Well Woman Exam Study Guide PDF

2/3/21 WELL WOMAN D r. K e lli S te p h e n s o n C e rtifie d N u rse M id w ife a n d F a m ily N u rse P ra c titio n e r 1 ◦ Used interchangeably...

2/3/21 WELL WOMAN D r. K e lli S te p h e n s o n C e rtifie d N u rse M id w ife a n d F a m ily N u rse P ra c titio n e r 1 ◦ Used interchangeably Pap smear & ◦ Pap sm ear: collection of cervical cells during a speculum exam well woman ◦ W ell wom an exam : a head-to-toe exam of a wom an; including a clinical breast exam (CBE), which exam m ay or m ay NOT include a pap sm ear; and/or additional testing 2 Myths Facts Myths Facts ◦ Collection of cervical cells should ◦ Most women fall into the routine be done yearly on every woman. screening category for their age ◦ As soon as a woman becomes group sexually active, she should have a ◦ Regardless of age of sexual pap. intercourse, pap smears do not ◦ Well….women do not need to start until age 21. No exceptions! come in yearly at all anymore ◦ Most insurance companies cover an annual well woman exam 3 1  2/3/21 Resources ◦ ASCCP ◦ https://www.asccp.org/mobile-app ◦ iOS devices and Google devices $9.99 ◦ Web based application is free (must enter email) ◦ US Prevention Task Force App ◦ Available for free for iOS and Google devices ◦ Hollier Text ◦ Dunphy Text 4 Meet our first patient of the day ◦ Annie ◦ 21 years old ◦ CC: W ell W om an Exam ◦ BP 120/80 P82 T98.2 ◦ Weight 120lb Height 5’5” ◦ Not sexually active & declines need for testing ◦ Declines birth control 5 Clinical Breast Exam (CBE) Have patient lay flat with arm s above head Looking at: Tem perature -> unusually warm or Palpate both breasts & axillary cold? area using one of the three Tenderness -> any distinct areas of different patterns, tenderness? Circular or clockwise Size -> are the breasts W edge approxim ately the sam e size? (it is Vertical norm al for one breast to be slightly larger than the other) Tip: W hen charting abnorm al Shape -> are they both breast results: think of the breast approxim ately the sam e shape as a clock Surface -> any rashes, wounds, open areas, peeling or cracking skin, dim ples or divots, any unusual color changes 6 2  2/3/21 ◦ Bimanual exam: ◦ Ovaries & Fallopian tubes -> tenderness or enlargement ◦ Uterus -> tenderness or enlargement & position ◦ Bladder -> tenderness or prolapse ◦ Cervix -> cervical motion tenderness ◦ Speculum exam: The GU exam ◦ Exterior -> any rashes, lesions, atrophy ◦ Vagina -> any foreign body; redness; irritation; excessive discharge; tenderness; prolapse. ◦ Cervix -> any discharge; redness; friability; bleeding; IUD strings ◦ Rectal exam -> note lesions; bleeding; irritation 7 ANNIE’S PAP RESULTS 8 ASC-US – M ost com m on abnorm al finding atypical Can be a sign of infection, such as squam ous cells HPV or a vaginal infection of unknown M ay be a sign of inflam m ation significance Low horm ones in postm enopausal wom en M OST OFTEN BENIG N LSIL – low grade Can also be called m ild dysplasia Types of pap smear results squam ous Usually caused by HPV intraepithelial M ay go away without any treatm ent lesion but can som etim es lead to cancer ASC-H – This m ay be a sign of high-grade abnorm al lesions squam ous cells This can becom e cervical cancer if cannot rule out left untreated high grade 9 3  2/3/21 ◦ HPV 16 ◦ HPV 18 ◦ HPV HR (this usually includes at least 12 known HPV strains that has been linked to cervical cancer) 10 com p le te a p re g na ncy te st Uterine Bleeding (AUB) M a na g e m e nt ◦ Re g ula r cycle -> N SA ID s ◦ LUS (Le vonorg e stre l Re le a sing Syste m ) ◦ M ire na ◦ O C Ps ◦ Surg e ry: hyste re ctom y; a b la tion 15 5  2/3/21 Amenorrhea Prim ary and Secondary: ◦ M ost com m on reason is PCOS Treatm ent: ◦ Depends largely on cause ◦ M ay include: ◦ OCPS ◦ M edication such as Clom id