Premenstrual Syndrome
• Why is PMS know as a syndrome
and not a disease?
a Group of physiological and
psychological symptoms
Premenstrual Syndrome
• What are the symptoms?
• Remember – these can vary from
month to month?
Premenstrual Syndrome
Treatment and Nursing Care
• Stress Reduction Techniques
• Initiation of an Exercise Program
• Diet Therapy
–
–
–
–
Avoid caffeine and alcohol
Eat complex carbohydrates, high-fiber
Reduce salt intake
Increase vitamin B12 , calcium and magnesium
Premenstrual Syndrome
Treatment and Nursing Care
• Drug Therapy
– Selective Serotonin reuptake inhibitors
• Prozac
• Zoloft
– Diuretics - spironolactone
– Prostaglandin inhibitors - ibuprofen
– Antidepressants, antianxiety - Xanax
– Oral contraceptives
Dysmenorrhea
• Discomfort associated with menstruation
• Cause - excessive prostaglandins
* What is the action of prostaglandins on
smooth muscles?
• Signs and Symptoms
– In addition to Abdominal what will the patient
complain of?
Dysmenorrhea
• Treatment and Nursing Care
– Drug Therapy
• NSAIDS/ Prostaglandin blockers • Oral Contraceptives
– Relaxation Techniques
– Heat Therapy
– Exercise
– Other
• Acupuncture
• Transcutaneous nerve stimulation
Abnormal Vaginal Bleeding
• Oligomenorrhea – long interval between menses
• Amenorrhea - absence of menses
• Menorrhagia – prolonged menstrual bleeding
• Metrorrhagia – irregular bleeding
Complications of Vaginal Bleeding
• Anemia
•
•
•
•
Order lab work – CBC, Hgb, Hct
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 – avoid use of superabsorbent
tampons and pads; change pads and tampons
frequently
Abnormal Vaginal Bleeding
• Treatment and Nursing Care
– Drug Therapy
• Oral Contraceptives
– Baloon 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
• Menopause is related to a decrease
in the production of _______ and
___________.
or
Surgically induced
Menopause Clinical Manifestations
• Cessation of menses
• Occasional vasomotor symptoms
• Atrophy of genitourinary tissue
• Stress incontinence
• Osteoporosis
• Sleep disturbances
Menopause
Treatment and Nursing Care
• Drug Therapy
– NO longer encourage the use of Hormone
Replacement Therapy – related to increase in risk
for development of breast cancer, stroke, heart
disease, DVT, pulmonary emboli
– Antidepressants
– Selective estrogen receptor modulators
• raloxifene (Evista)
– Bisphosphonates
• Fosamax or Actonel
Menopause
Treatment and Nursing Care
• Non-hormonal Therapy
– Cool environment
– Loose fitting clothing
– Moisturizing soaps and lotions
– Healthy diet with vitamin D
– Vitamin and mineral supplements
– Exercise
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
– Positioning
– Force fluids
– Heat to abdomen or Sitz bath
– Patient teaching – prevention of re-infection
Ask Yourself?
• The nurse caring for a patient with PID places
her in a semi-fowlers position in order to:
a. Relieve pain
b. Prevent the complication of sterility
c. Promote drainage and prevent abscess
d. Improve circulation and promote healing
Presence of normal Endometrial
Tissue outside the uterine cavity
Answer this!
• What is the big deal about
endometrial tissue being outside
the uterus?
Endometriosis
• What is the main symptom
of endometriosis?
Endometriosis
• Clinical Manifestations
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–
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Dysmenorrhea, pelvic pain
Dyspareunia, dysuria
Infertility
Chocolate cysts in ovaries
• Diagnosis
– Laproscopy
Endometriosis
How do these medications help
in treatment?
•
•
•
•
•
Ibuprofen (Advil)
Oral contraceptives
medroxyprogesterone (Depo-Provera)
danazol - Danocrine
Gonadotropin-releasing hormone agonists
– leuprolide (Lupron)
– Nafarelin (Synarel)
Endometriosis
• Treatment and Nursing Care
• Surgical Therapy
– Conservative
• Laparoscopic laser surgery / laparotomy
• Used in women who desire to bear children
– Definitive
• Hysterectomy
• Used in women who no longer desire children
Which of these diagnostic measures is used
most often to confirm the diagnosis of
endometriosis?
–
–
–
–
–
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
• Do they grow fast or slow?
