group of physical and emotional symptoms that occur in some women 7 to 10 days before menustration
Premenstrual Syndrome
This client presents w/:
- weight gain
- headache
- nervousness
- irritability
- abdominal bloating
- tender breasts
- breast enlargement
- sweet cravings
- swelling of hands and feet and ankles
- usually symptom free between the onset of menstruation and ovulation
Premenstrual Syndrome
tx for PMS
- Naproxen
- Eating 6 small meals daily
- complex carbs and foods high in calcium
- reduce sugar and salt intake
- eliminate alcohol prior to menstruation
- exercise aerobically for 30 minutes
- get enough sleep
- manage stress
- manage menstrual diary
painful menstruation
Dysmenorrhea
This client presents w/:
- lower abdominal pain and cramping that becomes more severe with fatigue, cold, and tension
Dysmenorrhea
Tx for dysmenorrhea
- mild analgesics
- local applications of heat (warm shower, moist heating pad, or water bottle
- knee-chest position
- adequate rest, nutrition, and relief
absence of menstrual flow
Amenorrhea
Tx of amenorrhea
treating the underlying cause
characterized by a cluster of signs and symptoms that include amenorrhea and oligomenorrhea
Polycystic Ovarian Syndrome (PCOS)
This client presents w/:
- overproduction and insufficient use of insulin and high testosterone levels
- interference w/ menstruation and ovulation, weight gain, excessive growth of body hair, acne, thinning hair/baldness, abnormal lipid levels, and hypertension
PCOS
Tx for PCOS
- contraceptives
- oral hypoglycemic agent
- lipid-lowering agents
excessive bleeding at the time of normal menstruation
Menorrhagia
Client presents w/:
- a cycle that last more than 7 days
- requires the use of an additional 2 pads per day or that extends 3 or more days longer than usual
Menorrhagia
Tx for menorrhagia
- estrogen and progestin
- nsaids
- dilation and curettage (D&C)
vaginal bleeding at the time other than a menstrual period
Metrorrhagia
nurse management for clients w/ Metrorrhagia
- advise client to see a PCP if experiencing unexplained bleeding
- the usual!
- "change of life" that takes place between the ages of 45-55
- cessation of menstrual cycle
- ovarian function diminishes
Menopause
This client presents w/:
- irregular periods and scanty/unusually copious menstrual flow
- hot flashes
- sweating
- sleep disturbances
- irritability/depression
- vaginal dryness
- decreased libido
- dyspareunia (discomfort during intercourse)
Menopause
Tx for menopause
- Estrogen replacement therapy
Nursing management and teachings for clients going through menopause
- bland skin creams or lotions to reduce skin dryness
- water-based lubricant prior to intercourse
- exercise program
- increase calcium intake
- schedule routine breast and gyn exams
- cultivate new interests and hobbies
inflamed vagina
- caused by feminine hygiene products, allergic reactions, age related tissue changes leading to infection
- also can be caused by douching and taking antibiotics
- Gardnerella vaginalis; trich vaginalis; candida albicans
Vaginitis
- curdy white, thick consistency
- strong odor
- causes burning on urination
candida albicans
- yellow/white, foamy consistency
- foul odor
- causes severe itching
trichonomas vaginalis
- grayish/white, watery consistency
- fishy odor
- causes more discharge after sex
Gardnerella vaginalis
Tx for vaginitis
Antimicrobials
- Metronidazole (antiprotozoal)
- Fluconazole (antifungal)
Nursing management and teachings for clients w/ vaginitis?
- avoid douching
- wipe front to back
- wear cotton undergarments
- change from wet swimsuits ASAP
- bathe daily
infection of the pelvic organs other than the uterus, including the ovaries (oophoritis), fallopian tubes (salpingitis), pelvic vascular system, and pelvic supporting structures
- ascending infections (infection travels up the uterus)
Pelvic inflammatory disease (PID)
This client presents w/:
- malodorous discharge
- backache
- severe abdominal/pelvic pain
- bearing-down feeling
- fever
- dyspareunia
- n/v
- menorrhagia
- dysmenorrhea
Pelvic inflammatory disease (PID)
Medical management for clients w/ PID
- complete bed rest
- antibiotics as soon as culture and sensitivity tests are obtained
- IV fluids
- antipyretics
a type of septic shock that is associated w/ the use of superabsorbent tampons that are not changed frequently and internal contraceptive devices that remain in place longer that usual
- Toxic shock syndrome (TSS)
This client presents w/ sudden onset of:
- fever
- chills
- tenderness
- pain in muscles
- nausea and vomiting
- diarrhea
- HYPOTENSION
- hyperemia (increased redness and congestion) of vaginal mucous membranes
- disorientation
- headache
- skin warm to touch
- RASH OF PALM OF HANDS OR THE BODY A FEW HOURS AFTER INFECTION LATE RESULTS IN SHEDDING OF THE SUPERFICIAL LAYER OF THE SKIN (DESQUAMATION)
- rapid thready pulse
TSS
Medical and nursing management for clients w/ TSS:
- IV fluids
- antibiotics
- Oxygen
- assess vitals
- measure intake/output (report output of <500 ml per day)
- use of perineal pads instead of tampons
- emphasize hand hygiene
occurs when tissue similar to the endometrium is found outside the uterus
Endometriosis
This client presents w/:
- severe dysmenorrhea
- copious menstrual bleeding
- dyspareunia
- pain on defecation
- cysts
- laparoscopy is used to dx
Endometriosis
Medical Management for Endometriosis
- natural or surgical menopause
- estrogen-progestin contraceptives
- surgery to remove cysts
- panhysterectomy
nursing management for endometriosis
- describe s/s; location of pain, # of days of menses; amount of menstrual flow, irregularities
- methods of relieving menstrual pain
