Exam 5 Review Guide
HPV
2
The nurse should include that Human papilloma virus is the main cause of cervical cancer.
Human Papilloma virus vaccine requires 2-3 doses and should be give between ages of 11 and 26
depending on the vaccine. Human papilloma virus causes genital warts not herpes. Parents decide to vax
or not for minor children – provide info
Vaccinations 2
Teaching the nurse should include about promoting life-long wellness includes receiving
recommended vaccinations.
Wellness
6
Breast mammograms are recommended yearly between ages 45 and 54. Cervical cancer screenings
should be conducted every 3-5 years. After age 50 colonoscopies should be conducted every 10 years
Pap test every 3 years for women age 19 to 29
Leading cause of death for women: heart disease – so when they present for well woman care they should
receive education of heart health and prevention of disease
A mammogram uses a specially designed low-dose x-ray machine to take an image of the breast to detect
abnormal changes. Each breast is placed between the x-ray plate and plastic plate. Pressure is gradually
increased to flatten the breast, allowing a clearer picture to be obtained. Women may experience a sense
of the breast being squeezed or pinched. The radiologist will compare the present x-ray with previous
breast x-rays, looking for changes, lumps or abscesses, and calcifications. When abnormalities are identified on a screening mammogram, further testing is needed; this may include a diagnostic mammogram,
ultrasound, MRI, or biopsy. Women with breast implants must inform the mammogram facility, as
implants can hide some of the breast tissue. Women should not wear any deodorants, perfume, lotion,
or powder under their arms or on their breasts on the day of the appointment. These substances can
make shadows on the x-ray.
Breast Cancer
6
for family history of breast cancer, BRCA 1 and 2 genes should be tested for
Think about post mastectomy therapeutic communication – what kinds of things would you say to a
woman in this situation, sometimes sit and listen is all you can do
Early detection of breast cancer when the tumor is small and has not spread provides the best
opportunity for successful treatment. Mammograms are recommended for women with average
risk for breast cancer; this includes those with no personal or family history of breast cancer and
no BRACA1 or BRACA2 gene mutation that increases breast cancer risk. MRI screening and
mammograms are recommended for women who are at high risk for breast cancer
(American Cancer Society, 2020). Women are considered high risk if they have a known BRCA1
or BR
CA2 gene mutation or a lifetime risk of breast cancer of 20% or greater. Lifetime risk for breast
cancer can be calculated using the breast cancer risk assessment tool at cancer.gov. When to
start breast cancer screening varies based on a woman’s risk for breast cancer. See Table 18-2
for recommended frequency of mammograms. Monthly self-breast examinations are no
longer recommended, but women should be aware of breast changes that need to be
reported to her health-care provider (Fig. 18–3).
Changes she should be instructed to report: lump in breast, skin dimpling, changes in skin
color/texture, nipple pulling in, leaking fluid or blood from the nipple
LGBTQ+
3
The nurse should understand that lesbian clients have a higher risk for breast and cervical cancer than
heterosexual women because of higher rates of smoking and alcohol use. Lesbians tend to have a higher
Body Mass Index than heterosexual women. Lesbians have a higher risk for gynecological issues than
heterosexual women because of increased Body Mass Index and increased use of alcohol and smoking.
Lesbians have a higher risk for osteoporosis than heterosexual women due to increased smoking and
alcohol and antidepressant use
Include the client’s partner in teaching and care. If the client desires to have her partner present the
nurse should include the partner
(LGBTQ) individuals experience health disparities related to societal stigma, discrimination, and denial
of civil rights. Lesbians face barriers to quality health care such as lack of health insurance, fear of
negative reaction from health-care providers due to sexual orientation, concern about confidentiality,
and lack of understanding by health-care providers of lesbian health issues. Due to these barriers, lesbians
see their health-care provider less often than do heterosexual women and they seek medical care at a later
stage than heterosexual women
IPV
1
IPV screening question: do you feel safe in your current relationship?
Menopause
6
Client often present with complaint of fatigue, hot flashes, heavy bleeding. Teaching the nurse should
include about coping with hot flashes include avoiding spicy foods as they can trigger hot flashes. The
client should avoid wool and synthetics and dress in layers. Hormonal replacement is not the only
effective treatment for hot flashes. Low-dose antidepressants as well as gabapentin and clonidine may
help with hot flashes urinary
Menopause is diagnosed when a woman has been amenorrheic for 12 months.
Technically menopause is a single day in life – the day a woman hits 12 months of amenorrhea. Prior to
it’s perimenopause and after that day she is post menopausal.
