Reproductive Health Concerns Updates Outline Complete PDF

Reproductive System Concerns  Breast Examination Clinical Breast Exam  Done by a health care professional  Every three years for women ages 20 to 39  Yearly for women ages 40 and older  Do NOT forget axilla Includes inspection and palpation and compression of the nipple. Breas...

Reproductive System Concerns  Breast Examination Clinical Breast Exam  Done by a health care professional  Every three years for women ages 20 to 39  Yearly for women ages 40 and older  Do NOT forget axilla Includes inspection and palpation and compression of the nipple. Breast Examination A few different ways Breast exam Self breast exams Clinical breast exams ⅛ women breast cancer in lifetime Early diagnosis is key  Breast Cancer vs. FCBD: Is there a difference in exam? Fibrocystic breast Cancerous tissue exam  Fixed   Painless Mobile   Tissue retraction Tender   Abnormal breast shape Do not cause skin retraction   Skin dimpling Regular margins  Nipple retraction  Unilateral mass Breast Cancer vs. FCBD Major of breast lumps found by person or partner fibrocystic breast disease Most Common benign noncancerous disease Can’t exercise for 1 week during PMS Cancerous tissue Skin could be orange peel like  Breast Cancer  Most common cancer in women/feared most  2nd leading cause of deaths from cancer (lung is first)  1:3 cancer diagnosed in the US is breast cancer  New case every 2 minutes  1:8 women will be develop sometime during lifespan  >1% of men develop breast cancer  Age-related risk:  30-40 1:262  40-50 1:68  50-60 1:36  60-70 1:27 Breast Cancer #1 Risk factor for developing cancer is advanced age 75% of breast cancer is random Risk of breast cancer increases risk Genetic components to breast cancer, aren’t most important  Breast Cancer: Are you at risk? White women over age 35 in the U. S. African American women under 35 in the U. S. African American women have higher incidence of dying from breast cancer *fast growing tumors *tend to be diagnosed at a more advanced stage Early menarche ( 55yrs) Nulliparity or first pregnancy after 35 years of age Previous h/o breast cancer (self and family) Family history of other cancers Long term hormone replacement therapy Breast Cancer Risk Black women higher risk b/c access Some tumor forms=estrogen dependent Stop in fluctuation of estrogen happens during pregnancy, lowers risk of breast cancer Family members w/ colon cancer= increased breast cancer risk BRCA1 and BRCA2 = increased risk for breast,ovarian cancer  Breast Cancer: Are you at Risk? Mutations in BRCA1 and BRCA2 genes are responsible for most familial breast cancers CHEK-2 gene mutation is responsible for breast cancer in BOTH men and women Offers for Gene positive for breast cancer Close observation, mastectomy Removal of ovaries When gene positive Sees genetic counselor  Breast Testing Mammogram 10 minute procedure  Screening age 40,( US Task Force just changed this recommendation)  Every 1-2 years after that  Detects lesions as small as 0.5 cm (SBE detects 2.5 cms)  Uncomfortable not unbearable B. Ultrasound: cystic areas C. MRI: questionable areas/common with implants D. Fine needle aspiration: tissue/fluid diagnosis If risk for breast cancer Ultrasound Breast Testing MRI Screen for cancer using mammogram 40-50 screening every 2 years To be diagnosed with breast cancer, 50 and up screening every year cancerous cells must be analyzed/present Breast cancer only diagnosed w/biopsy  Mammography Teaching points  Schedule after menses to reduce breast tenderness  No deodorant or powder day of the procedure (shadows)  Tylenol for pain  Leave neck jewelry at home  Facility accredited by American College of Radiology Mammography Done once a year 1 week after menstruation Powder/Deodorant can look like calcifications Non-accredited locations not good, will miss cancer  SBE SBE Any patient abnormality should be 2 different ways to feel breast reported to provider Spokes of a bike, start at nipple (tenderness,redness, swelling) Start in circle, go until nipple 6 months after breastfeeding should be no discharge Should be done every month after puberty  Pelvic Exam External organs Speculum Exam Pap Smear Cervical Cultures/STI testing Bimanual Exam (internal organs) Rectal Exam (only when indicated) Pap smear Average age for pelvic exam=15 years old Begins at 21 test for cervical cancer 2 parts to pap smear Most effective test for cancer Dna for hpv Screening & diagnostic Bi manual examination (provider feeling organs)  Speculum Examination Bivalve speculum to inspect the vagina and cervix (metal/plastic), first when sexually active Size, shape, color of cervix Lesions, discharge, lacerations Pap test: age 21 What does a Cervix look like? Gyn Examination Gyn Examination Ovaries should be walnut sized If felt they are enlarged,probably cancerous  Pap Test Detect changes in the cervix before cervical cancer develops (precancerous conditions) Human Papilloma Virus ( HPV ) testing Cervical cell sampling done via speculum exam Cervical slide with fixative/liquid pap test Pap Test Done w/ brush Cervical