- reinforce/clarify explanations of treatment options and consequences of each option
- emphasize the condition doesn't require immediate decision and avoid giving advice
- offer the option of seeking a 2nd opinion
- suggest client list the pros and cons of each option to help determine which choice is most compatible with her values and goals
- adhere to med schedule
- instruct client to seek care if pain increases, menstrual flow is extremely heavy , or pregnancy occurs
opening b/t ureter and vagina
ureterovaginal fistula
opening b/t bladder and vaginal
vesicovaginal fistula
opening b/t the rectum and vagina
rectovaginal fistula
This client presents w/:
- urine or stool that leaks from the vagina
- for dx testing, be sure to ask about client allergies
vaginal fistula
what is the tx for a vaginal fistula
surgery after an inflammation and edema have disappeared
nursing management for clients w/ vaginal fistulas
- antibiotic
- low-residue diet to keep stool soft
- enema and cleansing vaginal irrigation the morning of the surgery
- insert an indwelling catheter to keep bladder empty
post-surgery management for clients with fistulas
- serosanguineous vaginal drainage on the perineal pad is normal
- no urine or feces from the vagina indicates healing of the repaired fistula
- monitor catheter drainage closely
- keep suture area clean to prevent infection
- around the 3rd or 4th day post-op, a stool softener or rectal suppository may be ordered to prevent straining during a bowel movement
- bulging of the bladder into the vagina
- client experiences stress incontinence
cystocele
herniation of the rectum into the vagina
- constipation is often a problem
- client has to put her finger into the vagina and apply pressure to the posterior vaginal wall to reduce the herniation before being able to evacuate stool
rectocele
downward displacement of the cervix anywhere from low in the vagina to outside the vagina
- s/s include:
- backache
- pelvic pain
- feeling that something is falling out, esp when lifting a heavy object, coughing, or standing for long periods of time
uterovaginal prolapse
Medical and surgical management for pelvic organ prolapses
- pessary for when surgery can not be done or the client declines surgery
- pelvic floor strengthening exercises
- surgical repairs such as:
- surgical repair of the cystocele= anterior colporrhaphy
- repair of the rectocele= posterior colporrhaphy
- repairs in tears of the perineal floor= perineorrhaphy
Nursing management for pelvic organ prolapses
Show the client how to remove, clean, and reinsert a pessary
- remove the pessary and wash it thoroughly w/ warm, soapy water, followed by rinsing and drying
- inspect pessary to ensure all secretions were removed
- apply a sterile lubricant prior to reinsertion (discomfort= incorrect insertion)
- contact pcp if white or yellow discharge is seen from vagina (could indicate infection)
- assume knee-chest position to keep pessary and pelvic organs in good position
- avoid heavy lifting and straining during bowel movements
when a client has abnormal bleeding, this surgical procedure is done to determine the cause of or to control the bleeding
Dilation and Curettage (D&C)
This client presents w/:
- menorrhagia
- feeling of pressure in the pelvic region
- dysmenorrhea
- anemia, due to blood loss
- malaise
Fibroid tumor
medical and surgical tx for fibroid tumor
- D&C
- myomectomy
- Hysterectomy
- Uterine fibroid embolization
localized malignancy that, if left untreated, will invade other areas
Carcinoma in situ
Removal of the entire uterus and cervix
Hysterectomy
removal of the uterus only, with a stump of the cervix left in tact
Subtotal Hysterectomy
removal of the uterus, fallopian tubes, and ovaries
Panhysterectomy
removal of the uterus, cervix, ovaries, fallopian tubes: part of the upper vagina and some pelvic lymph nodes
Radical Hysterectomy
removal of all reproductive organs, rectum, colon, bladder, iliac blood vessels, and pelvic lymph nodes and peritoneum
pelvic exenteration
What preventatives are done to decrease the incidence of cervical cancer?
- Pap smears
- HPV vaccine (Gardasil)
a membranous sac filled w/ fluid, cells, or both
Ovarian Cyst
This client presents w/:
- pressure of the lower abdomen
- backache
- menstrual irregularities
- pain
- can be mistaken for appendicitis or urethral stone
Ovarian Cyst
Medical tx for ovarian cysts
- oral contraceptives for symptomatic relief
- if cyst ruptures = surgery
- oophorectomy: removal of the ovary
- oophorocystectomy: removal of the cystic tissue
- salpingo-oophorectomy: removal of the ovary and fallopian tubes
inflammation of the cervix
S/S:
- dyspareunia
- spotting/bleeding intermenstrually
- vaginal discharge
- slight bleeding after sex
Cervicitis
tx of cervicitis
- antibiotics
- electrocautery (a heat-generating device)
- conization (removal of the diseased portion of the cervical mucosa)
nursing management for cervicitis
- schedule procedure 5-8 days post menstrual period
- after electrocautery, instruct client to:
- rest more than usual for 1-2 days
- avoid straining or heavy lifting
- rest in bed and report any frank bleeding
- expect grayish-green, malodorous discharge is normal for about 3 weeks after cautery
- return for follow-up w/ PCP in 2-4 weeks
- abstain from sex until tissues are healed
- expect healing to take 6-8 weeks
This client presents w/:
- spotting
- pain
- symptoms of pressure on the bladder or bowel
- generalized wasting
Cervical and Endometrial Cancer
- increases after the age of 50, especially those taking estrogen
- other risk factors: early menarche, late menopause, never having been pregnant, obesity