• Irregular periods: The time between cycles may become longer or shorter.
• Menstrual flow changes: may become heavier or lighter.
• Cycles become anovulatory, and the woman is no longer fertile after menopause is complete.
• Hot flashes may occur: Hot flashes are the most common symptom of menopause; This
symptom is caused by a vasomotor response to changes in the hormonal levels. This change
triggers blood vessels near the surface of the skin to dilate, causing an increase of blood supply
and subsequent increase of heat to the skin surface; When a woman experiences a hot flash,
she feels a sudden sensation of warmth that spreads through her upper body and face. Her
neck and face become red, and she begins to sweat and may feel irritable and
exhausted; Warm rooms, alcohol, hot foods, spicy foods, caffeine, and stress can trigger a hot
flash.
• Night sweats: Night sweats are hot flashes that occur while the woman is sleeping, Women
who experience night sweats will wake up with their bed linens and nightwear soaked from
sweat.
• Sleep disturbances: Women may experience altered sleep patterns related to night sweats
and difficulty falling asleep and staying asleep.
• Sexual dysfunction: Sexual desire and arousal disorders may occur, Some women experience
vaginal atrophy as declining estrogen levels cause vaginal tissue to become thinner and
drier, Dyspareunia is also related to vaginal dryness.
• Psychological side effects may include: Mood swings, Irritability, Anxiety, Lethargy, Lack of
energy, Panic attacks, Forgetfulness, Difficulty coping, Depression
• Women may also experience: Thinning of hair or hair loss, Food cravings, Dry skin and loss
of skin elasticity, Weight gain, especially around the waist and hips, Irregular heartbeat and
palpitations
Sexual dysfunctions related to vaginal dryness: Use water-based lubricants during sexual
intercourse. Use vaginal moisturizers. Use estrogen vaginal cream. Soy flour and
flaxseeds in the woman’s diet may prevent or decrease the degree of vaginal dryness
Urinary Issues
3
Incontinence: Treatment is based on the degree of incontinence and the effect it has on quality
of life: Behavioral techniques, Bladder training: Waiting 5 minutes from feeling the urge to void
to urinating and gradually increasing the time between urge to voiding, Scheduled toilet trips:
Developing a schedule for voiding and not waiting to feel the urge to void, Limiting alcohol and
caffeine use: These act as a bladder stimulant and diuretic, Losing weight, Pelvic floor
exercises, Kegel exercises: Improve pelvic floor muscle strength, Medications: Tolterodine
(Detrol) and mirabegron (Myrbetriq): Used to treat overactive bladder, Estrogen cream applied
to the genital tissues: Improves the tone and tissue in the urethral and vaginal areas, Medical
devices, Pessary, Surgery
Symptoms of UTI in older women can include: Confusion or delirium, Agitation,
Hallucinations, Poor motor skills or dizziness, Falling
Menstruation 4
primary dysmenorrhea is cramping lasting 12-24 hours after menstruation begins. Pain with
intercourse is dyspareunia. Pain at any point in the menstrual cycle is considered secondary
dysmenorrhea. Excessive cramping related to endometriosis is considered secondary dysmenorrhea
Sometimes birth control pills can help with heavy menstrual bleeding
Hysterectomy
5
It is normal for women to have big feelings post hysterectomy. They often feel like less of a
woman or no longer “whole” anymore. They need to be heard and reassured – just sit and
listen, provide therapeutic communication. She may need referral, but first you must assess.
What is your priority immediately post op? Can you provide d/c teaching in the PACU? Priority
questions ask you to identify the MOST important item so there may be more than 1 correct
answer – which is more important?
