NCM109 PRELIMS 1 TRANS (1).pdf

CARE OF MOTHER, CHILD, AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC) MENSTRUATION CALATI, KELLY KETH JANN MR. ALLAN PAOLO BLAQUERA, RN ATTENDANCE: SCHEDULE: BUENAVENTURA, NIÑO KAE C....

CARE OF MOTHER, CHILD, AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC) MENSTRUATION CALATI, KELLY KETH JANN MR. ALLAN PAOLO BLAQUERA, RN ATTENDANCE: SCHEDULE: BUENAVENTURA, NIÑO KAE C. 09/14-15 (Study Own Topic & Make Outline) CABAYA, DANIEL VAN DER S. CALATI, KELLY KEITH JANN R. 09/15 (First SGL) CALIGUIRAN, MARIA ERIKA C. 09/15 (Discuss for the Final Hypothesis of the CASTILLO, MICHELLE T. Pathophysiology) COLLADO, DIANA NICOLE D. 09/16-17 (Pathophysiology Making) CORTEZ, ELLYZA L. DAYAG, CEE JAR MARIE G. 09/18 (NCP Making) FABELLAR, AIDON JOSH B. 09/18 (Meet for Finalization of Pathophysiology and NCP) GADDAO, CRISTIAN REY I. 09/19 (Presentation of Pathophysiology and NCP) I. MENSTRUATION offer facts to facilitate communication. Suggestions to improve – woman’s monthly bleeding or regular discharging of care include overcoming language barriers, providing blood and other materials from the lining of the uterus. appropriate materials in the patient’s language, asking about – is the sloughing and discharge of the lining of the uterus traditional beliefs and dietary practices, and asking about (endometrium) if conception does not occur, happens fears regarding care. Patience, sensitivity, and a desire to about every 28 days during the reproductive years, learn about other cultures and groups will enhance the nursing although normal cycles can vary from 25 to 35 days. The care of all women. flow usually lasts 4 to 5 days, during which time 50 to 60 mL of blood is lost. II. MENSTRUAL PHASE (MENSTRUATION) PSYCHOSOCIAL CONSIDERATIONS Follicular phase (Day 1-13) Girls who are approaching menarche (the onset of – FSH secretion menstruation) should be educated about the normal – The lining of the uterus called endometrium process of the menstrual cycle before it occurs. becomes thicker in preparation for implantation of Psychologically, it is much healthier and appropriate to the fertilized egg. If fertilization does not take refer to this event as a “period” rather than as “being sick.” place, menstruation happens. The next cycle is With adequate nutrition, rest, and exercise, most women then about to begin. feel little discomfort, although some report breast tenderness and a feeling of fullness 1 or 2 days before Ovulation phase (Day 14) menstruation begins. Others report fatigue and some – LH secretion discomfort in the lower back, legs, and pelvis on the first – Released of oocyte day and temperament or mood changes. Slight deviations – The pituitary gland secretes a hormone that from a usual pattern of daily living are considered normal, causes the ovary to release the mature egg cell. but excessive deviation may require evaluation. Regular exercise and a healthy diet have been found to decrease Luteal phase (Day 15-28) discomfort for some women. Heating pads or nonsteroidal – Progesterone secretion anti-inflammatory drugs (NSAIDs) may be very effective – The follicle develops into a hormone-producing for cramps. For women with excessive cramping or structure called the corpus luteum (production of dysmenorrhea, referral to a women’s health care provider estrogen and progesterone). is appropriate; following evaluation, providers may prescribe oral contraceptive agents. A. TYPES OF IRREGULAR PERIODS 1. Amenorrhea (when period stops) CULTURAL CONSIDERATIONS – when a woman stops getting her menstrual cycle Culture refers to knowledge, beliefs, customs, and values for three or more months. acquired as members of a racial, ethnic, religious, or social – amenorrhea means the woman is not ovulating group. The United States is becoming more culturally diverse. and has infertility. Various aspects of culture affect many health care encounters, and these encounters can be positive if nurses 2. Oligomenorrhea (infrequent periods) understand the various cultures of their patients. – menstrual cycle length of greater than 35 days. CULTURAL VIEWS AND BELIEFS ABOUT 3. Menorrhagia (heavy or prolonged menstrual bleeding) MENSTRUATION DIFFER. – caused by hormone problems, problems with the Some women believe that it is detrimental to change a pad or uterus and other health conditions. tampon too frequently; they think that allowing the discharge – It can cause infertility. to accumulate increases the flow, which is considered desirable. Some women believe they are vulnerable to illness 4. Metrorrhagia (irregular vaginal bleeding) during menstruation. Others believe it is harmful to swim, – vaginal bleeding that occurs at irregular times not shower, have their hair “permed,” have their teeth filled, or eat associated with the menstrual cycle. It’s similar to certain foods during menstruation. They may also avoid using a regular menstruation cycle but does not contraception during menstruation. represent a normal period. In such situations, nurses are in a position to provide women with facts in an accepting and culturally sensitive manner. The objective is to be mindful of these unexpressed, deep-rooted beliefs and to provide the facts with care. Aspects of gynecologic problems cannot always be expressed easily. The nurse needs to convey confidence and openness and to  POTENTIAL CAUSES OF IRREGULARITIES IN MENSTRUATION 1. Extremely low levels of body fat, which can be caused by malnourishment, extreme physical training, or eating disorders. 2. Endometriosis 3. Obesity 4. Polycystic ovary Syndrome (PCOS) 5. Sexually transmitted diseases (STDs) and pelvic inflammatory disease (PID) 6. Side effect of certain medications, such as birth control pills 7. Stress 8. Uterine fibroids or uterine polyps  CARE OF MOTHER, CHILD, AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC) INFERTILITY COLLADO, DIANA NICOLE D. MR. ALLAN PAOLO BLAQUERA, RN I. INFERTILITY Environmental and lifestyle factors such as smoking, – Couple’s inability to achieve pregnancy after 1 year or excessive alcohol intake and obesity can affect fertility. In longer of unprotected penile-vaginal intercourse addition, exposure to environmental pollutants and toxins – It is often a complex physical problem and causes are can be directly toxic to gametes (eggs and sperm), related to endometriosis, uterine factors, anovulation, resulting in their decreased numbers and poor quality, tubal obstruction, and male factors. leading to infertility Primary Infertility refers to a couple who has never II. DIAGNOSTIC FINDINGS had a child A. OVARIAN AND OVULATION FACTORS Secondary Infertility means that at least one Diagnostic studies performed to determine if ovulation conception has occurred, but currently the couple is regular and whether the pregestational cannot achieve a pregnancy. endometrium is adequate for implantation may CAUSES OF INFERTILITY include a serum progesterone level and an ovulation In the female reproductive system, infertility may be caused index by (WHO, 2020): Tubal disorders such as blocked fallopian tubes, 1. SERUM PROGESTERONE LEVEL which are in turned caused by untreated sexually – Serum progesterone test is a test to measure the transmitted infections (STIs) or complications of amount of progesterone in the blood. unsafe abortion, postpartum sepsis or – Progesterone are both produce by men and women abdominal/pelvic surgery but it’s mainly produce in the ovaries, which means Uterine disorders which could be inflammatory in women tend to have it more. nature (such as such endometriosis), congenital in – In men, progesterone is involved in the creation of nature (such as septate uterus), or benign in nature sperm, or spermatogenesis. (such as fibroids) – In women, it helps prepare the uterus for a fertilized Disorders of the ovaries, such as polycystic ovarian egg. syndrome and other follicular disorders; Normal serum progesterone level Disorders of the endocrine system causing imbalances of reproductive hormones. The endocrine Men, postmenopausal women, and women at the system includes hypothalamus and the pituitary beginning of their menstrual cycle: 1 ng/mL or