size, with nodal involvement and metastasis to distant organs.

    • Surgical Interventions:

      • Lumpectomy: Conserves the breast by removal of a circumscribed area along with the tumor. Usually done when the tumor is small and located on the peripheral area of the breast. (Stage 1 tumor)
        • Axillary nodes often removed as well.
        • Nipple is preserved.
        • Breast contour and muscle support are preserved if possible. Usually followed by 6 weeks of radiation therapy.
      • Simple Mastectomy: The removal of the entire breast. Skin flap is retained to cover the area. Both pectoralis major and pectoralis minor muscles left intact. Option of breast reconstruction afterwards.
      • Modified Radical Mastectomy: Performed if the tumor is 4cm or larger, invasive, or if in the patient’s best interest. Overlying skin, nipple, and pectoralis minor muscle are all removed.
        • Samples of axillary lymph nodes and fascia are also removed.
        • Pectoralis major remains intact.

    • Radiation: Used to destroy the tumor

      • May be primary treatment or with surgery to prevent reoccurrence, to shrink large tumor to operable size, or as palliative treatment for pain caused by local recurrence and metastasis.
      • Usually started 2-3 weeks after surgery, when the arm can be raised without harming the surgical wound.
      • External beam radiation: External beam of high energy protons, done 5 days a week for 5-6 weeks. Patient may have fatigue, erythema, pruritus, dryness, infection, or pain. Skin has a literal burned appearance.
      • Internal radiation (implant radiation or brachytherapy): Radioactive seeds are inserted into the breast after tumor removal and emit a high dose of concentrated radiation directly to the site where cancer is most likely to recur.

    • Chemotherapy:

      • Typically required for those with lymph node involvement or metastasis to distant organs.
      • Chemotherapy drugs reduce the size or slow growth of cancer. Most chemotherapeutic agents work by interfering in the cell replication process.
      • Both malignant and normal cells are affected by chemotherapy!
      • Cells that multiply rapidly (hematopoietic system, hair follicles, GI system) are affected the most.
      • Common adverse effects include bone marrow suppression, nausea/vomiting, alopecia, weight gain, mucositis, and fatigue.

    • Hormonal Therapy: Removes or blocks the source of estrogen, thus promoting tumor regression.

      • Receptor status must first be determined.
      • Drugs to inactivate the hormone-secreting glands can be administered.
      • Ovaries can be removed by surgery, radiation, or drug therapy to cause estrogen deprivation.
      • Hormonal therapy is used to treat recurrent or metastatic cancer but also as an adjuvant to primary treatment.
      • Other medications, such as bisphosphonates, are being used to delay bone metastases and reduce the occurrence of skeletal problems in those with advanced breast cancer.

    • Monoclonal antibody therapy: Trastuzumab (Herceptin) for metastatic breast cancer patients who are HER2 antigen positive.

    • Ovarian ablation through bilateral oophorectomy with combination drug therapy.

    • Bone marrow & stem cell transplantation:

      • Used to treat patients with advanced metastatic breast cancer
      • Autologous (self) bone marrow or stem cell transplantation combined with high-dose chemotherapy

    Nursing Interventions

    • Play an active role as a listener, reinforce information provided by the HCP, encourage the patient to verbalize concerns and recognize feelings about surgery and treatment.
    • Provide emotional support and prepare for anticipatory grieving for the loss of a body part.
    • Assess and identify members of the patient’s support system. Refer to support groups (ex.Reach for Recovery).
    • Establish a therapeutic relationship with the patient and family and support group; openly discuss the patient’s fears.
    • For those with radical mastectomy – Usual post-operative nursing care: maintenance of drains (JP or hemovac), monitor for bleeding since large vessels were involved, place at 45-degree Fowler’s to promote drainage when stable.
    • Monitor for pain at the incision and during arm exercise. Patient may also have numbness and referred pain in the shoulder or back.
    • Provide pain management and wound care as indicated and ordered.
    • Instruct the patient on isometric exercises or refer to physical therapy to increase circulation, prevent lymphedema, and prevent muscle contractures.
    • Provide interventions for body image acceptance. Assist the patient in finding helpful coping mechanisms. Include the patient in dressing changes and incision cleaning to make the absence of the breast real. Advise the patient that it takes time to accept the loss and to heal emotionally and physically.
    • Enable breast prosthesis if authorized by the HCP. Ensure proper fit of prosthesis and brassiere, preferably from a skilled fitter from a reliable company.

    Patient Teaching

    • Encourage coughing/deep breathing, early ambulation.
    • Teach the patient to elevate the affected arm on a pillow with the hand and wrist higher than the elbow, and the elbow higher than the shoulder joint. This facilitates the flow of lymphatic and venous fluid and prevents lymphedema.
    • Instruct not to have procedures involving the arm on the affected side (BPs, IV infusions, blood draws) which can cause edema or infection. Encourage to wear an ID bracelet on this arm.
    • Guard against infections from burns, needle pricks (sewing), and gardening injuries because defense mechanisms are lessened due to lymph node removal.
    • Refer to physical therapy to control lymphedema if it develops.
    • For the affected arm: Avoid lifting heavy objects 6-8 weeks, avoid sleeping on it, wear nonrestrictive clothing, no bracelets, or watches.
    • Follow a low sodium diet, take diuretics (if prescribed), and wear an elastic stockinette (if indicated) to prevent edema.
    • For severe lymphedama, a knit compression sleeve or pneumomassage sleeve with automatic inflation/deflation can be ordered.

    Breast Reconstruction

    • Benefits include the avoidance of an external prosthesis, greater choice of clothing, and loss of self-consciousness about appearance. Helpful in improving self-esteem and renewed sense of wholeness.
    • Goals for reconstruction are to select the simplest type that meets the patient’s needs and expectations, and to match the opposite breast in size, shape, and contour.
    • Can be performed immediately after surgery or later.
    • Breast implants can be placed under the pectoralis major.
    • Musculocutaneous flap procedure: For patients who have had the pectoralis major removed. A musculocutaneous flap is removed from elsewhere in the body and an implant (if needed) is also placed to reconstruct the breast. Complications include bleeding, hernia, and infection.
    • Nipple reconstruction: Usually performed as a separate procedure after breast reconstruction. Nipples can be constructed from available site or harvested tissue. Newer procedures may use a sutured tuck and a tattoo for the areola.

    Prognosis

    • Metastasis is by the lymphatic system and bloodstream.
    • 5-year survival rate for localized breast cancer is close to 100%. Once the cancer is metastatic, it drops to 22%.

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    Description

    This quiz covers the definitions and causes of amenorrhea and dysmenorrhea. It explores primary and secondary amenorrhea, along with symptoms, diagnostics, and management. Prepare to test your knowledge on menstrual health and related disorders.

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