NU 404 Unit 2 Exam Guide With
Complete Solution
Amenorrhea
Absence of menses during reproductive years.
Underlying etiology will not be on exam.
Normal before puberty, during pregnancy, postpartum, post menopause.
There are two types of primary amenorrhea:
-Absence of menses by age 15 with absence of development of secondary
sexual characteristics.
-Absence of menses by age 16 with normal development of secondary sexual
characteristics.
Secondary amenorrhea: the absence of regular menses for three cycles or
irregular menses for 6 months in women who have previously menstruated
regularly.
Management of Amenorrhea
Nursing Assessment: obtain a health history (sexually active) physical
assessment, labs and diagnostic tests.
Nursing Management: counseling and education.
Therapeutic Management: With primary amenorrhea management involves
correction of any UNDERLYING disorders and estrogen replacement therapy.
,With secondary amenorrhea management includes cyclic progesterone,
treatment of hyperprolactinemia, eating disorder, obesity, hypothalamic
failure, hypothyroidism.
Birth control can be used to regulate menstrual cycles ... there is
progesterone in birth control.
Dysmenorrhea
Painful menstruation.
Primary (Spasmodic): increased prostaglandin production (level highest day 2
of menses). Sharp, intermittent spasms of pain.
Secondary (Congestive): pelvic or uterine pathology, chronic pain, commonly
associated with endometriosis.
Management of Dysmenorrhea
Nursing Assessment: obtain health history such as sexual activeness, thyroid
disorder, physical trauma, family history and clinical manifestations. Physical
assessment, labs and diagnostic testing could include X-Ray and ultrasound.
Nursing Management: Educate!
***NSAIDS suppress prostaglandin production/reduce inflammation &
associated pain. Use Ibuprofen (Advil, Motrin, Midol) 400-800 mg TID.
Naproxen (Anaprox, Naprelan, Naprosyn, Aleve) 250-500 mg TID
Non Medical approaches: increase water consumption, heating pad, warm
bath, increase exercise & physical activity.
,Therapeutic Management: the overall goal is to provide adequate pain relief.
Ovarian Suppressive Agent - Lupron.
Hormonal Contraceptives (low-dose oral contraceptives, Depo-Provera
injection, Mirena IUD)
Complimentary Therapies: massage, acupuncture.
Surgery - last resort.
Abnormal Uterine Bleeding
Painless endometrial bleeding that is prolonged, excessive, and irregular and
not attributed to any underlying structural or systemic disease.
Check thyroid labs, prolactin level, hypothalamus is functioning properly.
Similar to and may overlap with other uterine bleeding disorders.
Common at the beginning and end of reproductive years.
Pathology related to hormonal disturbance.
Treat the underlying cause! Polyp, adenomyosis, leiomyosis, malignancy,
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet
classified.
Management: Abnormal Uterine Bleeding
Nursing assessment:
•Health history and clinical manifestations
•Physical assessment
•Laboratory and diagnostic tests: CBC, PT, U/S, pregnancy test
, Nursing management
•Education
•Medication therapy (high dose estrogen-nausea)
Therapeutic Management:
•Normalize the bleeding
•Correct the anemia
•Prevent or diagnose early cancer (yearly exams)
•Pharmacotherapy (oral contraceptives)
•Insertion of a hormone-secreting intrauterine system (IUD)
•Surgical interventions:
•Ablation-removes a thin layer of tissue (endometrium) that lines the uterus;
use heat or cold. Cannot get pregnant after this procedure.
•Hysterectomy- surgical procedure to remove the uterus. Cannot get
pregnant after this procedure.
•Uterine artery embolization (UAE) cut blood supply to fibroid
Uterine artery embolization (UAE)
UAE fibroids can grow in the uterus may need to be cut out; fibroids are very
vascular and fibroids are the main reason females experience AUB. Fibroids
grow and can fill up the whole uterus. Procedure used as last resort with
abnormal uterine bleeding.
