Women’s Health
Fibrocystic Breasts
Endometriosis
Polycystic Ovary Syndrome
Vaginal Infections
Uterine Tumors/Fibroids
Gynecological Cancers
Breast Cancer
Pelvic Relaxation/Hysterectomy
Female Circumcision
Fibrocystic Breasts
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Thickening of breast tissue due to
imbalance in estrogen and progesterone
Cyst formation is a late change in breasts
Most common benign breast disorder
Ages 30 – 50 years
May or may not increase risk of breast
cancer – depends on type of cellular
changes
Fibrocystic Breasts
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Symptoms increase approaching
menopause and decrease after
menopause
Pain, tenderness, swelling before
menses, “lumpy” feel to breasts
May have serosanguineous discharge
Fibrocystic Breasts
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Diagnostic studies:
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Mammography, sonography, palpation
Fine needle aspiration
Biopsy
Fibrocystic Breasts
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Treatment
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Restrict sodium intake
Limit caffeine
Mild diuretic
Mild analgesic
Hormone inhibitor – danazol
Oral contraceptives
Antiestrogen – tamoxifen
Oil of evening primrose
Endometriosis
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Endometrial tissue outside the
endometrial cavity
Endometrial tissue bleeds cyclically
like a menstrual period
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Causes inflammation, scarring,
adhesions
Occurs between 20 and 45 years of
age
Endometriosis
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Pelvic pain - related to menstrual cycle
Dyspareunia - painful intercourse
Abnormal uterine bleeding
Bimanual examination
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Fixed, tender, retroverted uterus
Palpable nodules in cul-de-sac
Diagnosis confirmed by laparoscopy
Endometriosis Treatment
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Surgical removal of visible endometrial
tissue
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Excision, endocoagulation, electrocautery, or
laser vaporization
Surgery is effective in relieving pain
Surgical removal of uterus, ovaries, tubes
Hormonal therapy, OCs
Women with minimal symptoms observation, analgesics, nonsteroidal antiinflammatory drugs
Polycystic Ovary Syndrome
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Imbalance of hormones
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Higher levels of androgens
Enlarged ovaries with many fluid-filled
cysts
Egg-containing cysts in ovaries grow
but do not release the egg
Not cancerous
Runs in families
Polycystic Ovary Syndrome
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Irregular, decreased or no periods
Less frequent ovulation
Excess growth of hair on face, chest,
abdomen, back, pubic area
Acne or oily skin
Weight gain, esp. waist area
Patches of thickened, dark colored
skin
Polycystic Ovary Syndrome
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Less common features:
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Male-pattern baldness
Skin tags in armpits or neck
High total cholesterol, low HDL chol.
High blood pressure
Diabetes
Polycystic Ovary Syndrome
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Diagnosis
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Pelvic ultrasound, hormone levels
Treatment
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Oral contraceptives
Exercise
Low calorie diet
Electrolysis, hair removal creams
Medicate to cause ovulation in infertility
Vaginal Infections
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Bacterial Vaginosis
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Alteration of vaginal pH allowing bacteria
to grow (Gardnerella, mycoplasmas)
Not an STI
Thin, watery white or gray discharge with
“fishy” smell
Treat with metronidazole (Flagyl)
Vaginal Infections
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Candidiasis – monilial yeast infection
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Vaginal “cottage cheese” discharge,
itching, dysuria, dyspareunia
Treatment - Clotrimazole
Sexually Transmitted
Infections (STIs)
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Trichomoniasis
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Protozoal infection
Toilet seats, wet bathing suits, wet towels
Yellow-green frothy odorous discharge
Treatment
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Metronidazole (Flagyl)
Treat both partners
STI
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Chlamydia
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Bacterial infection
Treatment
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Azithromycin, doxycycline
STI
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Gonorrhea
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Treatment
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Ciprofloxacin with doxycycline
STI
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Herpes
Treatment
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Acyclovir
STI
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Syphilis
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Can be transmitted transplacentally
Treatment
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Penicillin G
STI
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Human Papilloma Virus (HPV)
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Venereal warts
Soft, grayish-pink, cauliflower-like lesions
Treatment
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Cryotherapy, laser surgery
Linked to cervical cancer
STI
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Pediculosis Pubis
Abnormal Pap Smear Results
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Detects variety of abnormalities
Greatest impact on detection of cervical
cancer
Bethesda system most widely used Pap
Smear reporting system: Early detection
allows changes to be treated before
precancerous or cancerous cells develop
Deliver results in a caring way
Ovarian Masses
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May be palpated during a pelvic exam
Between 70% and 80% of ovarian masses
are benign
More than 50% are functional cysts
Occurs most commonly in women 20 to 40
years of age
May be asymptomatic or symptomatic