• What makes them grow?
Leiomyomas
• Signs and Symptoms
– Most do NOT have symptoms
If they do:
– Abnormal uterine bleeding- menorrhagia and
metrorrhagia
– Pain, pelvic pressure
Uterine Fibroids (Leiomyomas)
• Diagnosis
– Enlarged uterus distorted with nodular masses
• Treatment and Nursing Care
– Myeomectomy, Myeolysis
– hysterectomy
– Cryosurgery
– ExAblate 2000 system
Answer this!
• A 26 y/o woman who wishes to have children
is diagnosed with uterine fibroids
(leiomyoma). Which of the following is likely
to be the treatment of choice?
a. A hysterectomy will be necessary to remove the
tumor
b. A myomectomy may be performed
c. Aspirin and NSAID’s will be used to control the
pain
d. Hormonal therapy will be used to shrink the
tumor and maintain sterility
Chronic endocrine disorder
resulting in:
Insulin resistence
Hyperandrogenism
Altered gonadotropin functioning
Polycystic ovaries
Estrogen/ testosterone
progesterone
LH, FSH
No egg
released
from ovary
Small cysts
develop in
ovaries rt
failure to
release egg
Diagnosed – Pelvic Ultrasound
Polycystic Ovaries
• Signs and Symptoms
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–
–
–
–
Irregular menstrual periods – infrequent or absent
Hirsutism
Obesity
Acne
No ovulation
• These manifestations are related to estrogen
and high levels of ____________ and no
________________.
Polycystic ovaries
 How do each of these medications assist in
treatment?
a. oral contraceptives –
b. spironolactone (Aldactone) c. leuprolide (Lupron) d. Metformin (glucophage) e. clomiphene (Clomid) –
Surgery
• Oophorectomy
Additional Treatment Options
• Weight management
• Exercise
• Monitor lipid profile
• Monitor glucose levels
Polycystic Ovaries
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
Teach what to “Call the Doctor” for.
Cervical Cancer
Cervical cancer
• What are the risk
factors that could
lead to cervical
cancer?
Staging and Treatment
Endometrial Cancer
Endometrial Cancer
• Major Risk factor
– Prolonged exposure to Estrogen
• Other Risk factors
–
–
–
–
–
Age - >60
Infertility
Diabetes
Family history, other cancers
Lifestyle – obesity, smoking
Endometrial Cancer
What brings a woman
to her doctor?
Endometrial Cancer
Treatment and Nursing Care
• Diagnosed
– Endometrial biopsy
Treatment:
• Surgical Therapy
– Hysterectomy – first choice of treatment
• Chemotherapy
• Radiation - brachytherapy
Brachytherapy
• Internal radiation implantation which
delivers a high dose of radiation to a
localized area.
• The radiation device is placed
near the tumor (in vagina)
seeds, needles, catheters
• Radioisotopes are loaded into
the device after correct placement.
Nursing Care for Brachytherapy
• What are the special
considerations and nursing care
related to the woman undergoing
brachytherapy for endometrial
cancer?
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 family history
• 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
Clinical Manifestations
• Explain why how these symptoms are related
to ovarian cancer.
– Increase in abdominal girth
– Bowel and bladder dysfunctions
– Persistent pelvic or abdominal pain
– Menstrual irregularities
– Ascites
Ovarian Cancer
Diagnosis
• 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
• What is the only way to confirm the diagnosis
of 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
Vulvar Cancer
• Risk Factors
– 50 plus
– Chronic irritation
– History of HPV or Herpes 2
• Manifestations
– Pruritus
– Burning
– Enlarged inguinal lymph nodes
– Asymmetry
– Lesions or mass
– Change in color
Treatment options for all Caners
• Surgery
– Oophorectomy, Panhysterectomy
– Pelvic Exenteration
• Chemotherapy
• Radiation
– External
– Brachytherapy
Try This?
• Nursing responsibilities related to the patient
receiving brachytherapy for endometrial
cancer include:
a. Maintaining bedrest
b. Allowing the patient bathroom privileges
only
c. Limiting an individual nurses’ contact with
the patient to 1 hour per day
d. Allow visitors as long as they stay 6 feet
away from the bed
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
– Prevent straining at Bowel Movement by using a Low
residue diet and stool
– Restriction of heavy lifting and prolonged standing,
walking or sitting
– Prevention of urinary retention
That’s all folks!