under glands. Women in the middle of their menstrual cycle: 5 to 20 o Examples of common disorders affecting this ng/mL system include pituitary cancers and Pregnant women in the first trimester: 11.2 to 90 hypopituitarism. ng/mL Pregnant women in the second trimester: 25.6 to 89.4 In the male reproductive system, infertility may be caused by ng/mL (WHO, 2020): Pregnant women in the third trimester: 48.4 to 42.5 Obstruction of the reproductive tract causing ng/mL dysfunctionalities in the ejection of semen. o This blockage can occur in the tubes that carry Test results are considered abnormal if they fall outside the semen (such as ejaculatory ducts and seminal normal ranges. vesicles). o Blockages are commonly due to injuries or ü Progesterone levels don’t fluctuate regularly. This infections of the genital tract. would be determined through multiple tests. If the tests show that your progesterone levels don’t rise and fall on Hormonal disorders leading to abnormalities in a monthly basis the way they should, you may not be hormones produced by the pituitary gland, ovulating or having regular periods. This could make it hypothalamus and testicles. harder to get pregnant. o Hormones such as testosterone regulate sperm production. ü Low levels of progesterone. This could depend on o Example of disorders that result in hormonal what point in your cycle the test was done. If the test imbalance include pituitary or testicular shows a lower than normal level of progesterone, it cancers. could be because: Your ovaries aren’t working the way they should, Testicular failure to produce sperm or you didn’t ovulate o For example due to varicoceles or medical Possible unusual pregnancy treatments that impair sperm-producing cells (such as chemotherapy). ü High levels of progesterone. If your test shows higher-than-normal levels of progesterone, it could be Abnormal sperm function and quality. due to: o Conditions or situations that cause abnormal Pregnancy with one or more babies shape (morphology) and movement (motility) Cysts on your ovaries of the sperm negatively affect fertility. A growth that causes symptoms of pregnancy o For example, the use of anabolic steroids can (molar pregnancy) cause abnormal semen parameters such A disorder affecting your adrenal glands sperm count and shape. Ovarian cancer ü Progesterone within normal levels. Progesterone Retrograde ejaculation or ejaculation into the levels in a certain range can signal that you have bladder is assessed by urinalysis after ejaculation ovulated. The test should be done either 18 to 24 days Blood tests for male partners may include measuring after the first day of your period or 7 days before your testosterone, FSH, and LH (both of which are involved next expected period. in maintaining testicular function), and prolactin levels What does progesterone do to the endometrium? III. MEDICAL MANAGEMENT – Progesterone prepares the endometrium for the The specific type of treatment depends on the cause of potential of pregnancy after ovulation. It triggers the problem, if it can be identified. Many couples with the lining to thicken to accept a fertilized egg. It infertility have normal test results for ovulation, sperm also prohibits the muscle contractions in the uterus production, and fallopian tube patency. that would cause the body to reject an egg. Ovulatory dysfunction 2. OVULATION INDEX – Complex – Involves a urine dipstick test to determine whether – Many women with ovulation disorders have the surge in LH (Luteinizing Hormone) that polycystic ovary syndrome (PCOS) and may be precedes follicular rupture has occurred. treated with 5 days of clomiphene to induce ovulation. B. TUBAL AND UTERINE FACTORS Insulin sensitizing agents (e.g., metformin) are 1. HYSTEROSALPINGOGRAM (HSG) sometimes used, and once insulin levels are – is used to rule out uterine and tubal abnormalities normalized, ovulation often occurs. – A contrast agent injected into the uterus through the Some women have high prolactin levels, which inhibit cervix produces an outline of the shape of the uterine ovulation, and they are treated with dopaminergic drugs cavity and the patency of the tubes. after a pituitary adenoma is ruled out by MRI. – This process sometimes removes mucus or tissue If a woman has a premature ovarian failure, oocyte that is lodged in the tubes. donation may be considered. This is an X-ray procedure to see if the fallopian tubes are A. PHARMACOLOGIC THERAPY open and to if the shape of the uterine cavity is normal. A Pharmacologically induced ovulation is undertaken catheter is inserted into the opening of the cervix through the when women do not ovulate on their own or ovulate vagina. A liquid containing iodine (contrast) is injected irregularly. through the catheter. The contrast fills the uterus and enters o These couples are often treated with clomiphene the tubes, outlining the length of the tubes, and spills out to stimulate ovulation their ends if they are open. Gonadotropin treatment may also be used if conception does not occur. 2. LAPAROSCOPY Blood tests and ultrasound are used to monitor – Permits direct visualization of the tubes and other ovulation pelvic structures and can assist in identifying Various medications are used, depending on the main conditions that may interfere with fertility (e.g., cause of infertility (Chart 1) endometriosis) o Multiple pregnancies may occur with the use of these medications This is a surgical procedure in which a lighted telescope-like instrument (laparoscope) is inserted through the wall of the Ovarian hyperstimulation syndrome (OHSS) may also abdomen into the pelvic cavity. Laparoscopy is useful to occur if these medications are used evaluate the pelvic cavity for endometriosis, pelvic – This condition is characterized by enlarged adhesions, and other abnormalities. multicystic ovaries and is complicated by a shift of fluid from the intravascular space into the Fibroids, polyps, and congenital malformations are abdominal cavity. possible causative factors affecting the uterus. Their – The fluid shift can result in ascites, pleural effusion, presence may be determined by pelvic examination, and edema; hypovolemia may also occur. hysteroscopy, saline sonogram (a variation of a – Risk factors: sonogram), and HSG. Endometriosis, even if mild, is o younger age associated with reduced fertility o history of polycystic ovarian syndrome o high serum estradiol levels C. MALE FACTORS o a larger number of follicles o pregnancy. 1. SPERM ANALYSIS B. ARTIFICIAL INSEMINATION – This provides information about the number of sperm (density), percentage of moving forms, quality of This is the deposit of semen into the female genital tract forward movement (forward progression), and by artificial means. morphology (shape and form). Conditions must be optimal for conception before – 2 to 6 mL of watery alkaline semen is normal semen is transferred to the vagina or uterus. – 60 to 100 million sperm/mL (normal count) o The woman must have no abnormalities of the – When the count decreases to fewer than 15 million genital system sperm/mL – incidence of impregnation is lessened o fallopian tubes must be patent o ova must be available Men may also be affected by varicoceles (varicose In the male, sperm need to be normal in: veins around the testicle), which decreases semen o Shape quality by increasing testicular temperature o Amount o Motility o Endurance  The time of ovulation should be determined as V. MEDICATIONS THAT INDUCE OVULATION accurately as possible so that the 2-3 days during Clomiphene estrogen antagonist that increases which fertilization is possible each month can be citrate gonadotropin release, resulting in targeted for the treatment follicular rupture or ovulation o Ultrasonography and blood studies of Clomiphene is used when the varying hormone levels are used to pinpoint hypothalamus is not stimulating the the best time for insemination and to monitor pituitary gland to release follicle- for OHSS stimulating hormone (FSH) and In intrauterine insemination, semen is placed into luteinizing hormone (LH). the uterine cavity. This medication stimulates follicles in the