Women s Health Issues

Transcription

1 Women s Health Issues Chapter 22 Objectives Discuss toxic shock syndrome Discuss premenstrual syndrome Discuss dysmenorrhea and menstrual irregularities Discuss menopause and osteoporosis Identify screening tests for cancer detection Discuss breast cancer Discuss endometriosis and pelvic inflammatory disease Discuss violence against women Discuss sexually transmitted infections Women s Health Care in the 21st Century Positive health practices Pap smears Breast self-examination Proper nutrition Exercise Stress management Quit smoking 1

2 Healthy People 2010 Goals Unmet Goals: Health insurance Obesity Life expectancy Poverty Wage inequities Reduce smoking Provide mental health care Reproductive health care Reduce domestic violence Toxic Shock Syndrome Multisystem infection from toxins produced Staphylococcus aureus Risk factors: high absorbency tampons, diaphragm, cervical cap Symptoms: Sudden spiking fever Flulike symptoms: headache, muscle aches, vomiting, diarrhea, sore throat Hypotension Generalized rash resembling sunburn Elsevier items and derived items 2005, 2001, 1997, 1992, by Elsevier Inc. Premenstrual Syndrome (Ovarian cycle syndrome) Physical, psychological, or behavioral symptoms occurring between ovulation and onset of menses Symptoms: Weight gain Bloating Irritability Loss of concentration Mood swings Anger Fatigue Feel out of control 2

3 Dysmenorrhea Primary Caused by prostaglandins produced by uterus during menses TX: oral contraceptives, prostaglandin inhibitors (ibuprofen, aspirin) Self care: exercise, rest, heat, proper nutrition Secondary Associated with pathologic condition of reproductive tract Causes: endometriosis, PID, ovarian cysts Self care: vitamin E, warm tea, heat, massage, relaxation, daily exercise Menstrual Irregularities (Dysfunctional Bleeding) Menorrhagia: excessive bleeding during menses Postmenopausal: occurs at least 1yr after spontaneous menopause Dysfunctional: occurs with abnormal frequency Amenorrhea: absence of menstrual bleeding Primary: before regular menses established Secondary: after regular menses established Menopause Cessation of menses for 1 year Climacteric (change of life): physiologic and psychologic alterations that occur at menopause Physical changes are result of lowered estrogen levels HRT Benefits: bone density, osteoporosis/fractures, colorectal cancer risk Risks: breast cancer, risk heart disease, stroke, venous thrombosis, gallbladder disease 3

4 Osteoporosis Degenerative musculoskeletal disorder; bone density results in porosity in bone making person more vulnerable to fractures Risk factors: Greatest risk: women Asian descent; smallboned, fair-skinned white women of Northern European descent Other risk factors: family history, early menopause, sedentary lifestyle, inadequate calcium intake Decrease bony skeletal mass: caffeine, alcohol, smoking, long-term use of steroids Osteoporosis Osteoporosis Prevention is primary goal and should begin at youth Calcium intake Young women: 1200mg/day Post-menopause: 1500mg/day Vitamin D mg to aid in calcium absorption Calcitonin, Fosamax HRT (must weigh risk against benefits) Height measured annually 4

5 Screening Tests for Cancer Detection Papanicolaou Test: detects precancerous and cancerous cells shed by cervix Breast Self-Examination: Perform monthly approximately 1 week after each menstrual period, breasts are usually not tender or swollen at this time. Clinical exam should be performed every 1 to 3 years in women 40yrs old, then annually >40 Mammography: Every 1-2 years age Annually >50 High risk should begin before age 40 Breast Cancer Risk Factors Two inherited genes linked to breast cancer Age greater than 50 Family history of pre-menopausal breast cancer Use of alcohol Smoking High-fat diet High caffeine intake Early menarche Late menopause Nulligravid status Breast Cancer Treatment Lumpectomy Simple mastectomy Modified radical mastectomy Radical mastectomy Adjuvant Therapy: Estrogen blocking drugs-tamoxifen Elsevier items and derived items 2005, 2001, 1997, 1992, by Elsevier Inc. 5

6 Endometriosis Presence of endometrial tissue implanted in extrauterine sites Management varies with severity of pain, extent of disease, desire for children, woman s age, and threat to GI or GU tract TX: NSAIDs for pain; surgical intervention for severe symptoms Nonpharmacologic measures: rest, heat, moderate exercise, well-balanced diet Suppression of endocrine production with gonadotropin releasing hormone agonists to limit lesion growth and medically induce menopause Endometriosis Pelvic Inflammatory Disease Chlamydia trachomatis and Neisseria gonorrhea most common cause Risk factors: early onset of sexual activity and multiple sexual partners Places woman at increased risk of infertility, ectopic pregnancy, pelvic abcess, and adhesions Diagnosis: pelvic pain, adnexal/cervical motion tenderness, fever, purulent vaginal discharge Treatment: based on symptoms, if serious, may require hospital care 6

7 Pelvic Inflammatory Disease Violence Against Women Abuse: physical, emotional, sexual, social, financial Violence deliberate, often severe and typically repeated Nursing responsibilities Assessment Counseling Referral to community resources Violence Against Women Rape Trauma Syndrome Immediate response: fear of death or mutilation After attack: focused inward, anxiety, shock, disbelief, fear, guilt, shame Long-term response: change in lifestyle, distrust of men, phobias/fears, post-traumatic stress disorder 7

8 Vaginitis Predisposing factors: Antibiotics Douching Sexual intercourse Pregnancy Tight clothing, synthetic undergarments Poor hygiene STDs Symptoms: Vaginal discharge Pruritis Frequent or painful urination Vulvovaginal Candidiasis (Candida albincans) Most common vaginal infection (second only to bacterial vaginosis) SX: itching (pruritis), painful intercourse (dyspareunia), and thick, white, odorless discharge Increased risk from antibiotic use, local spermicidal contraceptives, oral contraceptives, DM, restrictive clothing TX: OTC (clotrimazole) or prescribed (fluconazole) local, topical or oral antifungal drugs Sexually Transmitted Infections Prevention: education, screening, immunizations, a mutually monogamous relationship is best Treatment: Syphilis: Penicillin Gonorrhea (GC): Ciprofloxacin Chlamydia: Azithromycin or Doxicycline Herpes simplex virus (HSV): Incurable but can suppress recurrent episodes with Acyclovir or Valtrex Human papillomavirus (HPV): Condylox gel, laser therapy or surgery may be indicated 8

9 Human Immunodeficiency Virus (HIV) Acquired Immunodeficiency Syndrome (AIDS) Transmission: exchange of any body secretions, can occur from a single act of sexual intercourse Invasive activities such as amniotomy or fetal scalp electrode placement should be avoided Breastfeeding not recommended Opportunistic infection: Often the first sign of HIV Pt will develop pneumonia due to the weakened immune system 9