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
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