ovary. It is usually taken for 5 C. ASSISTED REPRODUCTIVE TECHNOLOGIES days beginning on the 5th day of the Assisted reproductive technologies include in vitro menstrual cycle. Ovulation should fertilization (IVF) and its modifications occur 4 to 8 days after the last dose. IVF refers to a set of procedures that, if successful, Menotropins a combination of FSH and LH, may results in a pregnancy. These procedures involve be used to stimulate the ovaries to ovarian stimulation, egg retrieval, fertilization, and produce eggs. embryo transfer. These agents are used for women Gamete intrafallopian transfer (GIFT), a variation of with deficiencies in FSH and LH. IVF, is the treatment of choice for patients with ovarian When followed by administration of failure human chorionic gonadotropin, Successful rate for GIFT are similar to those for IVF menotropins stimulates the ovaries, so monitoring by ultrasound and Most common indications for ICF and GIFT hormone levels is essential because o Irreparable tubal damage overstimulation may occur. o Endometriosis Follitropin alfa, may be used to treat ovulation o Unexplained infertility follitropin beta, disorders or to stimulate a follicle o Inadequate sperm and and egg production for intrauterine o Exposure to diethylstilbestrol urofollitropin insemination or in vitro fertilization or other assisted reproductive D. ADDITIONAL ASSISTED REPRODUCTIVE technologies. TECHNOLOGIES Gonadotropin- suppress FSH, prevent premature release egg release, and shrink fibroids. 1. INTRACYTOPLASMIC SPERM INJECTION (ICSI) hormone – an ovum is retrieved, and a single sperm is injected agonists through the zona pellucida, through the egg (Leuprolide membrane, into the cytoplasm of the oocyte. and Nafarelin – The fertilized egg is then transferred back to the acetate) donor. Bromocriptine may be used in treatment for – ICSI is the treatment of choice in severe male factor infertility due to elevated prolactin infertility. levels. Progesterone help improve the uterine lining after 2. TUBAL EMBRYO TRANSFER (TET) vaginal ovulation. – involves the placement of fertilized eggs or embryos suppositories into the fallopian tube. Urofollitropin which contains FSH with a small – A laparoscopic procedure is needed to place the amount of LH, is used in some embryos in the fallopian tubes. disorders (e.g., polycystic ovarian – Some women choose TET after IVF failure syndrome) to stimulate follicle growth. Clomiphene is then used to IV. NURSING MANAGEMENT stimulate ovulation. Nursing interventions when working with couples during Chorionic which mimics LH, releases an egg infertility evaluations include: gonadotropin after hyperstimulation and supports ü Assisting in reducing stress in the relationship the corpus luteum. ü Encouraging cooperation, protecting privacy, fostering Metformin may be used in polycystic ovarian understanding, and syndrome to induce regular ü Referring the couple to appropriate resources when ovulation. necessary Aspirin and may be used to prevent recurrent heparin pregnancy loss in patients with Smoking cessation is encourage because smoking, elevated antiphospholipid smokeless tobacco, electronic nicotine delivery systems antibodies. (ENDS) including e-cigarettes, e-pens, e-pipes, e- hookah, and e-cigars have an adverse effect on the success of assisted reproduction Diet, exercise, stress reduction techniques, folic acid supplementation, health maintenance, and disease prevention are emphasized in many infertility programs. Nurses can be helpful listeners and information resources in these deliberations.  CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM (ACUTE & CHRONIC) CYTOLOGIC TEST FOR CANCER (PAP SMEAR) FABELLAR, AIDON JOSH B. MR. ALLAN PAOLO BLAQUERA, RN CYTOLOGIC TEST FOR CANCER (PAP SMEAR) – Used to detect cervical cancer o Cervical cancer is a type of cancer that occurs in the cells of the cervix in women. – Cervical secretions are gently removed from the cervical os and may be transferred to a glass slide and fixed immediately by spraying with a fixative or immersed solution. – If the Pap smear reveals atypical cells, the liquid method allows for HPV (Human Papillomavirus) testing Terminology used to describe findings includes the following categories: No abnormal or atypical cells Atypical squamous cells of undetermined significance Inflammatory reactions and microbes identified Positive deoxyribonucleic acid (DNA) test for HPV Precancerous and cancerous lesions of the cervix identified If the Pap smear (liquid immersion method) shows atypical cells and no high-risk HPV types, the next Pap smear is performed in 1 year HOW IT IS DONE? You'll lie down on our back on an exam table with your knees bent. Your heels rest in supports called stirrups. Your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of your vagina apart so that your doctor can easily see your cervix. Inserting the speculum may cause a sensation of pressure in your pelvic area. Then your doctor will take samples of your cervical cells using a soft brush and a flat scraping device called a spatula. This usually doesn't hurt. WHY IS IT DONE? The Pap smear is usually done in conjunction with a pelvic exam. In women older than age 30, the Pap test may be combined with a test for human papillomavirus (HPV). it is a common sexually transmitted infection that can cause cervical cancer. HOW OFTEN SHOULD THIS TEST BE REPEATED? Generally, the doctors will recommend repeating pap testing every three years for the women who ages 21-65 yrs old NORMAL RESULT? If only normal cervical cells were discovered during your Pap smear, you're said to have a negative result ABNORMAL RESULT? If abnormal or unusual cells were discovered during your Pap smear, you're said to have a positive result. A positive result doesn't mean you have cervical cancer. What a positive result means depends on the type of cells discovered in your test.  CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM CONTRACEPTION DAYAG, CEE JAY MARIE G. MR. ALLAN PAOLO BLAQUERA, RN I. CONTRACEPTIVE while still erect to prevent the Birth control, also known as contraception, is the use ejaculate from leaking. of medicines, devices, or surgery to prevent pregnancy. – The latex condom also creates a barrier against There are many different types. Some are reversable, transmission of STIs (gonorrhea, chlamydial while others are permanent. Some types can also help infection, and HIV) by body fluids and may prevent sexually transmitted diseases (STDs). reduce the risk of herpes virus transmission. WHAT TO REMEMBER: Those who are sexually active and do not want to become pregnant but could become pregnant if they and their partners fail to use a contraceptive method, are at risk of unintended pregnancy. Family planning benefits mothers, newborns, families, and communities. It is important for women to receive unbiased and nonjudgmental information, understand the benefits and risks of each contraceptive method, learn about alternatives and how to use them, and receive positive reinforcement and acceptance of their choice. CONTRAINDICATION – Coexisting medical disorders may make contraception a complex issue. b. Female Condom – Contraception needs to be addressed individually in – consists of a cylinder of polyurethane women with preexisting conditions. enclosed at one end by a closed ring that – With the aid of a thorough history, nurses are well covers the cervix and at the other end by an positioned to aid patients in choosing the safest, most open ring that covers the perineum effective method of contraception to meet their – part of the condom is inserted into the vagina individual needs. before intercourse to prevent sperm from entering the uterus. o Advantages: degree of protection A. BARRIER METHOD from STIs (i.e., HPV, herpes simplex – Prevent pregnancy by blocking sperm. This stops the virus, and HIV) sperm from reaching an egg. o Disadvantages: more costly than male condoms and the inability to use 1. CONDOMS the female condom with some – Made of very thin, loose-fitting pouch or sheath, positions (i.e., standing). latex (rubber), polyurethane or polyisoprene and are – was developed to give