Common GYN Disorders Student Copy PDF

Chapter 4 Common Gynecologic Issues  Common Menstrual Disorders Dysfunctional Dysmenorrhe uterine Amenorrhea a bleeding (DUB) Premenstrual Premenstrual...

Chapter 4 Common Gynecologic Issues  Common Menstrual Disorders Dysfunctional Dysmenorrhe uterine Amenorrhea a bleeding (DUB) Premenstrual Premenstrual dysphoric syndrome Endometriosis disorder (PMS) (PMDD)  Menstrual disorders Infertility Common Female Contraception Reproductiv e Issues Abortion Menopause  Absence of menses during reproductive years Amenorrhe Two types of primary amenorrhea a #1 Absence of menses by age 14 with absence of development of secondary sexual characteristics Absence of menses by age 16 with normal development of secondary sexual characteristics Secondary amenorrhea: the absence of regular menses for three cycles or irregular menses for 6 months in females who have previously menstruated regularly  Therapeutic management Primary: involves the correction of any underlying disorders and estrogen replacement therapy Secondary: cyclic progesterone, treatment of hyperprolactinemia, Amenorrhe eating disorder, obesity, hypothalamic failure, hypothyroidism a #2 Nursing assessment Tanner stages of breast development Laboratory testing Nursing management Teaching Guidelines 4.2  Question #1 Primary amenorrhea Is the following occurs in females statement true or who have false? previously menstruated regularly.  Answer to Question #1 False Primary amenorrhea is the absence of menses by age 14 with the absence of secondary sexual characteristics, or absence of menses by age 16 with normal development of secondary sex characteristics. Secondary amenorrhea is the absence of menses for three cycles or 6 months in females who have previously menstruated  Painful menstruation Primary (spasmodic) Etiology and Types Increased prostaglandin of production (primary) Dysmenorr Secondary (congestive) hea Pelvic or uterine pathology (secondary) Endometriosis most common cause of secondary dysmenorrhea  Is the following statement true or false? Questio n #2 Endometriosis is the most common cause of secondary dysmenorrhea. Answer to Question #2 True Secondary amenorrhea is most commonly due to endometriosis. Primary amenorrhea is related to increased prostaglandin production. Nursing Management of Dysmenorrhea Nursing assessment Past medical history, sexual history, menstrual history; bimanual pelvic examination Manifestations: pain, nausea, vomiting diarrhea, fatigue, fever, headache, dizziness, bloating, water retention, weight gain, muscle aches, food cravings, breast tenderness Patient education Comfort measures: heat, lifestyle changes, pain relief Teaching Guidelines 4.3 Tips for Managing Dysmenorrhea Copyright © 2025 Wolters Kluwer. All rights reserved. 12 Abnormal Uterine Bleeding (AUB) #1 Painless endometrial bleeding that is prolonged, excessive, and irregular and not attributed to any underlying structural or systemic disease Similar to and may overlap with other uterine bleeding disorders Occurs most often at beginning and end of reproductive years Etiology related to hormone disturbance Treatment involves treating the underlying cause Nursing management involves patient education Abnormal Uterine Bleeding (AUB) #2 Therapeutic management: goal is to normalize the bleeding, correct the anemia, prevent or diagnose early cancer, and restore quality of life Pharmacotherapy or insertion of a hormone-secreting intrauterine system Surgical intervention: dilation and curettage (D&C), endometrial ablation, uterine artery embolization, or hysterectomy Nursing assessment Nursing management Clinical Judgment & Nursing Process 4.1 Premenstrual Syndrome (PMS) Wide range of recurrent symptoms More severe variant: premenstrual dysphoric disorder (PMDD) Etiology: unknown Therapeutic management Multidimensional approach Vitamin supplements, diet changes, exercise, lifestyle, medications Treatment Options for PMS and PMDD Copyright © 2025 Wolters Kluwer. All rights reserved. 