cancer grows slowly  Cervical Cancer Statistics Third most common reproductive cancer 70% are caused by HPV 0.4% of all female deaths Highest in Hispanic women Average age :40-50 years 1 out of 50 cancer related deaths Incidence has decreased by 70% since 1940 Great disparities within the U.S among women in Cervical Cancer rates (ie. health care access, underinsured or uninsured) Cervical Cancer Slow growing cancer  Risk factors for cervical cancer Early age of first coitus Multiple sexual partners (more than 2) High parity Low socioeconomic status Long term oc use Smoking Highest mortality rates in AA population, highest incidence in hispanic population Risk Factors for Cervical Cancer #1 risk factor for cervical cancer= early onset of sexual intercourse Long term oral contraceptive use **Idea for unilateral network connecting patient lab results nationally**  Screening for cervical cancer Pap : detects 90% of cervical changes Begins age 21 Women age 21-29: every 3 years Women 65 or older: with 3 negative HPV can stop Management of cervical cancer: depends on stage o Colposcopy o Radiation o surgery Screening for Cervical Cancer Over 65 with 3 negative pap smears mean no more pap smears 3 years most likely means patient will extend to 6 years or more  Cancer of the Uterus Most common form of cancer of the reproductive system Age: 50-65 Risk factors: o Obesity o Nulliparity o Late onset menopause o Family hx of breast , ovarian cancer, colorectal o Slow growing: usually good prognosis Risk Factors for Uterine Cancer Cancer of the Uterus Pear shaped Cancer in the body the uterus Over 50 Most common form of cancer in uterus white Most important factor=diagnosing early Nulliparous Most uterine cancer=good prognosis Uterine Cancer-Treatment TAH Total abdominal hysterectomy  Treatment Surgical: o TAH o BSO o Radiation o Radical hysterectomy o Chemo o Depo o tamoxifen  Ovarian Cancer Second most frequent occurring cancer of reproductive system. Whisper cancer: symptoms are vague Most likely originates in the fallopian tubes Dg late stage Risk factors: o Nulliparity o Family history of breast and ovarian ca o BRCA1 and BRCA2 o HRT use o ? Talc powder, high fat diet, fertility drugs Ovarian Cancer Whisper cancer b/c symptoms vague Quick growing Mostly fatal, low 5 year survival rate CA125 Blood test for ovarian cancer Ovarian Cancer symptoms If elevated can indicate risk for ovarian Can't button pants cancer Constipation Diarrhea Ovarian Cancer-Risk Factors Nulliparous  Testicular Cancer: Treatable Cancer: 90% cure rate Most common between ages 15-40 Biggest risk: o undescended testicle o Born with penis abnormalities o Male with HIV Testicular Cancer Highly treatable “Young man’s cancer” Risk Factors- Testicular Cancer Penis abnormalities (no opening on meatus) Screening 1x month Feeling for lumps,bumps, swelling and changes Testicular Cancer Menstrual Cycle Disorders Menstrual Cycle Disorders #1 reason for reproductive health help= menstruation problems  Amenorrhea: Absence of menses Amenorrhea  Primary:  Absence of menstruation w/o secondary sexual characteristics  Etiology: Multiple causes  Weight gain or loss / anorexia  Congenital abnormalities  Sports / excessive exercise  Medical conditions: Cushing’s disease, polycystic ovaries, cystic fibrosis, hypothyroidism  Pregnancy  Secondary  Absence of menses x 3 cycles or 6 months in women who have previously menstruated regularly  Etiology – many of the same / most likely is pregnancy, breast feeding, malnutrition, chemo or secondary= have period but no period anymore radiation, some medications, early menopause Higher risk of developing osteoporosis All girls should have period by 16 Amenorrhea Absence of period Secondary amenorrhea Send off urine or serum HcG first #1 reason is pregnancy Pregnancy until proven otherwise primary=girl not having period Treatment-Amenorrhea Potential disease process #1 treatment is oral contraception; beginning point Analyze weight as reason why: psychological anorexia, medical anorexia  Amenorrhea Assessment  History & physical  Labs : pregnancy test, hormone levels  Treatment Based on the underlying cause Oral contraceptives Meds to correct lab findings (i.e. thyroid medication) Nursing management  Education: diverse causes, effect on sexuality, purpose & procedure of each test & when the results will be available  Counseling: Nutritional counseling – eating disorders are common Turner syndrome Uterus and vagina not connecting  Dysmenorrhea  Dysmenorrhea: painful menstruation = CRAMPS  Etiology  increased prostaglandins causing painful uterine contractions  Clinical manifestations: debilitating painful periods  Assessment: detailed gyn history & sexual history Treatment: pain relief, treat infections, specialized studies Nursing management o Education : increase exercise, limit salt, stop smoking, lose weight, stress reduction / relaxation o Counseling @ medication usage, lifestyle changes Dysmenorrhea Severely painful periods Prevent women from daily activities Treatment-Dysmenorrhea Oral contraceptives Lifestyle changes  Premenstrual Syndrome (PMS)  