control of barrier designed to prevent pregnancy by stopping sperm protection to women—to provide them with from meeting an egg. protection from STIs and HIV as well as – Condoms work by keeping semen (the fluid that pregnancy contains sperm) from entering the vagina. The male condom is placed on the penis when it becomes erect. – They can also protect against STIs if used correctly during vaginal, anal and oral sex. The nurse must assess the patient for possible latex allergy because the use of latex barrier methods (e.g., diaphragm, cervical cap, male condoms) may cause severe allergic reactions, including anaphylaxis, in patients with latex allergy. TYPES OF CONDOMS a. Male Condom – an impermeable, snug-fitting cover applied to the erect penis before it enters the vaginal canal o The tip of the condom is pinched while being applied to leave space for ejaculate. o If no space is left, ejaculation may cause a tear or hole in the condom and reduce its effectiveness. o The penis, with the condom held in place, is removed from the vagina  CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM CONTRACEPTIVE CEE JAY MARIE G. DAYAG MR. ALLAN BLAQUERA, RN 2. DIAPHRAGM o Advantages: they are nonhormonal, are – an effective contraceptive device that consists of a user controlled, do not cause systemic round, flexible spring (50 to 90 mm wide) covered side effects, and are immediately effective with a domelike latex rubber cup o Disadvantages: do not protect women from o A spermicidal (contraceptive) jelly or HIV or other STIs cream is used to coat the concave side of the diaphragm before it is inserted deep into the vagina, covering the cervix B. HORMONAL METHOD completely. – The diaphragm is not felt by the user or her partner when properly fitted and inserted. Because women vary in size, the diaphragm must be sized and fitted by an experienced clinician – Hormonal methods of birth control (contraception) contain either estrogen and progestin or progestin only; they are a safe and reliable way to prevent pregnancy for most people. – Prevents pregnancy mainly by stopping the ovaries from releasing eggs or by keeping mucus in the cervix thick so that sperm cannot pass through 3. CERVICAL CAP o Oral contraceptives block ovarian stimulation – much smaller (22 to 35 mm) than the diaphragm by preventing the release of FSH from the and covers only the cervix. anterior pituitary gland. In the absence of FSH, o Advantage: may be left in place for 2 days a follicle does not ripen, and ovulation does after coitus not occur. Progestins (synthetic forms of o Disadvantage: may cause cervical progesterone) suppress the LH surge, prevent irritation; therefore, before fitting a cap, ovulation, and also render the cervical mucus most primary providers obtain a Pap impenetrable to sperm. smear and repeat the smear after 3 – Combination methods include the combination of oral months contraceptive pills, vaginal ring, and transdermal – used with a spermicide and does not require patch. Progestin-only methods include the progestin- additional spermicide for repeated penile-vaginal only pills or “mini-pills,” once-every-3-month injection, intercourse. levonorgestrel-releasing intrauterine system, and single-rod subdermal implant Patients need to be aware that hormonal contraceptives protect them from pregnancy but not from STIs or HIV infection. In addition, sex with multiple partners or sex without a condom may also result in chlamydial and other infections, including HIV infection. 1. ORAL CONTRACEPTIVES (PILLS) – Pills that a woman takes every day. They may contain only progestin or both progestin and estrogen. – Many women use oral contraceptive preparations of synthetic estrogens and progestins. – Extended regimens of oral hormonal contraceptive agents are an option for women who have heavy or 4. SPERMICIDE uncomfortable menstrual bleeding or who wish to – a substance that can kill sperm cells have fewer periods. – are made from nonoxynol-9 or octoxynol, and are o women may have an increased occurrence available over the counter as foams, gels, films, of breakthrough bleeding; the blood may suppositories, and sponges and also on condoms be dark brown rather than red. – can be used alone or with a diaphragm or cervical o It may be more difficult to tell if a cap pregnancy occurs with this method, o You put it into the vagina near the uterus although pregnancy is unlikely if pills are taken as prescribed  o a subcutaneous formulation is also available o can be used by women who are lactating and those with hypertension, liver disease, migraine headaches, heart disease, and hemoglobinopathies – with continued use, women must be prepared for irregular bleeding episodes and spotting decrease, or amenorrhea o Advantages: reduction of menorrhagia, dysmenorrhea, and anemia due to heavy 2. TRANSDERMAL CONTRACEPTIVES (PATCH) menstrual bleeding. It may reduce the risk – Transdermal contraception is done through a thin, of pelvic infection, has been associated beige, matchbook-size skin patch that releases an with improvement in hematologic status in estrogen and a progestin continuously women with sickle cell disease, and does o It is changed every week for 3 weeks, and not interfere with the efficacy of seizure no patch is used during the fourth week, agents. It decreases the risk of resulting in withdrawal bleeding. endometrial cancer, PID, endometriosis, o may be applied to the torso, chest, arms, and uterine fibroids or thighs; it should not be applied to the o Disadvantages: Possible side effects of breasts. long-acting progestin include irregular o Advantage: convenient and more easily menstrual bleeding, bloating, headaches, remembered than a daily pill hair loss, decreased sex drive, bone loss, o Disadvantage: not as effective for women and weight loss or weight gain. The who weigh more than 90 kg (198 lb), thus, contraceptive does not protect against side effect with the patch includes possible STIs. Although bone loss may occur while skin reaction such as irritation, redness, using the injections, when the injections pigment changes, or rash at the site of the are stopped, sometimes all of the bone patch loss is regained. Use of this method should be limited to 2 years of use because of loss of bone mineral density 3. VAGINAL CONTRACEPTIVES (VAGINAL RING) ABSTINENCE – an etonogestrel/ethinyl estradiol vaginal ring is a – Also known as celibacy, is the only completely combination hormonal contraceptive that releases effective means of preventing pregnancy estrogen and progestin o The woman inserts the ring into the C. LONG-ACTING REVERSIBLE CONTRACEPTIVES vagina, where it continually releases (LARCs) hormones for three weeks. She takes it out – Long-acting reversible contraception (LARC) methods for the fourth week. After that week, she are the most effective reversible methods for pregnancy puts in a new ring. prevention with a failure rate of less than 1% – as effective as oral contraceptive agents and results – Encouraging the use of LARC methods for appropriate in lower hormone blood levels than oral candidates may help lower unintended pregnancy rates contraceptives – usually more expensive than oral contraceptives 1. IMPLANTS – a single, thin rod that a provider inserts under the skin of a women's upper arm, containing the hormone called progestogen – works by stopping your ovaries from releasing an egg, effective for 3 years – very convenient as once it is in place the patient does not have to do anything else to prevent pregnancy – almost all women are able to use the implant, even those who are lactating – Women should be warned about possible 4. INJECTABLE CONTRACEPTIVES discomforts that can be treated with NSAIDs. – an injection of a hormone that a woman gets once every three months – an intramuscular injection of a long-acting progestin every 13 weeks inhibits ovulation and provides a reliable, private, and convenient contraceptive method  o Heavy or prolonged bleeding should be TYPES OF STERELIZATION evaluated for an underlying gynecologic a. Tubal Ligation problem, such as interactions with other – a surgery that permanently prevents medications, an STI, pregnancy, or