1. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Chapter 11 The Nurse’s Role in Women’s Health Care

2. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 2 Preventive Health Care for Women  Teaching women how to perform breast self-examinationbreast self-examination  Mammography Mammography  Vulvar examination  PAP test for all women, 18 years or older (or whenever they become sexually active, whichever comes first) PAP test

3. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 3 Amenorrhea  The absence of menstruation  Normal before menarche, during pregnancy, and after menopause  Primary  Secondary

4. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 4 Abnormal Uterine Bleeding  Three types  Too frequent  Too long in duration  Excessive in amount  Common causes  Pregnancy complications  Lesions of the vagina, cervix, or uterus  Breakthrough bleeding when on contraceptives  Endocrine disorders  Failure to ovulate

5. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 5 Menstrual Cycle Pain  Mittelschmerz is pain that many women experience around ovulation, near the middle of their menstrual cycle  Dysmenorrhea is painful menses or cramps  Primary—no evidence of pelvic abnormality  Secondary—a pathologic condition is identified

6. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 6 Endometriosis  The presence of tissue that resembles the endometrium outside of the uterus  Can cause pain, pressure, and inflammation  Can cause dyspareunia (painful sexual intercourse)

7. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 7 Premenstrual Dysphoric Disorder  Formerly called premenstrual syndrome  Associated with abnormal serotonin response to normal changes in estrogen levels  Symptoms occur between ovulation and the onset of menstruation  Symptoms are not present the week after menstruation has occurred

8. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 8 Preventing Vaginal Infections  Teach the woman to  Wear cotton underwear  Avoid tight nylon or Spandex pants  Wipe front to back after toileting  Wash hands frequently  Eat a high-fiber, low-fat diet  Exercise  Avoid douching or using internal feminine hygiene products

9. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 9 Toxic Shock Syndrome (TSS)  Usually caused by strains of Staphylococcus aureus that produce toxins that can lead to shock, coagulation defects, and tissue damage if they enter the blood stream  Usually results from the trapping of bacteria in the reproductive tract for a prolonged period Use of high-absorbency tampons Use of a diaphragm or cervical cap for contraception

10. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 10 Signs and Symptoms of TSS  Sudden, spiking fever  Flu-like symptoms  Hypotension  Generalized rash that resembles a sunburn  Skin peeling from palms of hands and soles of feet after 1 to 2 weeks of the illness

11. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 11 Prevention of TSS  Hand hygiene  Change tampons at least every 4 hours  Do not use superabsorbent tampons  Use peripads rather than tampons when sleeping  Do not use diaphragm or cervical cap during the menstrual period  Remove diaphragm or cervical cap as recommended by the health care provider

12. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 12 Sexually Transmitted Infections  Infections that can be spread by sexual contact, although some have other modes of transmission

13. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 13 Types of Sexually Transmitted Infections  Fungal or bacterial  Candidiasis  Trichomoniasis  Bacterial vaginosis  Chlamydia  Gonorrhea  Syphilis  Pelvic Inflammatory Disease (PID)  Viral  Herpes genitalis  Condylomata acuminata (HPV)  HIV/AIDS

14. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 14 The Nurse’s Role  Answering general questions concerning contraceptive methods  Teaching correct use of contraceptive methods

15. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 15 Factors That Influence the Choice of Contraceptive Methods  Age  Health status  Religion or culture  Impact of unplanned pregnancy on the woman or family  Desire for future children  Frequency of sexual intercourse  Convenience and degree of spontaneity desired  Expense  Number of sexual partners

16. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 16 Natural Family Planning  Also called fertility awareness  Involves learning to identify the signs and symptoms associated with ovulation  Acceptable to most religions  Requires no administration of medication or use of devices  Natural family planning is reversible

17. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 17 Types of Natural Family Planning  Basal body temperature  Cervical mucous  Calendar or rhythm method  Abstinence

18. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Class Activity  Two Groups  Group 1 Identify permanent methods of birth control and list them from least effective to most effective. Group 2 Identify temporary methods of birth control and list them from least effective to most effective. Both Groups – What are the advantages and disadvantages of each method, including side effects and contraindications. How would you educate your patient? Slide 18

19. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 19 Hormonal Contraception  Another form of temporary birth control  Types  Monthly  Extended  Delayed menstruation  Implants  Injections  Transdermal patch  Vaginal ring

20. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 20 Barrier Contraceptives  Diaphragm  Cervical cap  Male condom  Female condom  Spermicides

21. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 21 Emergency Contraception  The “morning-after pill” is a method of preventing pregnancy  Must be taken no later than 72 hours after unprotected sexual intercourse and must be repeated 12 hours after the first pill  Insertion of a copper 380-A IUD within 5 to 7 days is also effective in preventing unwanted pregnancy and in providing long-term protection from pregnancy  RU 486 (mifepristone) and misoprostol administered 36 to 48 hours after unprotected sexual intercourse is also considered to be an effective postcoital contraceptive regimen

22. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 22 Unreliable Contraceptive Methods  Withdrawal  Douching  Breastfeeding  Providing 10 breastfeedings in a 24-hour period can inhibit ovulation

23. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 23 Permanent Contraception  Male sterilization  Vasectomy  Female sterilization  Tubal ligation

24. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 24 Infertility Care  Infertility occurs when a couple engages in regular, unprotected sexual intercourse for 1 year and cannot conceive

25. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 25 Social and Psychological Implications Related to Infertility  Assumption of fertility  Psychological reactions  Guilt  Isolation  Depression  Stress on the relationship  Cultural and religious considerations

26. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Class Activity  Two Groups  Group 1 Identify Female causes of infertility. Group 2 Identify male causes of infertility. Both Groups – How are these discovered and what are the treatment options for these? Slide 26

27. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 27 Factors Affecting Fertility  Male  Abnormal Sperm Erections Ejaculation Seminal fluid  Female  Disorders of ovulation  Abnormal Fallopian tubes Uterus, cervix, or ovaries Hormones

28. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 28 Factors Influencing Fertility  Coital frequency  Age  Cigarette smoking  Exercise, diet, and weight  Emotional factors  Medical problems  Drugs and chemicals

29. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 29 Evaluation of Infertility  Male  Semen analysis  Endocrine test  Ultrasonography  Testicular biopsy  Female  Ultrasonography  Postcoital test  Endocrine test  Hysterosalpingogram  Endometrial biopsy  Hysteroscopy

30. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 30 Therapy for Infertility  Medications  Surgical procedures  Therapeutic insemination  Surrogate parenting  Advanced reproductive techniques  GIFT  TET  ZIFT  Microsurgical techniques

31. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 31 Menopause  Cessation of menstrual periods for a 12- month period because of changes in estrogen production  Climacteric, also known as change of life or the perimenopausal period (which is 2 to 8 years before menstruation ceases)  Pregnancy can still occur during the climacteric!

32. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 32 Physical Changes in Menopause  Usually caused by a decrease in estrogen  Changes in the menstrual cycle  Vasomotor instability (“hot flashes”)  Decreased elasticity and moisture of the vagina  Dyspareunia  Change in libido (sexual desire)  Breast atrophy  Loss of estrogen also means an end to the protective effect of estrogen on the woman’s cardiovascular and skeletal systems

33. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 33 Psychological and Cultural Variations  Can threaten the woman’s feelings of health and self-worth  Liberation from monthly periods  Ends fear of unwanted pregnancy

34. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 34 Treatment Options  Exercise  Increase in calcium, magnesium, and high-fiber diet  Hormone replacement therapy (HRT), which may increase risk of heart attack and stroke  Complementary and alternative therapies  Prevention of osteoporosis

35. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 35 Pelvic Floor Dysfunction  Occurs when the muscles, ligaments, and fascia that support the pelvic organs are damaged or weakened  Can result in  Vaginal wall prolapse Cystocele Rectocele  Uterine prolapse  Urinary incontinence

36. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 36 Management of Pelvic Floor Dysfunction  Pessary  Surgical intervention

37. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 37 Nursing Care  Instructing the woman on  The use of exercises  Diet  Prevention of constipation  Adequate fluid intake

38. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 38 Other Female Reproductive Tract Disorders  Uterine fibroids (leiomyomas)  Benign growths of uterine muscle cells  Grow under influence of estrogen  Result in irregular bleeding, pelvic pressure, dysmenorrhea, and menorrhagia

39. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 39 Treatment of Fibroids  If asymptomatic, then they can be observed and periodically reevaluated by health care provider  Hormones  Surgical interventions  Myomectomy  Embolization  Hysterectomy

40. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 40 Ovarian Cysts  Follicular ovarian cysts develop if the follicles fail to rupture and release their ova during the menstrual cycle  Lutein cysts occur when the corpus luteum fails to regress  Ovarian cysts that rupture or become twisted and cut off the blood supply may cause pelvic pain  Laparotomy is the treatment of choice

41. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier Inc. Slide 41 Cultural Aspects of Pain Control  It is the 5th vital sign  Culture can influence the expression of pain  Ethnicity can affect drug metabolism  Diet can affect drug absorption  CAM therapy can affect the action of prescribed drugs  Pain clinics are available  Some cultural groups will not report embarrassing side effects of drugs  Nurses must understand the cultural influences on pain expression