NR 602 Final Exam Study Guide / NR602 Final Exam Study Guide(V3)(Latest, 2024):Chamberlain | Study Guides, Projects, Research Nursing | Docsity (2024)

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NR 602 Final Exam Study Guide ● Dysmenorrhea ○ painful menstruation ■ attributed to prostaglandin activity ■ increased leukotriene levels ○ one of the most common complaints ○ pain prevents normal activity and requires medication ○ 3 types of dysmenorrhea: ■ primary (no organic cause) ■ secondary (pathologic cause) ● endometriosis, adenomyosis, pelvic inflammatory disease, cervical stenosis, fibroids, and endometrial polyps ■ membranous (cast of endometrial cavity shed as a single entity ● rare; it causes intense cramping pain due to passage of a cast of the endometrium through an undilated cervix ○ Clinical Findings ■ almost always is associated with ovulatory cycles, it does not usually occur at menarche but rather later in adolescence ■ 14–26% of adolescents miss school or work ■ pain occurs on the first day of the menses - about the time the flow begins ● may not be present until the second day. ■ Nausea ■ Vomiting ■ Diarrhea ■ Headache ■ No significant pelvic disease ■ When symptomatic - generalized pelvic tenderness, perhaps more so in the area of the uterus than in the adnexa. ■ Occasionally, ultrasonography or laparoscopy is necessary to rule out pelvic abnormalities such as endometriosis, pelvic inflammatory disease, or an accident in an ovarian cyst. ○ Treatment ■ continuous heat to the abdomen in addition to NSAIDs decreases pain significantly ● Ibuprofen and Naproxen are prefered - First Line ■ Severe Pain ● Codeine or stronger pain medications ● cyclooxygenase-2 (COX-2) ○ Rofecoxib, valdecoxib, and lumiracoxib are effective for treating primary dysmenorrhea ■ must be used at the earliest onset of symptoms, usually at the onset of, and sometimes 1–2 days prior to, bleeding or cramping ■ Cyclic administration of oral contraceptives, usually in the lowest dosage but occasionally with increased estrogen, prevents pain in most patients who do not obtain relief from antiprostaglandins or cannot tolerate them ● given for 6–12 months. Many women continue to be free of pain after treatment has been discontinued ● Cystocele aka Anterior vagin*l Prolapse ○ vagin*l wall weakens and stretches and allows the bladder to bulge into the vagin* ○ Causes- ■ childbirth ■ chronic constipation ■ violent coughing ■ heavy lifting ■ Overweight ■ Age ■ hysterectomy (increased vag weakness) ○ Sx ■ felling of fullness or pressure in vagin* ■ increased discomfort when you strain/cough/bear down ■ feeling of incomplete empty ■ repeated bladder infection ■ pain or urinary leak during sex ■ bulge of tissue into vagin*l opening ○ Prevention ■ Kegels ■ prevent constipation ■ avoid heavy lifting ■ avoid wt gain ● Rectocele aka Posterior vagin*l Prolapse ○ When thin tissue of vagin* separates the vagin*l and rectum allowing vagin*l wall to bulge ○ Sx ■ soft bulge of tissue in vagin*l ■ difficult BM ■ sensation of rectal pressure ■ incomplete emptying after BM ■ sexual concerns-dyspareunia ○ Causes ■ constipation/strain ■ chronic cough ■ heavy lifting ■ Overweight ■ Childbirth ■ age ○ Prevention ■ Kegels ■ prevent constipation ■ avoid heavy lifting ■ Cough ■ avoid wt gain ● Uterine prolapse aka Apical Prolapse ○ pelvic floor muscles and ligaments stretch and weaken and no longer provide support for uterus and