new women from getting pregnant pathologic uterine conditions (e.g., polyps, – commonly been called "getting your tubes fibroids) tied" – "Tubal" refers to your fallopian tubes, and "ligation" means to tie off 2. INTRAUTERINE DEVICE (IUD) – a small device, usually T shaped that is inserted into the uterine cavity to prevent pregnancy o Advantages: effectiveness over a long period of time, few if any systemic effects, and reduction of patient error. Almost all women are able to use an IUD b. Vasectomy o Disadvantages: possible excessive – a surgery that permanently prevents men bleeding, cramps, and backaches; a slight from getting someone pregnant risk of tubal pregnancy; slight risk of pelvic – cuts the supply of sperm to your semen infection on insertion; displacement of the – done by cutting and sealing the tubes that device; and, rarely, perforation of the carry sperm cervix and uterus. If pregnancy occurs with an IUD in place, the device is removed immediately to avoid infection. Spontaneous abortion (miscarriage) may occur on removal (ACOG, 2017). TYPES OF IUD a. Hormonal IUD – releases levonorgestrel, (form of progestin), a 3-year type and a 5- year are approved for use b. Nonhormonal IUD – contain a copper coil filament whose chemical release is contraceptive, effective for up to 10 years DIANE 35 PILLS – Contains a progesterone and an estrogen hormone, and therefore works similarly to the combined oral contraceptive birth control pill – Anti-adrogen, used for pcos patient, blocks androgen – Blocking the effects of androgens such as testosterone and by activating the progesterone receptor SIDE EFFECTS OF DIANE 35 PILLS Abdominal cramps Appetite changes Breast pain, tenderness, or swelling Brown, blotchy spots on exposed skin D. STERELIZATION Discomfort wearing contact lenses – a permanent form of birth control that is extremely Excess hair growth on face, chest, legs effective at preventing pregnancy Hair loss Increased of decreased interest in sexual Women and men who choose sterilization should be certain intercourse that they no longer wish to have children, no matter how the Can also happen during pregnancy, risk of circumstances in their life may change. having blood clots in higher in Diane-35 users than in non-users, but not as high as during pregnancy  Insulin resistant and pcos patient – prescribed metformin, for diabetic person Clominophene citrate – for fertility/ low sperm count si Mr. DC  CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEM VULVOVAGINAL INFECTION – STI DAYAG, CEE JAY MARIE G. MR. ALLAN PAOLO BLAQUERA, RN SEXUALLY TRANSMITTED INFECTION Enterobius Rectal pruritus, Oral administration – diseases acquired through sexual contact with a person vermicularis especially on rising of an anthelmintic, who is infected (pinworm) in the morning such as – They range in severity from easily treated infections, mebendazole such as trichomoniasis, to HIV infection, which, despite (Vermox) advances in therapy, is life threatening. Treponema Painless ulcer on Benzathine – Infections caused by organisms not generally pallidum (syphilis) vulva or vagina penicillin, considered STIs can also be transmitted during sexual administered contact—for example, G. lamblia, usually associated intramuscularly with contaminated water, can be transmitted through Streptococcus Vaginitis, vulvar Antibiotic such as sexual exposure. itching; edema and amoxicillin – If these diseases are discovered in young children, the reddening of vulva possibility of sexual maltreatment has to be considered Foreign body Vaginal discharge; Removal of foreign (Hornor, 2017) odor body during pelvic – Adolescents account for almost half of the new cases of examination STIs each year, which includes heterosexual and same-sex transmission (Goyal, Shea, Hayes, et al., WHAT TO REMEMBER: 2016). Education about prevention of STIs includes information about risk factors and behaviors that can COMMON VULVOVAGINAL INFECTIONS lead to infection. Abstinence or condom use provides the best protection CAUSATIVE COMMON against STIs. SYMPTOMS AGENT THERAPY o The use of condoms to provide a protective Candida albicans Vulvar reddening Clotrimazole barrier from transmission of STI-related and pruritus; thick, (Lotrimin) or organisms has been broadly promoted, white, cheese-like miconazole especially since the recognition of HIV/AIDS. vaginal discharge (Monistat) vaginal suppositories or Infection with one STI suggests the possibility of infection fluconazole with other diseases as well. After one STI is identified, (Diflucan) orally; diagnostic evaluation for others should be conducted. The bathing with dilute possibility of HIV infection should be pursued when any STI sodium bicarbonate is diagnosed. solution may relieve pruritus Young women and those who are pregnant should also Trichomonas Thin, irritating, Metronidazole be instructed about the importance of routine screening frothy, gray-green (Flagyl) or for chlamydia discharge; strong, tinidazole Additional measures include voiding immediately and putrid odor; itching (Tindamax) orally; washing genitals well with soap and water after coitus douching with weak as well as choosing sexual partners who are at low risk vinegar solution to for infection (i.e., avoiding persons who are intravenous reduce pruritus drug users or those with multiple sexual partners). Herpesvirus type 2 Painful pinpoint Bathing with dilute Educating adolescents about safer sex practices, vesicles on an sodium bicarbonate including the need for condom use and the importance erythematous base solution, applying of health screening for these disorders, is an important with a watery lubricating jelly to nursing responsibility. vaginal discharge lesions, or an oral Pay particular attention to adolescents who do not have possible; voiding analgesic such as a strong family support system because it may be may be irritating ibuprofen may be particularly difficult for these youth to receive correct and painful necessary for pain information about preventing STIs (Hudson, 2012). relief; topically applied acyclovir STIs are becoming more difficult to treat because the (Zovirax) helps heal causative organisms are becoming increasingly resistant to lesions antibiotics. Always reinforce the fact that little immunity Gardnerella Edema and Metronidazole develops from STIs, so such diseases can be contracted reddening of vulva; (Flagyl) or repeatedly. In most instances, an infected partner should milky gray clindamycin also be treated or the disease can recur from cross infection. discharge; fishlike odor Chlamydia Watery, gray-white Tetracycline or trachomatis vaginal discharge; doxycycline; vulvar itching erythromycin during pregnancy Neisseria Possibly Ceftriaxone and gonorrhoeae symptomless; may doxycycline have profuse yellow-green vaginal discharge  A. SYPHYLIS read as negative, usually about 2 years after – an acute and chronic infectious disease caused by the therapy is completed. spirochete Treponema pallidum. It is acquired through sexual contact or may be congenital in origin b. Treponemal Tests – is a reportable communicable disease – fluorescent treponemal antibody absorption (FTA-ABS) test and the STAGES OF SYPHILIS microhemagglutination test for Treponema 1. Primary Syphilis – pallidum (MHA-TP) o occurs 2 to 3 weeks after initial inoculation with – used to verify that the screening test did not the organism. represent a false-positive result o painless lesions at the site of infection, called – Positive results usually are positive for life chancres, usually resolve spontaneously within and therefore are not appropriate to 3 to 12 weeks, with or without treatment (Norris, determine therapeutic effectiveness 2019). MEDICAL MANAGEMENT 2. Secondary Syphilis – Treatment of all stages of syphilis is administration of – occurs by hematogenous spread leading to antibiotic medications generalized infection – Penicillin G benzathine is the medication of choice for – the rash of secondary syphilis occurs from 1 early syphilis or early latent syphilis of less than 1 week to 6 months after the chancre (Norris, year’s duration via IM at a single session 2019). – Patients