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Premenstrual Syndrome (PMS) • PMS is a group of physiological and psychological symptoms Causes: • Related to release of serotonin, estrogen and progesterone and nutritional deficiencies • • • • • • • Premenstrual Syndrome Manifestations Headache Breast discomfort Peripheral edema Abdominal bloating Sensation of weight gain Binge eating Depression, Anxiety, Irritability Premenstrual Syndrome Treatment and Nursing Care • Stress Reduction Techniques • Initiation of an Exercise Program • Diet Therapy ?? Premenstrual Syndrome Treatment and Nursing Care • Drug Therapy – Selective Serotonin reuptake inhibitors • Fluoxetine hydrochloride • Sertraline hydrochloride – – – – Diuretics - Spironolactone Prostaglandin inhibitors - Ibuprofen Antidepressants, antianxiety – Alprasalom Oral contraceptives Dysmenorrhea • Discomfort associated with menstruation • Cause - excessive prostaglandins • Signs and Symptoms – Abdominal pain- colicky, radiates to lower back and upper thighs – Nausea, diarrhea, – Fatigue – Headache, light-headedness Dysmenorrhea • Treatment and Nursing Care – Drug Therapy • NSAIDS • Oral Contraceptives – Relaxation Techniques – Heat Therapy – Exercise – Others Abnormal Vaginal Bleeding • Oligomenorrhea – long interval between menses • Amenorrhea - absence of menses • Menorrhagia – prolonged menstrual bleeding • Metrorrhagia – irregular bleeding – Complication is low hemoglobin Complications of Vaginal Bleeding • Anemia • Assess for excessive fatigue • Monitor vital signs • Provide for safety with the weak patient • Toxic Shock Syndrome (TSS) • Assess for high fever, vomiting, diarrhea, weakness, myalgia, and sunburn-like rash • Patient teaching ?? Abnormal Vaginal Bleeding • Treatment and Nursing Care – Drug Therapy • Oral Contraceptives – Balloon Thermotherapy – Myomectomy Endometrial Ablation • A resectoscope is a special type of telescope inserted inside the uterus. It has a built in wire loop that uses high-frequency electrical energy to cut or coagulate or ablate tissue. • The resectoscope has the advantage of being able to remove polyps and some fibroids at the time of ablation. Menopause Cessation of menses Menopause Perimenopause • Irregular menses • Vasomotor instability • Atrophy of genitourinary tissue • Stress incontinence • Breast Tenderness • Mood changes Menopause • Cessation of menses • Occasional vasomotor symptoms • Atrophy of genitourinary tissue • Stress incontinence • Osteoporosis • Sleep disturbances Menopause • Bleeding becomes irregular rt: – follicles no longer respond to FSH – ovarian production of estrogen and progesterone declines OR • Surgically induced Menopause Treatment and Nursing Care • Drug Therapy – NO longer use Hormone Replacement Therapy – Why? – Antidepressants – Selective estrogen receptor modulators • raloxifene (Evista) Menopause Treatment and Nursing Care • Non-hormonal Therapy – Cool environment – Loose fitting clothing – Moisturizing soaps and lotions – Health diet with vitamin D – Calcium supplements; vitamin E and B6 – Exercise – weight bearing and aerobic Review • To prevent or decrease age-related changes that occur after menopause in a patient who chooses not to take HRT, the nurse teaches the patient that the most important self-care measure is a. Maintain sexual activity b. Increase intake of dairy products c. Performing regular aerobic, weightbearing exercise d. Taking vitamin E and B6 supplements Infection of uterus, fallopian tubes, ovaries, and peritoneal cavity Pelvic Inflammatory Disease • Cause – gonorrhea and chlamydial infections spread up the reproductive system into the peritoneal cavity • Manifestation – Abdominal pain – Fever – Vaginal discharge • Diagnosis – Vaginal culture Pelvic Inflammatory Disease • Complications – Septic Shock – Infertility – Ectopic pregnancy • Treatment and Nursing Care – Drug Therapy – antibiotics – Bedrest in Semi-fowlers position – Force fluids – Heat to abdomen or Sitz bath – Patient teaching – ?? Presence of normal Endometrial Tissue outside the uterine cavity Endometriosis • Clinical Manifestations – – – – Dysmenorrhea, pelvic pain Dyspareunia, dysuria Infertility Chocolate cysts in ovaries • Diagnosis – Laparoscopy Endometriosis • Treatment and Nursing Care – Drug Therapy • Oral contraceptives • Androgens • Gonadotropin-releasing hormone agonists – leuprolide (Lupron) – Nafarelin (Synarel) Endometriosis • Treatment and Nursing Care • Surgical Therapy – Conservative • Laparoscopic laser surgery / laparotomy • Used