Premenstrual syndrome: wide range of symptoms that begin the 2 nd half of cycle & resolve with onset of menstruation  Etiology: unknown ; perhaps hormonal, maybe serotonin  Clinical manifestation: irritability, tension, dysphoria  Diagnosis: one of the following affective & somatic symptoms during the 5 days before menses in each of the previous 3 cycles  Affective: depression, angry outbursts, irritability, anxiety  Somatic: breast tenderness, abd bloating headache, edema  Symptoms relieved days 4-13 of the cycle Premenstrual Syndrome (PMS) Irritability; mental abnormality related to hormonal imbalance Symptoms must be present 2 weeks before getting period Treatment-PMS Antidepressants 2 weeks before period  PMS – health promotion education  Lifestyle changes  Reduce stress (meditate, exercise, spiritual nourishment, good nutrition, limit caffeine & alcohol, stop smoking)  Vitamins & minerals  Daily multivitamin  Medications: based on provider recommendations  Alternative therapies: Acupuncture/ acupressure; massage; homeopathy; therapeutic touch; tai chi Education, Promotion-PMS Decrease caffeine Yoga Exercise  Endometriosis  The most common gyn disease  Incidence:30-45% in infertile patients o 5-15% in reproductive age  Functioning endometrial tissue outside the uterus  Respond to normal hormonal cycles (cramp / bleed)  Etiology unknown Endometriosis How to know if patient has endometriosis? Can't get pregnant Severe pelvic pain Diagnosed based of laparoscopy  Endometriosis  Chronic & progressive disease  Symptoms include  Infertility  Menstrual problems  Dysmenorrhea & Hypermenorrhea (very heavy periods)  Irregular, frequent menses, mid-cycle spotting  Dyspareunia  Painful urination & painful bowel movements  Chronic pelvic pain (pelvic adhesions) Do not trivialize the symptoms early recognition is the key to preserving fertility Endometrial cells slough off and place in bladder,pelvis,ovaries Most common reason for infertility  Endometriosis  Treatment: suppress estrogen & progesterone  Surgery  Remove endometrial lesions / reduce pain & preserve fertility  Hysterectomy – eliminate pain but total loss of fertility  Medications  NSAIDS  Oral contraceptives, progestins Treatment-Endometriosis Oral contraceptives NSAIDS Symptoms-Endometriosis Painful urination Painful sex  Fibroids Fibroids Benign tumors grown in urinary tract watermelon or golf ball size Treatment  Treatment Goal: symptom relief reduction of tumor size Medications Surgery  Uterine artery embolization: disrupts fertility  Myomectomy: remove the fibroid  Laser surgery: can cause adhesions / further pain  Hysterectomy: remove the uterus  2015: no longer use laparoscopic surgery with morcelator  Menopause Climacteric/Peri Menopause o Transitional period when ovarian function and hormone production decline o May span 10-15 years Menopause o Refers to the last menstrual period Dates with certainty after one full year without menses o Average age 51.4 (35-60) Menopause Menstrual cycle stops Peri-menopause occurs 10-15 years before menopause onset  Menopause Physical Changes o Alteration in menstrual pattern o Vasomotor instability-hot flashes and night sweats (usually begin in perimenopause) o Urogenital atrophy-d/t loss of estrogen o Skin changes- pigment change (hypo or hyper) o Thinning of skin, decrease in scalp, pubic, and axillary hair o Increased bone loss-osteoporosis Psychological Symptoms o Change in mood o Libido changes o Insomnia Menopause and Bone Loss Menopause and Bone Loss Kyphosis caused by lack of estrogen  Menopause Physical affects  Cardiovascular: increased risk of cardiovascular disease  Skeletal: loss of bone density (osteoporosis)  Breasts: increase fat tissue w/ loss of glandular tissue  Genitourinary: vaginal dryness, stress incontinence  GI : poor calcium absorption, increased risk of fractures  Integumentary: Decreased collagen levels, skin thins  Body shape: increased waist size & increased abdominal fat stores Menopause #1 killer of aging women is CVA (heart attack, stroke) Symptoms present differently in men vs. women Estrogen Diagram To prescribe aging patient estrogen, pt must say they have hot flashes If pt has clotting risk, must be transdermal use only Estrogen can be taken lifelong  Menopause: Assessment & Treatment  Screen for  Lifestyle changes  Osteoporosis  Diet  HTN & cardiac disease  Exercise  Pap smears  Use of fans  Regular mammograms  Layer clothing  Colon cancer  Stop smoking  Bone density  Limit alcohol  Regular gyn care  Calcium: 1200 – 1500 mg/d  Vitamin D: 400 – 600 IU  Relaxation / spiritual care / Menopause yoga / meditation Increase vitamin D Adequate nutrition is key  Menopause Counseling o Nutrition o Aerobic and weight-bearing exercise o Contraception o Routine health assessment and screening o Sexual health o ?Hormone Replacement Therapy (HRT) Hormone Replacement Therapy HRT=hormone replacement therapy WHI= women’s health initiative that HRT causes breast cancer (study debunked incorrect); HRT may prevent breast cancer HRT=keeps vessels healthy, decreases osteoporosis Patches placed on skin for treatment