with late latent or latent syphilis of unknown o Transmission can occur through contact duration should receive three injections at 1-week with these lesions. intervals. o Generalized signs of infection may – The patient treated with penicillin is monitored for 30 include lymphadenopathy, arthritis, minutes after the injection to observe for a possible meningitis, hair loss, fever, malaise, and allergic reaction (CDC, 2020s). weight loss. – Patients who are allergic to penicillin are usually treated with doxycycline. After the secondary stage, there is a period of latency, when the person who is infected has no signs or symptoms of NURSING MANAGEMENT syphilis. Latency can be interrupted by a recurrence of – In any health care facility, a mechanism must be in secondary syphilis symptoms (Norris, 2019). place to ensure that all patients who are diagnosed are reported to the state or local public health department If you aren't treated for syphilis, the disease moves from the to ensure community follow-up secondary stage to the hidden (latent) stage, when you have – The public health department is responsible for no symptoms. The latent stage can last for years. Signs and identification of sexual contacts, contact notification, symptoms may never return, or the disease may progress to and contact screening. the third (tertiary) stage. – Lesions of primary and secondary syphilis may be highly infective. Gloves are worn when direct contact 3. Tertiary Syphilis with lesions is likely, and hand hygiene is – is the final stage in the natural history of the – performed after gloves are removed. disease – estimated that between 20% and 40% of those PREVENTING THE SPREAD OF SYPHILIS infected do not exhibit signs and symptoms in this final stage The nurse instructs the patient to: – may present as a slowly progressive ü Complete the full course of therapy if multiple inflammatory disease with the potential to affect penicillin injections are required. multiple organs ü Refrain from sexual contact with previous or current o The most common manifestations at this partners until the partners have been treated. level are aortitis and neurosyphilis, as ü Be aware that if you have primary or secondary evidenced by dementia, psychosis, syphilis, skin lesions and other sequelae of infection paresis, stroke, or meningitis (Norris, will improve with proper treatment, and serology 2019). eventually will reflect cure. ü Recognize that condoms significantly reduce the risk ASSESSMENT AND DIAGNOSTIC of transmission of syphilis and other STIs. – syphilis shares symptoms with many diseases, so ü Be aware that having multiple sexual partners clinical history and laboratory evaluation are important increases the risk of acquiring syphilis and other – the conclusive diagnosis of syphilis can be made by STIs. direct identification of the spirochete obtained from the chancre lesions of primary syphilis – Serologic tests used in the diagnosis of secondary and tertiary syphilis require clinical correlation in interpretation. TYPES OF SEROLOGIC TESTS a. Nontreponemal or reagin tests – Venereal Disease Research Laboratory (VDRL) or the rapid plasma reagin circle test (RPR-CT) – generally used for screening and diagnosis – After adequate therapy, the test result is expected to decrease quantitatively until it is  B. Chlamydia trachomatis and Neisseria gonorrhea MEDICAL MANAGEMENT Infections Because patients are often coinfected with both – Chlamydia trachomatis and Neisseria gonorrhoeae gonorrhea and chlamydia, dual therapy is are the most commonly reported infectious recommended, even if only gonorrhea has been diseases in the United States. laboratory proven (CDC, 2020r). – Coinfection with C. trachomatis often occurs in o The CDC guidelines should be used to patients infected with N. gonorrhoeae. The greatest determine alternative therapy for the patient who risk of C. trachomatis infection occurs in young is pregnant or allergic or who has a complicated women between 15 and 24 years of age (CDC, chlamydial infection 2020q, 2020r). Although the number of resistant strains of gonorrhea – are reportable communicable diseases has increased, that is not the reason for the use of combination antibiotic therapy o Such therapy is prescribed in order to treat both CLINICAL MANIFESTATIONS gonorrhea and chlamydia, because many – Both C. trachomatis and N. gonorrhoeae infections patients with gonorrhea have a coexisting frequently do not cause symptoms in women. chlamydial infection. – When symptoms are present, mucopurulent cervicitis Patients with uncomplicated gonorrhea who are treated with exudates in the endocervical canal is the most with CDC-recommended therapy do not routinely need frequent finding. to return for a proof-of-cure visit. – Women with gonorrhea can also present with o If the patient reports a new episode of symptoms symptoms of urinary tract infection or vaginitis or tests are positive for gonorrhea again, the most likely explanation is reinfection rather than Although men are more likely than women to have symptoms treatment failure. when infected, infection with N. gonorrhoeae or C. o Serologic testing for syphilis and HIV should trachomatis can be asymptomatic. When symptoms are be offered to patients with gonorrhea or present, they may include burning during urination and penile chlamydia, because any STI increases the risk discharge. Patients with N. gonorrhoeae infection may also of other STIs (CDC, 2020r) report painful, swollen testicles (CDC, 2020q, 2020r). NURSING MANAGEMENT In any health care facility, a mechanism should be in COMPLICATIONS place to ensure that all patients who are diagnosed are – WOMEN: pelvic inflammatory disease (PID), ectopic reported to the local public health department to ensure pregnancy, endometritis, and infertility are possible follow-up of the patient. complications of either N. gonorrhoeae or C. The public health department also is responsible for trachomatis infection. interviewing the patient to identify sexual contacts – MEN: epididymitis, a painful disease that may lead to so that contact notification and screening can be infertility, may result from infection with either initiated bacterium. The target group for preventive patient education about – BOTH: arthritis or bloodstream infection may be gonorrhea and chlamydia is the adolescent and young caused by N. gonorrhoeae (CDC, 2020q, 2020r) adult population. Along with reinforcing the importance of abstinence, when appropriate, education should address ASSESSMENT AND DIAGNOSTIG FINDINGS postponing the age of initial sexual exposure, – The patient is assessed for fever, discharge (urethral, limiting the number of sexual partners, and using vaginal, or rectal), and signs of arthritis condoms for barrier protection – Diagnostic methods used in N. gonorrhoeae infection include Gram stain (appropriate only for male urethral PREGNANCY AND Chlamydia samples), culture, and nucleic acid amplification – Screening for Chlamydia via a vaginal culture is usually tests (NAATs) done during a woman’s first prenatal visit o Gram stain and the direct fluorescent antibody – If a woman has multiple sexual partners, screening may test can be used in chlamydia be repeated again in the third trimester o NAATs are also available for C. trachomatis. – Doxycycline (Vibramycin), the therapy for o Because N. gonorrhoeae organisms are nonpregnant women, is contraindicated during susceptible to environmental changes, pregnancy because of possible fetal long-bone specimens for culture must be delivered to the deformities; azithromycin (Zithromax) or amoxicillin laboratory immediately after they are obtained. (Amoxil) are used instead. – WOMEN: samples are obtained from the endocervix, o A woman’s partner also should be treated to anal canal, and pharynx. prevent her from becoming reinfected. – MEN: specimens are obtained from the urethra, anal canal, and pharynx It’s important that chlamydial infections be treated during pregnancy because they are associated with premature Because as many as 70% of chlamydial infections are rupture of the membranes, preterm labor, and endometritis in asymptomatic, the CDC recommends Chlamydia testing for the postpartum period. An infant who is born while a all women who are pregnant. Annual testing is also chlamydial infection is present can develop conjunctivitis or recommended for women younger than 25 years who are pneumonia after birth sexually active, and for women over 25 years who have a new sexual partner or multiple partners (CDC, 2020q, 2020r).  – Both miconazole (Monistat) for 7 days or a single E. CANDIDIASIS dose of oral fluconazole 2915 (Diflucan) are – a vaginal infection spread by the fungus Candida, an approved for use during pregnancy. organism that thrives on glycogen (Rome, 2012) – so common that as many as 90% of women will have it Treating the infection during pregnancy is important not only sometime in their life because the profuse vaginal discharge and pruritus is – Because oral contraceptives produce a uncomfortable but also because if the infection is present in pseudopregnancy state, adolescents using oral the vagina at the time of childbirth, it may cause a candidal contraceptives tend to have frequent vaginal candidal infection, or thrush, in the newborn infections – If being treated with an antibiotic for another infection (which destroys normal vaginal flora and lets fungal F. TRICHOMONIASIS organisms grow more readily), they are also particularly – a curable STI and has the highest prevalence among susceptible to this infection. adolescents (Swartzendruber, Sales, Brown, et al., – Incidence is also strongly associated with immune 2014) suppression and diabetes mellitus because – The incubation period is 4 to 20 days. hyperglycemia provides the perfect glucose-rich – A serious consequence of trichomoniasis is that environment for candidal growth. infection can cause such genital inflammation that it makes it easier for the person to be infected with the ASSESSMENT HIV virus or to pass the HIV virus on to a sex partner – Because of the scant mucus production in the period (Centers for Disease Control and Prevention [CDC], before menses, symptoms may be most acute at this 2017). time. – The adolescent will notice vulvar and vaginal ASSESSMENT reddening, burning and itching, and even bleeding – With a trichomonal infection, females may notice only a from hairline fissures. slight vaginal discharge or else notice extreme – A thick, cream cheese– like discharge can usually be vaginal itching and a frothy white or grayish-green observed at the vaginal outlet. vaginal discharge – Internally, the vagina shows white “patches” that – The upper vagina looks reddened and may have cannot be scraped away without bleeding on the pinpoint petechiae walls. – In some women, these changes can be so extreme, a – There may be accompanying pain on coitus or on Pap test taken during this time may be misinterpreted tampon insertion as showing abnormal tissue – Candidal infections can also be present at other body – Males with the same infection tend not to report any sites, such as the oral cavity or a moist area such as symptoms. the umbilicus – The infection is diagnosed by microscopic examination – Candidal infections are diagnosed by removing a of a sample of the vaginal discharge; trichomonads sample of the discharge from the vaginal wall and typically appear as rounded, mobile structures. placing it on a glass slide. THERAPEUTIC MANAGEMENT THERAPEUTIC MANAGEMENT – Oral metronidazole (Flagyl) or tinidazole (Tindamax) – includes vaginal tablets or cream applications of eradicates trichomonal infections antifungal preparations such as over-the-counter o Metronidazole interacts with alcohol (to cause miconazole (Monistat) or clotrimazole (Lotrimin) acute nausea and vomiting), caution older once a day for 3 to 7 days. adolescents and women to not drink alcoholic – Oral fluconazole (Diflucan) can be administered as beverages during the course of treatment with a one-time dose this drug. – Teach women to insert antifungal tablets or creams at – Use of condoms by sexual partners help prevent bedtime, so the drug does not drain from the vagina recurrence of Trichomonas in both parties immediately afterward. o Treatment should not be interrupted until it is PREGNANCY AND TRICHOMONIASIS complete, even during a menstrual period. – Trichomoniasis infections are associated with preterm – If a girl has frequent candidal infections, her urine labor, premature rupture of membranes, and should be tested for glucose to rule out diabetes postcesarean infection. mellitus – The drug of choice during pregnancy is single-dose oral – If she is using an oral contraceptive, she might be metronidazole counseled to use another reproductive planning o Although classified as a Class B method. pregnancy drug, it may not be prescribed – If an adolescent is sexually active, treatment of the during the first semester of pregnancy to male partner may be necessary to break a reinfection avoid detrimental fetal effects cycle (McGreal & Wood, 2013). G. BACTERIAL VAGINOSIS PREGNANCY AND CANDIDIASIS – is defined as the absence or deficiency of lactobacilli – Candidiasis occurs more frequently during pregnancy in the vaginal flora and it occurs frequently among than usual because the increased estrogen level woman of childbearing age (Parma, Vanni, Bertini, et present during pregnancy causes the vaginal pH to be al., 2014) less acidic and even more favorable for yeast growth – An intensely pruritic vaginal discharge appears milky- – Women with repeated infections should have their urine white to gray and has a fishlike odor. tested for glucose to determine whether gestational – Microscopic examination of the discharge shows gram- diabetes is present. negative rods adhering to vaginal epithelial cells (termed clue cells).  – Like trichomoniasis, bacterial vaginosis can increase a woman’s susceptibility to other STIs, such as herpes simplex virus (HSV), chlamydia, and gonorrhea, as well as HIV – The treatment is oral or vaginal metronidazole for 7 days. The woman’s sexual partner should also be treated to prevent recurrence of the infection. Therapy with probiotic lactobacilli to change vaginal organisms is a future possibility for prevention PREGNANCY AND BACTERIAL VAGINOSIS – The treatment during pregnancy is oral metronidazole or clindamycin for 7 days in order to prevent preterm labor as well as premature rupture of the membranes (Bennett, 2012).  CARE OF MOTHER, CHILD, AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC) ENDOMETRIOSIS GADDAO, CRISTIAN MR. ALLAN PAOLO BLAQUERA, RN ENDOMETRIOSIS destroy endometrial-like tissue that's growing outside – Endometriosis is a chronic disease affecting between the uterus. 7% and 10% of women of reproductive age, occurring more frequently in women who have never had children C. RISKS (Casanova et al., 2019). Never giving birth – Consists of a benign lesion or lesions that contain Starting your period at an early age endometrial tissue (like that lining the uterus) found in Going through menopause at an older age the pelvic cavity outside the uterus. Extensive Short menstrual cycles — for instance, less than 27 endometriosis may cause few symptoms, or an isolated days lesion may produce severe symptoms. Heavy menstrual periods that last longer than seven – It is a major cause of chronic pelvic pain and infertility. days – With endometriosis, the endometrial-like tissue acts as Having higher levels of estrogen in your body or a endometrial tissue would — it thickens, breaks down greater lifetime exposure to estrogen your body and bleeds with each menstrual cycle. But because this produces tissue has no way to exit your body, it becomes Low body mass index trapped. When endometriosis involves the ovaries, One or more relatives (mother, aunt, or sister) with cysts called endometriomas may form. endometriosis Any medical condition that prevents the passage of A. SYMPTOMS blood from the body during menstrual periods Painful periods (dysmenorrhea). Pelvic pain and Disorders of the reproductive tract. cramping may begin before and extend several days into a menstrual period. You may also have lower back D. DIAGNOSIS and abdominal pain. A health history, including an account of the menstrual Pain with intercourse. Pain during or after sex is pattern, is necessary to elicit specific symptoms. On common with endometriosis. bimanual pelvic examination, fixed tender nodules are Pain with bowel movements or urination. You're sometimes palpated, and uterine mobility may be most likely to experience these symptoms during a limited, indicating adhesions. Laparoscopic menstrual period. examination confirms the diagnosis and helps stage Excessive bleeding. You may experience occasional the disease. heavy menstrual periods or bleeding between periods (intermenstrual bleeding). STAGE 1: Superficial or minimal lesions. Infertility. Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility. STAGE 2: Mild involvement Other signs and symptoms. You may experience fatigue, diarrhea, constipation, bloating or nausea, STAGE 3: Moderate involvement especially during menstrual periods. STAGE 4: Extensive involvement and dense B. CAUSES adhesions, with obliteration of the cul-de-sac. Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back E. TREATMENT through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells stick Treatment depends on the symptoms, the patient’s desire for to the pelvic walls and surfaces of pelvic organs, where pregnancy, and the extent of the disease. If the woman does they grow and continue to thicken and bleed over the not have symptoms, routine examination may be all that is course of each menstrual cycle. required. Other therapy for varying degrees of symptoms may be NSAIDs, oral contraceptive agents, GnRH Transformation of peritoneal cells. In what's known agonists, or surgery. as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial-like cells. Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty. Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision. Endometrial cell transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body. Immune system disorder. A problem with the immune system may make the body unable to recognize and SIDE NOTES Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. The condition often affects members of the same nuclear family, such as sisters, mothers, and grandmothers. People with cousins who have the condition are also at an increased risk. Endometriosis can be inherited via the maternal or paternal family line. Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation, and abdominal cramping. Contrary to previous findings, low-dose aspirin therapy before conception and during early pregnancy may increase pregnancy chances and live births among women who have experienced one or two prior miscarriages, suggests a study by researchers at the National Institutes of Health. Myra E can help boost sperm function in men which increases the chances of pregnancy in women. Also, it helps promote the general health of female reproductive system which boosts the rate of conceiving. However, more studies are needed to scientifically prove the relation between Myra e and pregnancy.  CARE OF MOTHER, CHILD, AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC) POLYCYSTIC OVARY SYNDROME (PCOS) COLLADO, DIANA NICOLE D. MR. ALLAN PAOLO BLAQUERA, RN POLYCYSTIC OVARY SYNDROME (PCOS) o Increasing lean meat, fruits, and vegetables and – Type of hormonal imbalance or cystic disorder that decreasing the amount of concentrated affects the ovaries carbohydrates in their diet is encouraged. – Involves a disorder in the hypothalamic-pituitary and o This eating pattern also lowers blood glucose ovarian network or axis, resulting in chronic anovulation levels, improves the body’s use of insulin, and and hyperandrogenism, often along with multiple small helps to normalize testosterone secretion ovarian cysts. Two final therapies to help achieve pregnancy – Features can include: o In vitro fertilization (IVF) o Obesity o Ovarian drilling – surgery technique done by o Insulin resistance laparoscopy that reduces the size of the ovaries o Glucose intolerance and limits the amount of testosterone the ovaries o Dyslipidemia are able to produce o Sleep apnea Antiandrogens such as spironolactone (Aldactone) o Infertility and finasteride (Propecia) can be tried to decrease – Adolescents with the syndrome begin to develop an hair growth and reduce acne symptoms increased androgen (male hormone) level, which then prevent follicular ovulation cysts from maturing, a situation that leads to typical symptoms. SYMPTOMS Irregular/missed menstrual periods – resulting from lack of regular ovulation Acne Infertility Obesity o The androgen increase is usually directly related to obesity, and further exacerbates insulin resistance Hirsutism (excessive hair growth) Type 2 diabetes Anovulation (absence of ovulation) – Diagnosis is based on clinical criteria, including hyperandrogenism, chronic anovulation, and polycystic ovaries on ultrasound examination – Women with PCOS are at increased risk for: o Diabetes o Increased blood lipids o Endometrial cancer due to anovulation o Cardiovascular disease o Nonalcoholic fatty liver disease o Anxiety o Depression ASSESSMENT ü Thorough history and physical exam ü Pelvic exam – to determine the consistency and size of ovaries, and perhaps an ovarian ultrasound for the same purpose ü Serum androgen and glucose levels will also be assessed MEDICAL MANAGEMENT Oral contraceptive agents are often prescribed to treat PCOS o When pregnancy is desired, medications to stimulate ovulation (clomiphene citrate) are often effective Lifestyle modification is critical, and weight management is part of the treatment plan Weight loss as little as 5% to 10% of total body weight can help with hormonal imbalance and infertility o Metformin often regulated periods and can help with weight loss § Another method to reduce blood glucose to prevent type 2 diabetes from developing  CARE OF MOTHER, CHILD, AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC) MENOPAUSE CABAYA, DANIEL VAN DER S. MR. ALLAN BLAQUERA, RN MENOPAUSE Premature menopause occurs when a woman reaches – is the end of a woman's menstrual cycle. The word can the age of 40 for any reason. refer to any of the changes you go through right before or after your menstruation stops, signifying the end of RISKS your reproductive years. The loss of estrogen linked with menopause is tied to a number – Most women stop menstruating between 41 and 59 of health problems that become more common as women age. years of age. After menopause, women are more likely to have: Due to a decrease in estrogen levels, menopause may Bone loss (Osteoporosis) be associated with some atrophy of breast tissue and Heart disease genital organs, loss in bone density and vascular Bladder and bowels that don’t work like they should changes. Higher risk of Alzheimer’s disease Menopause starts gradually and is usually signalled by More wrinkles changes in menstruation. Poor muscle power and ton The monthly flow may increase or decreased, become Risk for Urinary Tract Infection irregular, and finally cease. Weaker vision, such as from cataracts (clouding of the Ovulation occurs less frequently, estrogen level lens of the eye) and macular degeneration (breakdown fluctuate, and FSH levels increase in an attempt to of the tiny spot in the centre of the retina that is the stimulate estrogen production. centre of vision) POSTMENOPAUSAL BLEEDING DIAGNOSTIC ASSESSMENT Bleeding 1 year after menses cease at menopause A change in menstrual patterns and the appearance of must be investigated hot flashes are usually the first signs. Although blood A transvaginal ultrasound can be used to measure the tests are not required, healthcare providers can run thickness of the endometrial lining. blood or urine tests to determine levels of the hormones o The uterine lining in women who are estradiol, follicle-stimulating hormone (FSH), and postmenopausal should be thin because of low luteinizing hormone (LH). estrogen levels o A thicker lining warrants further evaluation by STAGES OF MENOPAUSE endometrial biopsy or a D&C. 1. Perimenopause CLINICAL MANIFESTATIONS – Menstrual transition period before menopause that Increase in body fat and intraabdominal deposition of begins on average 4 years before the last body fat (systemic effect)