Symptoms: Cramping, dyspareunia,
irregular bleeding, delayed menses
Ovarian Masses
Ovarian Masses (cont’d)
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Treatment: Oral contraceptives, surgery
considered for large masses
Most ovarian cysts resolve on their own
Ovarian cancer is the most fatal of all
cancers in women
Difficult to diagnose
Often spread throughout the pelvis before it
is detected
Uterine Masses
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Fibroid tumors/leiomyomas
Most common benign disease entities
in women
Most common reason for gynecologic
surgery
Between 20% and 50% of women
develop leiomyomas by age 40
Common in women of African heritage
Uterine Fibroids
Uterine Masses (cont’d)
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Frequently asymptomatic
Symptoms include: Lower abdominal pain,
fullness or pressure, menorrhagia,
dysmenorrhea
Diagnosis: Ultrasonography revealing
masses or nodules
Masses or nodules involving the uterus
palpated on pelvic examination
Treatment: None, embolization (plug artery
supplying blood), U/S, or surgery
Endometrial Cancer
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Most common disease of postmenopausal
women
High rate of cure if detected early
Hallmark sign is vaginal bleeding in
postmenopausal women not treated with
hormone replacement therapy
Diagnosis: Endometrial biopsy, transvaginal
ultrasound, posthysterectomy pathology of
uterus
Endometrial Cancer
Endometrial Cancer (cont’d)
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Treatment: Total abdominal hysterectomy
(TAH) and bilateral salpingo-oophorectomy
(BSO)
Radiation therapy may also be indicated
Nursing management
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Reinforce knowledge of etiology, symptoms, and
treatment options
Schedule follow-up appointments
Provide emotional support and counseling
Breast Cancer
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Unregulated growth of abnormal cells
in breast tissue
Most common cancer in women
Second leading cause of death in
women
Can metastasize to bone, brain, lung,
liver, skin, lymph nodes
Staging 0, I, II, III, IV
Manifestations of Breast Cancer
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Breast mass or thickening
Unusual lump in underarm or above the
collarbone
Persistent skin rash near the nipple area
Flaking or eruption near the nipple
Dimpling, pulling, or retraction in an area of
the breast
Nipple discharge
Change in nipple position
Burning, stinging, or pricking sensation
Diagnostic Tests for Breast Cancer
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Breast examination
Mammogram
Needle biopsy
Excisional biopsy
Ductal lavage and nipple aspiration
Treatment for Breast Cancer
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Mastectomy
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Lumpectomy
Simple
Modified radical
Radiation therapy
Chemotherapy
Breast Reconstruction
Pelvic Relaxation
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Cystocele
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Relaxation of anterior vaginal wall with
prolapse of bladder
Pelvic Relaxation
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Rectocele
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Relaxation of posterior vaginal wall with
prolapse of rectum
Pelvic Relaxation
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Uterine Prolapse
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Downward displacement of uterus
Pessaries
The GELLHORN pessary provides
support for a second to third degree
uterine prolapse or procidentia.
The DONUT pessary provides support
for a third-degree uterine prolapse as
well as cystocele and rectocele.
RING pessaries, with or without support,
provide relief for first and second-degree
uterine prolapse or cystocele.
Hysterectomy
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Surgical removal of uterus
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TAH or TVH w/ BSO
TAH preferred for cancer, large
fibroids, endometriosis
TVH preferred for small fibroids,
abnormal uterine bleeding
Female Circumcision
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Female genital mutilation performed
on 2 million girls/year in African and
Asia countries
Cultural practice of womanhood
Sunna – excision of clitoris
Excision – removal of entire clitoris
and part or all of labia
Infibulation – excision of clitoris, labia
minora and scraping out labia majora
Female Circumcision
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Provide privacy
Create environment of trust where
patient can talk openly
Use warmed pediatric speculum for
exams
Provide health education about
reproductive care and pregnancy care
Develop birth plan to meet cultural
needs
NCLEX Question
The nurse is planning to teach couples factors
that influence fertility. What should not be
included in the teaching plan?
A. Sexual intercourse should occur 4 times a
week.
B. Wait one hour to urinate after intercourse.
C. Do not douch.
D. Use stress reduction techniques.
NCLEX Question
A menopausal woman tells the nurse that
she experiences discomfort from vaginal
dryness during sexual intercourse, and
asks, “What should I use as a lubricant?”
What should the nurse recommend?
A.
B.
C.
D.
Petroleum jelly
Water-soluble lubricant
Body cream or lotion
Less-frequent intercourse
NCLEX Question
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A.
B.
C.
D.
A nursing tech is assisting with nursing
care of a postmastectomy client. What
information does the nurse reinforce
with the nursing tech?
Maintain strict Intake and Output
No BP on the mastectomy side
Begin arm exercises immediately
Elevate proximal joint higher than
distal joint
NICU Nurse’s Prayer
Help me to remember to care for the
littlest of children with tenderness and
compassion.
Keep me ever mindful that babies can’t
tell me of their needs, so I must use
every one of my senses in taking care
of them.
Walk with me in every task of my day so
that I will stay alert to any changes that
need my attention.
NICU Nurse’s Prayer
Let me encourage the parents as they
learn how to care for their babies.
Give me the grace to teach them with
patience and show them unconditional
love.
Help us to care for each other when the
shift is long and the work is stressful.
Remind us to be thankful and to
celebrate this healing ministry.