A pessary can be used for uterine prolapse to avoid surgery
There is a risk of injury to ureters and bladder with abdominal hysterectomy
CPP/rectocele/ cystocele
4
Chronic pelvic pain (CPP) is defined as pain in the pelvic region that lasts 6 months or longer
and results in functional or psychological disabilities; not improved with usual pain
treatments. It can affect the woman’s physical, emotional, social, and material well-being
(International Pelvic Pain Society, 2021). Women with CPP experience a variety of abdominal or
pelvic pains:
CPP can be caused by: Reproductive causes such as pelvic inflammatory disease (PID),
leiomyoma, adhesions, endometriosis, and intrauterine contraceptive devices, Urological
causes such as bladder neoplasm, chronic urinary tract infection (UTI), and kidney
stones, Musculoskeletal causes such as compression fracture of lumbar vertebrae, poor
posture, and fibromyalgia, Gastrointestinal causes such as Crohn’s disease, celiac disease,
colitis, irritable bowel syndrome, and colon cancer, Neurological causes such as shingles,
degenerative joint disease, and herniated disc, Psychological causes such as personality
disorders, depression, and sleep disorders, Sexual or physical abuse
PCOS/endometriosis
3
PCOS
Signs and Symptoms:
Infertility: Usually related to anovulatory menstrual cycles, Menstrual disorders: AUB, Hirsutism:
Increased hair growth on face, chest, stomach, and back, Ovarian cysts, Obesity, Oily skin and
acne, Pelvic pain, Alopecia
Medical Management:
Diet and exercise to assist in weight loss. It also helps: Reduce risk for type 2
diabetes; Decrease levels of androgens; Improve the frequency of ovulation and
menstruation; Reduce risk of cardiovascular disease (Fig. 19–2); Hormone therapy: Low-dose
hormonal contraceptives for women who do not wish to conceive. These contraceptives inhibit
LH production, decrease testosterone levels, and reduce degree of acne and hirsutism; Antiandrogen medications: Reduces scalp hair loss, facial and body hair growth, and acne, Should
not be used by women who are pregnant or attempting pregnancy; Fertility therapy: Medications
that induce ovulation, such as Clomid, may be used, Assisted reproductive technology, such as
in vitro fertilization, may be used for women who do not respond to medications; Diabetic
medications: Antidiabetic medications are prescribed to lower blood glucose levels and
glucose monitoring is often done. They can also lower testosterone, which reduces the
degree of acne, hirsutism, and abdominal obesity and may help regulate the menstrual cycle
and treat infertility.
Endo
S/Sx:
One-third of women with endometriosis are asymptomatic. Symptoms vary depending on the
location of the lesions. The degree of symptoms does not correlate with the size of lesions.
Pelvic pain and dysmenorrhea usually begin a few days before menses and stop at the end of
menstruation. Other symptoms include: Low back pain; Sharp pelvic pain; Pelvic
pressure; Dyspareunia; Infertility; Dysmenorrhea; AUB; Diarrhea, pain with defecation, and
constipation usually present when there are lesions of the bowel; Bloody urine and dysuria
usually present when there are lesions on the bladder; Fixed retroverted uterus; Enlarged and
tender ovaries
Know symptoms of PMS (what’s in your book, not what you know from society!) Table pg 616
Ovarian issues
2
Several types of ovarian cysts. Typically clients will present to ER with acute one sided pelvic
pain, often have painful vaginal and rectal spasms. Sometimes surgery is needed, sometimes
a ruptured cyst can cause bleeding that needs surgery or transfusion.
Medications 5
Alendronate – for osteoporosis, adverse effect symptoms, instructions for use
Hormonal therapy of choice will be conjugated estrogen post hysterectomy. if the client has a uterus the
hormonal therapy of choice would be conjugated estrogen plus medroxyprogesterone acetate. Hormonal
therapy may not replace all other osteoporosis medication and may not have fewer side effects than other
medications. Side effects of hormonal replacement therapy should also be included in the teaching
Study hormone replacement therapy – know contraindications (breast cancer)
Tamoxifen – for breast cancer
Nafarelin – used for endometriosis, side effects, instructions for use
Azithromycin – antibiotic
Oral contraceptives are used for many issues other than birth control – PMS, AUB, regulation/
suppression of cycle, recurrent ovarian cysts, more. They maintain a consistent level of estrogenprogesterone
Osteoporosis5
Osteoporosis is the loss of bone mass that occurs when more bone mass is absorbed than the
body creates. Bone mass in women usually decreases after age 35. Bone loss accelerates in
the first 2 to 3 years after menopause. Osteoporosis affects both men and women, but 80% of
Americans diagnosed with osteoporosis are women. Women who experience osteoporosis are
at greater risk for vertebral and hip fractures.
Osteoporosis is diagnosed with a dual-energy x-ray absorptiometry (DXA) scan, which
measures the bone density in the hip, spine, and forearm. These numbers are compared with
the average peak density for those of the same sex and race, assigning a number called a T
score:
• A T score of –2.5 or below is indicative of osteoporosis.
• A T score of –1 to –2.5 is indicative of osteopenia, which is lower than normal bone density
that puts the person at risk for osteoporosis.