in women who ?? – Definitive • Hysterectomy • Used in women who ?? As a nurse caring for a patient with endometriosis, what would be expected in the diagnostics? – – – – – A. CBC with differential C. Pelvic ultrasound D. Exploratory laproscopy E. Biopsy F. Ablation Tutorial on endometriosis • Go to the following website for a tutorial on endometriosis: • http://www.nlm.nih.gov/medlineplus/tutorials /endometriosis/htm/index.htm Leiomyomas Polycystic ovary Uterine Fibroids (Leiomyomas) • Benign smooth muscle tumors in uterus diagnosed with Hysteroscopy • Signs and Symptoms – Most do NOT have symptoms – Abnormal uterine bleeding – Pain, pelvic pressure Uterine Fibroids (Leiomyomas) • Diagnosis – Enlarged uterus distorted with nodular masses • Treatment and Nursing Care – Myeomectomy, hysterectomy – Cryosurgery – ExAblate 2000 system Chronic endocrine disorder resulting in: Insulin resistance Hyperandrogenism Altered gonadotropin functioning Polycystic ovaries LH, FSH No egg released from ovary Diagnosed – Pelvic Ultrasound Small cysts develop in ovaries rt failure to release egg Polycystic Ovaries Polycystic ovaries • Treatment and Nursing Care – Drug therapy • Oral contraceptives • GnRH agonist • Metformin (Glucophage) – Surgery • Oophorectomy Diagnostic Testing Pelvic Examination • What are the duties of the nurse in assisting with a pelvic exam? Pap Test Colposcopy LUMA Cervical Imaging System Conization Loop Electrosurgery Excision Procedure Endometrial Biopsy Cervical Cancer Cervical cancer • Risk factors – In situ 25-40 years old – Invasive 40-60 years old – Dysplasia – DES exposure – Lifestyle – STD exposure • HPV, HSV II Staging and Treatment Endometrial Cancer Endometrial Cancer • Major Risk factor – Prolonged exposure to Estrogen • Other Risk factors – – – – – Age - >60 Infertility Diabetes Family hx, other cancers Lifestyle – obesity, smoking • Clinical Manifestations – Abnormal vaginal bleeding Endometrial Cancer Treatment and Nursing Care • Diagnosed – Endometrial biopsy Treatment: • Surgical Therapy – Hysterectomy – first choice of treatment • Chemotherapy • Radiation - brachytherapy Postop interventions for PanHysterectomy • • • • • • • Analgesia Ambulation I&O Passage of flatus Heat to abdomen Psychological support Teaching for home care Ovarian Cancer Ovarian Cancer • Greatest risk factor is ?? • Other risk factors include – – – – – Age High-fat diet Greater number of ovulatory cycles Hormone replacement therapy Use of infertility drugs • 90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells Ovarian Cancer Manifestations • • • • • • General abdominal discomfort Sense of pelvic heaviness Loss of appetite Feeling of fullness Change in bowel habits Abnormal vaginal bleeding Clinical Manifestations • As malignancy grows, there can be an – Increase in abdominal girth – Bowel and bladder dysfunctions – Persistent pelvic or abdominal pain – Menstrual irregularities – Ascites Ovarian Cancer Diagnosis • Exploratory laparotomy to diagnose and stage disease • Screening for high risk women should include CA-125, ultrasound, and yearly pelvic examination • CA-125 is positive in 80% of women with ovarian cancer Tutorial on ovarian cancer • http://www.nlm.nih.gov/medlineplus/tutorials/o variancancer/htm/index.htm • Treatment of Ovarian Cancer – Surgery – most common – Chemotherapy Vaginal Cancer • Risk Factors – Elderly – Cancer of the cervix or endometrium – Young women - DES exposure • Manifestations – Bleeding not related to menses – Dyspareunia, Dysuria – Vaginal discharge – Teachings Vulvar Cancer • Risk Factors – 50 plus – Chronic irritation – History of HPV or Herpes 2 • Manifestations – Pruritis – Burning – Enlarged inguinal lymph nodes – Asymmetry – Lesions or mass – Change in color Treatment options for all Cancers • Surgery – Oophorectomy, Panhysterectomy – Pelvic Exenteration • Chemotherapy • Radiation – External – Brachytherapy Problems with Pelvic Support Uterine Prolapse • Downward displacement of uterus into vagina Second degree First degree Third Degree Uterine Prolapse • Signs and symptoms – Stress incontinence – Dyspareunia – Heavy feeling in pelvis • Treatment and Nursing Care – Pessary – Hysterectomy with A&P repair Cystocele and Rectocele • Cystocele – support is lost and bladder protrudes into the vagina • Rectocele – support is lost and rectum protrudes into the vagina Treatment and Nursing Care • Patient teaching – Kegels exercises • Surgery – Anterior or Posterior colporrhaphy – Post-op nursing care • Patient teaching ?? Lunch Time!