Complete Solution
Amenorrhea
Absence of menses during reproductive years.
Underlying etiology will not be on exam.
Normal before puberty, during pregnancy, postpartum, post menopause.
There are two types of primary amenorrhea:
-Absence of menses by age 15 with absence of development of secondary
sexual characteristics.
-Absence of menses by age 16 with normal development of secondary sexual
characteristics.
Secondary amenorrhea: the absence of regular menses for three cycles or
irregular menses for 6 months in women who have previously menstruated
regularly.
Management of Amenorrhea
Nursing Assessment: obtain a health history (sexually active) physical
assessment, labs and diagnostic tests.
Nursing Management: counseling and education.
Therapeutic Management: With primary amenorrhea management involves
correction of any UNDERLYING disorders and estrogen replacement therapy.
,With secondary amenorrhea management includes cyclic progesterone,
treatment of hyperprolactinemia, eating disorder, obesity, hypothalamic
failure, hypothyroidism.
Birth control can be used to regulate menstrual cycles ... there is
progesterone in birth control.
Dysmenorrhea
Painful menstruation.
Primary (Spasmodic): increased prostaglandin production (level highest day 2
of menses). Sharp, intermittent spasms of pain.
Secondary (Congestive): pelvic or uterine pathology, chronic pain, commonly
associated with endometriosis.
Management of Dysmenorrhea
Nursing Assessment: obtain health history such as sexual activeness, thyroid
disorder, physical trauma, family history and clinical manifestations. Physical
assessment, labs and diagnostic testing could include X-Ray and ultrasound.
Nursing Management: Educate!
***NSAIDS suppress prostaglandin production/reduce inflammation &
associated pain. Use Ibuprofen (Advil, Motrin, Midol) 400-800 mg TID.
Naproxen (Anaprox, Naprelan, Naprosyn, Aleve) 250-500 mg TID
Non Medical approaches: increase water consumption, heating pad, warm
bath, increase exercise & physical activity.
,Therapeutic Management: the overall goal is to provide adequate pain relief.
Ovarian Suppressive Agent - Lupron.
Hormonal Contraceptives (low-dose oral contraceptives, Depo-Provera
injection, Mirena IUD)
Complimentary Therapies: massage, acupuncture.
Surgery - last resort.
Abnormal Uterine Bleeding
Painless endometrial bleeding that is prolonged, excessive, and irregular and
not attributed to any underlying structural or systemic disease.
Check thyroid labs, prolactin level, hypothalamus is functioning properly.
Similar to and may overlap with other uterine bleeding disorders.
Common at the beginning and end of reproductive years.
Pathology related to hormonal disturbance.
Treat the underlying cause! Polyp, adenomyosis, leiomyosis, malignancy,
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet
classified.
Management: Abnormal Uterine Bleeding
Nursing assessment:
•Health history and clinical manifestations
•Physical assessment
•Laboratory and diagnostic tests: CBC, PT, U/S, pregnancy test
, Nursing management
•Education
•Medication therapy (high dose estrogen-nausea)
Therapeutic Management:
•Normalize the bleeding
•Correct the anemia
•Prevent or diagnose early cancer (yearly exams)
•Pharmacotherapy (oral contraceptives)
•Insertion of a hormone-secreting intrauterine system (IUD)
•Surgical interventions:
•Ablation-removes a thin layer of tissue (endometrium) that lines the uterus;
use heat or cold. Cannot get pregnant after this procedure.
•Hysterectomy- surgical procedure to remove the uterus. Cannot get
pregnant after this procedure.
•Uterine artery embolization (UAE) cut blood supply to fibroid
Uterine artery embolization (UAE)
UAE fibroids can grow in the uterus may need to be cut out; fibroids are very
vascular and fibroids are the main reason females experience AUB. Fibroids
grow and can fill up the whole uterus. Procedure used as last resort with
abnormal uterine bleeding.
