NR 602 NRWeek 8 final topics

Nr 602 final topics Week 8: ACOG guidelines regarding well women exams ACOG Pap smear guidelines Start @ 21, every 3 Age 30+ PAP & HPV repeat every 5 if negative (co-test) or 3 yr no co-test @65 may stop if (-) hx for 10 yrs or hysterectomy w/o hx of cancer Amenorrhea (Primary and Secondary) Primary and Secondary Amenorrhea  Primary amenorrhea: No menarche by the age of 15 years (with or without development of secondary sexual characteristics). Half of cases are caused by chromosomal disorders (50%) such as Turner syndrome.  Puberty is delayed if there is no breast development by age 13 years, absence of pubic hair at age 14 years, and no menarche by age 15 years.  Secondary amenorrhea: No menses for three cycles, or 6 months if previously had menses. Most common cause is ). Secondary Amenorrhea Associated With Exercise and Underweight  Excessive exercise and/or sports participation have a higher incidence of amenorrhea (and infertility) due to relative caloric deficiency  "Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis Labs  Pregnancy test (serum human chorionic gonadotropin [hCG])  Serum prolactin level (rule out prolactinoma-induced amenorrhea)  Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing hormone (LH; rule out premature ovarian failure)  If amenorrhea for more than 6 months, measure bone density Treatment Plan  Educate about increasing caloric intake and decreasing exercise  Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin E 400 IU daily Complications  Osteopenia/osteoporosis (stress fractures)  Myocardial atrophy, arrhythmia (sudden death), bradycardia, hypotension  Hypoglycemia, dehydration, electrolytes  Lanugo (fine downy hair), telogen effluvium (hair loss), xerosis (dry skin), infertility