MISSOURI-COLUMBIA | STUDY GUIDE |
QUESTIONS AND ANSWERS | NURSING
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,Cervical Cancer Risk Factors early age at first intercourse,
multiple sex partners,
cigarette smoking,
STI history
Cervical cancer prevention HPV Vaccine: Gardasil/Gardasil 9
Females/males ages 9-26 years; approval underway for older ages
HPV subtypes 16, 18, 6, 11 (G-9 additional strains)
Cervical cancer pathogenesis -cervical cell dysplasia: atypical cells with nuclear and cytoplasmic changes
-continuum of change: indistinct changes, in situ, invasive cancer (or regress)
-cervical intraepithelial neoplasia (CIN)
grading system for dysplastic changes
premalignant changes have minor to severe dysplasia
Cervical cancer diagnosis Pap Smear (endocervical cells in transformation zone)
Screen for HPV/cytology age/history dependent
Dysplasia = cone biopsy, endocervical curettage ,hysteroscopy
Bethesda system designates pre-malignant cervical disease as squamous intraepithelial lesions (SILs) (Pap
smear)
Cervical cancer manifestations -Poorly defined endocervical lesion
-Abnormal vaginal bleeding/ spotting/ discharge
-Bleeding after intercourse
-Pelvic/back pain (advanced disease), radiating down leg
-Hematuria (blood in urine)
-Fistulas (rectovaginal or vesicovaginal)
Metastasis to supraclavicular/ Inguinal lymph nodes
cervical cancer treatment -lesion removal
-invasive disease: radiation therapy (teletherapy, brachytherapy)
-surgery
,Uterine Disorders: Endometriosis The growth of endometrial tissue outside the uterus
Cause is unknown
Endometriosis risk factors no deliveries, high exposure to estrogen (period very young or late menopause)
Endometriosis manifestations -beginning in reproductive years
-pain (dysmenorrhea) bleeding between periods (in/out uterus)
-bleeding into surrounding structures- adhesions
-pain with defecation and micturition (urinating)
-infertility: adhesions distort pelvic anatomy, impair ovarian release and transport
endometriosis diagnosis laparoscopy (definitive); symptoms mimic other pelvic disorders
endometriosis treatment treat pain, suppress endometrial growth and ovulation (hormone suppression)
-surgery goal: restore normal anatomy, remove visible lesions, slow disease progression
-definitive treatment: hysterectomy with salpingo-oophorectomy
4 D's of endometriosis dysmenorrhea (cramps)
dyspareunia (pain during intercourse)
dysuria (pain urinating)
dyschezia (pain defecating)
Uterine leiomyomas- fibroids -benign tumors of the smooth muscle organ
-Most common pelvic tumor (1:4-4 females >35 years)
-Different layers of uterine corpus
most common: intramural fibroids
Uterine leiomyomas- fibroids manifestations -None
-enlargement of uterus (abdominal distention), abnormal vaginal bleeding, pain, infertility,
anemia
-rectal pressure/ constipation
-may grow during pregnancy, OCP use, menopause, estrogen replacement therapy
Uterine leiomyomas- fibroids diagnosis examination, symptoms
Uterine leiomyomas- fibroids treatment -depends on symptoms
-hysterectomy
-may regress with menopause
, pelvic inflammatory disease (PID) Polymicrobial infection upper reproductive tract (uterus, fallopian tubes, ovaries)
pelvic inflammatory disease associated with -STI microbes: N. gonorrhoeae, C. trachomatis
-Endogenous microbes: H. influenzae, streptococci
pelvic inflammatory disease factors Nulliparity
multiple sexual partners
previous PID infection
pelvic inflammatory disease manifestations -Lower abdominal/back pain, dyspareunia, painful cervical motion on exam
-Purulent cervical discharge, fever (> 101 F), increased ESR
-Coinfection with chlamydia/gonorrhea
pelvic inflammatory disease diagnosis -Elevated C-reactive protein levels (inflammation)
-Lower abdominal pain, adnexal tenderness (pelvic area ovaries, fallopian tubes, support
ligaments), cervical motion tenderness with no other causes
pelvic inflammatory disease treatment antibiotics
Polycystic Ovarian Syndrome (PCOS) -Endocrine disturbance-increased androgenic hormones
-Frequent source chronic anovulation
-Cause:? Genetic (autosomal dominant)
Polycystic Ovarian Syndrome Etiology/ Pathogenesis -Anovulation (irregular menses, polycystic ovaries)
-Elevated LH with normal estrogen & FSH levels
-Elevated total/free testosterone
-Hyperprolactinemia
-hypothyroidism
Polycystic Ovarian Syndrome Manifestations -Hyperinsulinemia (elevated hormones, obesity) —effect on ovaries
-Long term: cardiovascular disease, diabetes mellitus
PCOS diagnosis -rule out other diseases
-oligomenorrhea (infrequent menstrual periods)
-signs of hyperandrogegism (acne, excessive body hair)
-ultrasound
-fasting blood glucose, 2-hour oral glucose tolerance test