Chapter 27: Female Genitourinary System Exam

Chapter 27: Female Genitourinary System Exam External Genitalia - Answer- -(vulva) mons pubis, clitoris, external urinary meatus, urethra, bartholin's glands, vagina, labia minora, labia majora, hymen What is the mons pubis? - Answer- -round, firm pad of adipose tissue covering the symphysis pubis Vestibular Glands (Bartholin) - Answer- -secrete clear lubricating fluid Internal Genitalia - Answer- -ovaries, uterus, vagina, rugae, cervix, Fallopian tubes What is the uterus? - Answer- -pear shaped, thick walled muscular organ The Aging Woman - Answer- -menopause cessation of the menses, occurs around 48-50 -the preceding is 1-2 years of decline in ovarian function shows irregular menses that gradually become farther apart and produce lighter flow -ovaries stop producing estrogen and progesterone More Aging Woman - Answer- -uterus shrinks -ovaries atrophy to 1-2 cm not palpable after menopause -sacral ligaments relax, and pelvic musculature weakens; thus uterus drops -cervix shrinks and looks paler with a thick, glistening epithelium -vaginal epithelium atrophies —> thinner, drier, itchy —> fragile mucosal surface at risk for bleeding and vaginitis HPV vaccine - Answer- -linked to steep decline in the presence of the virus in teenage girl and young women -recommended for boys and girls age 11 and 12 -HPV causes almost all cervical cancers as well as vulvar, vaginal, anal, and oropharyngeal cancers in female Female Genital Mutilation - Answer- -is a ice coercive procedure performed on girls before puberty -social custom, illegal in US -involves the removal of partial or total of clitoris, believed to inhibit sexual pleasure -can case, severe bleeding, death, sterility, infection, psychological trauma, and severe consequences during childbirth Subjective Data - Answer- -menstrual history -obstetric history menopause -patient centered care -acute pelvic pain -urinary symptoms -vaginal discharge -past history -sexual activity -contraceptives use -STI contact Menstrual History - Answer- -usually nonthreatening, good place to start What is LMP? - Answer- -last menstrual period What is menarche? - Answer- -first period -usually 12-13 yo, delayed onset suggests endocrine or underweight problem Period Cycle - Answer- -normally every 28 days; varies from 18-45 days Amenorrhea - Answer- -absent period Duration of Period - Answer- -average 3-7 days Menorrhagia - Answer- -heavy period What is dysmenorrhea? - Answer- -painful period, responds to ibuprofen because it works on uterine smoothie muscles Menopause - Answer- -when they have actually stopped getting period for over a year Premenopausal - Answer- -ranges from 40-55 and has hormone shifts resulting in vasomotor instability PAP tests - Answer- -dont start until 21 -once every 3 years for women 21-30 -HPV and pap "co-testing" every 3 years for women 30-65 Delaying PAP test - Answer- -delaying until 21 allows HPV infections to regress spontaneously in adolescents, avoiding overtreatment Acute Pelvic Pain - Answer- -less than 3 months -consider urgent conditions: pelvic inflammatory disease (PID), appendicitis, ruptured ovarian cyst, ovarian torsion Urinary Symptosm - Answer- -urgency dysuria, nocturia, hematuria (blood in urine, occurs with UTI and kidney disease), bile in urine or UTI Vaginal Discharge - Answer- -normal is small, clear, or cloudy, always nonirritating Postmenapausal Bleeding - Answer- -warrants pelvic exam, transvaginal ultrasonography Position for Inspecting Vagina - Answer- -lithotomy position -have her empty bladder, ask if she wants family member, elevate head, place legs in stirrups (but dont abduct too far), communicate Palpation - Answer- -assess Bartholin glands, palpate posterior part of labia majora with index finger in vagina and thumb outside at 5 and 7 o'clock positions Speculum Examination - Answer- -instruct woman to "bear down", turn speculum blade horizontal, insert at 45 degree angle downward, bringing cervix into view Inspect Cervix and Os - Answer- -color: pink and even, during pregnancy its blue (Chadick sign), after menopause its pale -position: midline -size -os: small round -surface: smooth Nulliparous Cervix - Answer- -someone who never had baby, no dilation of cervix -small and round Porous Cervix - Answer- -after having babies -slit like What are nabothian cysts? - Answer- -benign growths that commonly appear on cervix after childbirth -small, smooth, yellow nodules that may be single or multiple Cervical Secretions - Answer- -clear and thin, or thick, opaque, and stringy -always odorless and nonirritating -abnormal: foul-smelling, irritating, with yellow, green, white, or gray discharge Vaginal Pool - Answer- -gently rub blunt end of an Ayre spatula over vaginal wall under and lateral to cervix; wipe specimen on glass slide Cervical Scrape - Answer- -Use a cytobrush or insert the bifid end of the Ayre spatula into the vagina with the more pointed bump into the cervical os -Rotate it 360 to 720 degrees, using firm pressure. The rounded cervix fits snugly into the spatula's groove. The spatula scrapes the surface of the squamocolumnar junction (SCJ) and cervix as you turn the instrument. -Dip into a liquid vial or spread the specimen from both sides of the spatula onto a glass slide. Use a single stroke to thin out the specimen, not a back-and-forth motion. This specimen is important for the adolescent whose endocervical cells have not yet migrated into the endocervical canal. Endocervical Specimen - Answer- -insert cytobrush into the os to pull endocervical cells from the SCF (squamocolumnar jxn) Saline Mount, or "Wet Prep" - Answer- -spread sample of discharge onto a glass slide and add one drop of normal saline solution and a coverslip CONTINUES.......