16 Categorizing Premenstrual Syndrome Symptoms Nursing assessment: irritability, tension, dysphoria (most prominent and consistent symptoms) A: anxiety C: craving D: depression H: hydration O: other ACOG criteria Mood disorders: main symptoms of PMDD  Question #3 When assessing a patient for premenstrual syndrome, which of the following would the nurse be least likely to find? a. Irritability b. Tension c. Dysphoria d. Weight loss  d. Weight loss Answer to Question #3 The patient with PMS typically reports weight gain, not weight loss, irritability, tension, and dysphoria  Etiology: risk factors; exact cause unknown Endometrio Therapeutic management Medication sis #1 Surgery therapy Nursing assessment: infertility and pain; nonspecific pelvic tenderness; tender nodular masses on uterosacral ligaments, posterior uterus, or posterior cul-de-sac Endometriosis #2 Nursing management oEducation oHealthy lifestyle habits oSupport groups  Primary or secondary Cultural expectations for reproduction Impact of culture, ethnicity, and religion Infertility on perceptions and management of infertility Multiple known and unknown factors affecting fertility Male and female risk factors Therapeutic management: drugs or surgery  Male factor assessment: semen analysis, sexual characteristics, external and internal reproductive organ examination, digital prostate Assessment examination Female factor assessment: ovarian function, pelvic organs Fertility Laboratory and diagnostic testing: home ovulation predictor kits, clomiphene citrate challenge test, hysterosalpingogram, laparoscopy Selected Treatment Options for Infertility Copyright © 2025 Wolters Kluwer. All rights reserved. 24 Nursing Management of Infertility Respect for couple Education, anticipatory guidance, stress management, counseling Assistance in decision making; advocacy Assistance with financial strategies  Contraception: Behavioral Methods Abstinence Fertility awareness Cervical mucus ovulation method Basal body temperature Symptothermal method Standard days method Withdrawal (coitus interruptus) Lactational amenorrhea method  Condoms Diaphragm Contracepti on: Barrier Methods Cervical cap Contraceptive sponge  Which method would the nurse identify as a barrier method of contraception? Question a. Basal body temperature #4 b. Transdermal patch c. Diaphragm d. Symptothermal method  c. Diaphragm Answer to Question #4 The diaphragm is a barrier method of contraception. Basal body temperature and the symptothermal method are fertility awareness methods. The transdermal patch is a hormonal method of contraception.  Oral contraceptives Injectable contraceptives Contracepti Transdermal patches on: Vaginal rings Hormonal Methods Implantable contraceptives Intrauterine contraceptives Emergency contraception  Sterilization for females Tubal A laparoscope is inserted; fallopian tubes are grasped Contracept ligation and sealed ion: Sterilizatio n Sterilization for males Usually performed under Vasecto local anesthesia Involves cutting the vas my deferens, which carries the sperm  Nursing Management of the Patient Choosing a Contraceptive Method #1 Nursing assessment oMedical history oFamily history oOB/GYN history oPersonal history oDiagnostic testing oPhysical examination Nursing Management of the Patient Choosing a Contraceptive Method #2 Nursing interventions oPatient/couple participation in decision making oPatient education Misconceptions Mechanism of action, advantages and disadvantages, danger signs to report Method failure and backup method  Surgical abortion Medical abortion Abortion Methotrexate followed by misoprostol Mifepristone followed by misoprostol  Brain: hot flashes; sleep, mood, and memory problems Heart: lower levels of HDL; increased risk of CVD Impact of Bones: bone density loss; increased risk of osteoporosis Menopau Breasts: duct and gland tissue replaced by fat se on the Genitourinary: vaginal dryness, stress Body incontinence, cystitis Gastrointestinal: less Ca+ absorbed; increased fractures Skin: skin dry, thin; collagen decreases  Menopausal Transition Nursing Nursing assessment Screening for osteoporosis, cardiovascular disease, and cancer risk management Health maintenance education; risk reduction Lifestyle to plan strategies to prevent Lifestyle modifications chronic conditions Stress management Questions… …..