DXA frequency based on health history/risk factors – know risk factors for osteoporosis,
pg 604
Risk reduction – pg 604 Durham – CA, Vit D, exercise, avoid smoking, limit alcohol
Risk Reduction:
Maintain a diet high in calcium and vitamin D. This should start around 9 years of age to help
form a strong bone matrix and should continue throughout the woman’s life based on these
guidelines: 1,300 mg of calcium for girls aged 9 to 18 years; 1,000 mg of calcium per day for
women aged 19 to 50 years; 1,200 mg of calcium for women aged 51 years and older; 600 to
1,000 IU of vitamin D per day for women 50 years and older; Engage in weight-bearing
exercise; Walking, jogging, dancing, and weight lifting three to four times per week; Avoid
smoking; Avoid both firsthand and secondhand smoke; Limit alcohol use; Heavy drinking
is linked to lower bone density.
Puberty
4
Outward sign of the onset of puberty is axillary and pubic hair growth; puberty is complete when
menstruation becomes regular. Puberty usually begins age 8-13 and Menarche usually begins two years
after puberty begins. Early puberty is not a sign of future gynecologic problems. With puberty there is
often rapid growth of the body which begins with the feet and ends with the face
Physical: Biological changes that occur include sexual maturity (development of primary and
secondary sex changes), increases in height and weight (adolescent female will grow 2 to 8
inches and gain 15 to 55 pounds), and completion of skeletal growth.
• Cognitive: The adolescent moves from being a concrete thinker to thinking abstractly, using
logic to solve problems, using deductive reasoning, and planning for the future. Adolescents
begin to be concerned with moral and social issues and compare beliefs with those of peers.
• Psychosocial: The adolescent is working toward role identity—who they are and who they will
be in life. They develop personal moral and ethical values and a greater sense of self-esteem
and self-worth as well as a satisfactory sexual identity.
Most adolescents are physically healthy but are at risk for health problems. Health problems
and issues for female adolescents include: Menstrual disorders, Acne, Eating disorders—
obesity, anorexia, and bulimia. Sexually transmitted illnesses—chlamydia and gonorrhea are
prevalent in adolescents. Teen pregnancies—Rates are 16.6 births per 1,000 females aged 15
to 19 and 0.2 births per 1,000 females aged 10 to 14 (Hamilton et al., 2019). Issues related to
self-esteem—20% of high school students report being electronically bullied, and 23.6% report
being bullied on school property (CDC, 2021). Mental health issues—46.6% of female high
school students reported persistent feelings of sadness and hopelessness (CDC, 2021).
Unintentional injuries, suicide, and homicides—these are the leading causes of death for
females aged 15 to 19 (Heron, 2019).
Endometrial/uterine/cervical cancer
4
The American Cancer Society recommends women to be screened for cervical cancer following these
guidelines: Pap test every 3 years for women age 19 to 29. 30-39, a Pap test and HPV test together
every 5 years. 40-64, a pap test and HPV test every 5 years. 65 and older, frequency is based on health
history. Women older than 65 can stop cervical cancer screening if they have not had any precancerous
cells found in the previous 10 years. These guidelines are only if there have been normal results!!!
KNOW CANCER STAGING, pg 634 Durham!
Likely to receive chemo, radiation, or a combo of both
Education should include teaching about surgical menopause
Pap smear and HPV test are used for cervical cancer screening (see Chapter 18 for
recommended screenings and immunizations for women across the life span). Women with
abnormal Pap smear or HPV test need further evaluation, since these are screening not
diagnostic tests. A colposcopy examination with a biopsy of the abnormal area is done for
definitive diagnosis. Most women who are diagnosed with cervical cancer have not had regular
Pap testing or have not followed up on abnormal results.
Memorize side effects for radiation for cervical cancer, pg 634 Durham
STI's 5
Important to teach safe sex practices – not just abstinence! Proper education has been
demonstrated to decrease teen pregnancy rates and subsequently abortions and complications
related to unwanted pregnancies etc. Abstinence is the only 100% way to prevent pregnancy
and STI but safe sex practices should be taught, including part of safe sex is using a barrier
method.
It is possible to get sexually transmitted infections through oral sex – and the infection can
present in the throat or rectum.
Diaphragms, cervical caps and sponges do not protect against STIs!!
Candida vaginitis – not an STI (no where else to put it on this review); memorize symptoms pg
623
Know stages of syphilis and differences of symptoms for various STIs, table pg 623 Durham
HPV is the most common sexually transmitted virus in the United States. It is the main
cause of cervical cancer and genital warts and can cause cancers of the cervix, vulva,
vagina, penis, or anus. It can also cause oropharyngeal cancers, which involve cancer in the
back of the throat, base of the tongue, and tonsils.
Obesity 2
People need 150min weekly of moderate intensity exercise, esp for BMI over 30
Know how to use a BMI chart to figure BMI
Math 5
Total item count
75