for pregnancy 16 ◦ M ost com m on is lum p in breast ◦ Age can vary ◦ Com m only found in wom en on HRT or OCPs ◦ M ay note one during certain points in Breast m enstrual cycle concerns ◦ M ost often they are benign in nature ◦ Fibrocystic or mammary dysplasia ◦ W om en and fam ily highly anxious 17 Tenderness Symptoms Rapid changes in size May see redness, dimpling, peeling 18 6  2/3/21 ◦ Difficult to tell between cancer or cysts ◦ Testing is necessary ◦ Mammogram Testing ◦ Ultrasound ◦ Breast biopsy 19 Treatment / self care Avoid Avoid trauma Wear Wear good fitting bras Eliminate Eliminate caffeine, HRT, OCPs, progesterone supplements Breast Stress importance of breast self awareness and CBE Awareness 20 ◦ Painful cram ping associated with at least one of the following ◦ Sweating; headaches; N/V/D; leg or back pain ◦ Can affect up to 90% of wom en in their lifetim e ◦ Prim ary: teen’s – 20’s -> no underlining reason Dysmenorrhea ◦ Secondary: 20’s – 30’s -> usually a pathology Treatm ent: ◦ Prim ary -> NSAIDs, OCPs heating pad; TENS unit; reassurance ◦ Secondary -> treatm ent depends on cause ◦ Refer to specialist 21 7  2/3/21 Menopause ◦ Spontaneous: no period for 12 months ◦ Perimenopause: menstrual cycle is abnormal, may have some s/s ◦ Premature menopause: risk for osteoporosis ◦ Primary ovarian insufficiency; risk for osteoporosis Treatment: ◦ Calcium and Vitamin D supplementation ◦ SSRIs ◦ HRT -> caution -> must use progesterone if patient has a uterus ◦ Cannot use with current, past or suspected breast cancer ◦ Estrogen sensitive malignancy ◦ Undiagnosed vaginal bleeding ◦ MenoPro Mobile App (Free) 22 Com m on findings ◦ Vaginal / vulvar changes ◦ Dry, irritated, painful sex, spotting or bleeding after sex ◦ Vaginal atrophy ◦ Thin, pale, decreased elasticity ◦ Bladder issues ◦ Increase in frequency and urgency ◦ Common to get UTIs GSM ◦ Incontinence Treatm ent ◦ Nonhorm onal treatm ents ◦ Horm onal treatm ents ◦ Local estrogen 23 Deloris 53 years old, LMP 8 months ago BP 138/80; Weight 145lb No significant family history Hx of lipid disorder SH: negative Follow up to menopausal signs and symptoms 24 8  2/3/21 Etiology is unknown ◦ Common feature is hypersecretion of androgens In adult women 2 of the 3 must be present for a diagnosis ◦ Hyperandrogenism ◦ Oligo—ovulation or anovulation ◦ Polycystic ovaries on ultrasound PCOS Treatment ◦ Depends on if pregnancy is desired Can be a lifelong disease 25 LS ◦ Irretractable itching ◦ Unknown cause ◦ Often m isdiagnoses for yeast infection, genital herpes ◦ Exam ◦ White wrinkle appearing plaques or patches, tissue is usually red around it Testing: punch biopsy; rule out coexisting vaginal infection Treatm ent: use ointm ent over cream 26 Vulvodynia -> vulvar pain x3 m onths with no cause ◦ Etiology is unknown M any wom en have issues with sexual intercourse Diagnosis Vulvodynia ◦ Based on exam and history and ◦ Rule out any co-existing conditions Dyspareunia Treatm ent -> pelvic floor therapy & referral to G YN ◦ Hollier pg 790-791 27 9  2/3/21 Yeast Infection ◦ M ost com m on cause of vaginal itching Exam : ◦ Thick discharge; thick white patches in vaginal m ucosa; usually no odor Testing ◦ KOH-prep Treatm ent ◦ Topical is available OTC; oral and topical m ay also be prescribed 28 References ◦ ASCCP Risk-Based m anagem ent consensus guidelines. (n.d.). ASCCP. https://www.asccp.org/Default.aspx ◦ Dunphy, W inland-Brown, Porter, & Thom as. (2019). Prim ary Care: Art and Science of Advanced Practice Nursing - An Interprofessional Approach (5th ed.). F.A. Davis Com pany. ◦ Hollier, A. D. (2018). CLINICAL G UIDELINES IN PRIM ARY CARE (3rd ed.). Advanced Practice Education Associates, Inc. ◦ Jordan, R. G., Engstrom , J., M arfell, J., & Farley, C. L. (2014). Prenatal and Postnatal Care (1st ed.). W iley-Blackwell. 29 10