protrude into vagin*. ○ Causes ■ Pregnancy ■ large baby delivery ■ lower estrogen level after menopause ■ obesity ■ Common in postmenopausal and one or more childbirth ○ Sx ■ heaviness or pulling into pelvis ■ tissue protruding from vagin* ■ urinary probs (leakage, retention) ■ trouble having BM ■ feeling of sitting on small ball ■ sexual concerns ○ Prevention ■ HSV-1: usually oral infection, sometimes genital ■ HSV-2: causes most cases of recurrent genital herpes, can be oral ■ Clinical Manifestations ● May have prodrome (itching, burning, and tingling) on site. ● Sudden onset of small vesicles sitting on erythematous base. ○ Easily ruptures and is painful ○ Vesicle fluid and crusts are contagious ● Primary episode is more severe and can last from 2-4 wks. ● Recurrent breakouts ○ Virus lays dormant and can be reactivated ■ Treatment ● Herpes viral culture or RPR assay for HSV-1 and HSV-2 DNA. ● Tzanck Smear ○ Old test ● First episode ○ Acyclovir 400 mg TID x 7-10d ■ 200mg 5 times/d x 7-10d. ○ Famciclovir 1g BID x 7-10d ○ Valacyclovir (Valtrex) TID x 7-10d ● Flare-up Tx ○ Best if tx srt within 1 d of onset ○ Famciclovir 125 mg BID x 5d ○ Zovirax BID or TID x 5d or Valtrex BID x 5d ● Suppressive Tx ○ Acyclovir 400 mg BID ○ Famciclovir 250 mg PO BID ■ Prevention ● consistent condom use b/c viral shedding can occur in asymptomatic periods and can lead to transmission. ■ ALL cases of genital ulcers R/O syphilis and HSV ■ Pregnant women, mechanical methods are used to destroy genital warts ○ Chancroid pg 704 ■ Transmitted via sexual contact or on hands that have touched lesion. Caused by Haemophillus ducreyi ■ Reportable disease ■ Sx ● erythematous papule that evolves into pustule and degenerates into saucer shaped ragged ulcer that is circ*mscribed by inflammatory wheal. ● Tender ● heavy foul discharge that is contagious ■ Dx ● culture that grows H ducreyi ■ Tx ● Azithromycin 1 g PO once, ceftriaxone 250 mg IM once, cipro 500 mg PO BID x3 days, erythromycin 500 mg PO TID x 7d. ● Personal hygiene, clean w/ soap and water, sitz bath ○ Neisseria Gonorrhoeae ■ Reportable ■ Gram negative ■ Can become systemic ■ If positive for gonorrhea, tx for chlamydia too. ■ NO QUINOLONES due to high resistance ■ Labs: ● NAATs ■ Clinical Manifestations ● Purulent green vagin*l discharge ● May walk with shuffling gait to avoid pelvic pain ● Speculum exam reveals friable cervix with purulent discharge ● Males will have Penile Discharge with Dysuria ● Vag discharge ● Urinary frequency ● Dysuria ● unilateral swelling of intoitus ● anal itching ● Pain ● Pharyngitis ● Conjunctivitis ● systematic triad (polyarthalgia, tenosynovitis, and dermatitis) ● Usually hx of new partner with in last 3 months or multiple partners ● Inconsistent condom use ● Cervicitis ○ Mucopurulent cervix ○ Pain ○ Bleeding after intercourse ○ Dyspareunia ● Urethritis ○ Scant-copious purulent discharge ○ Dysuria ○ Frequency ○ Urgency ● Proctitis ○ Pruritus ○ Rectal pain ○ Tenesmus ○ Feeling urge to defecate when no stool present ○ Avoidance of defecation due to pain ● Pharyngitis ○ Severe sore throat not responsive to traditional tx ○ Purulent green discharge on posterior pharynx ● Bartholin’s Gland Abscess ○ Cystic lump that is red and warm ■ Located on introitus or vestibule ○ Can have purulent discharge ● Endometritis ○ Menometrorrhagia (heavy prolonged menstrual bleeding) ● Salpingitis and PID ○ One-sided pelvic/lower-abdominal pain ○ Adnexal pain ○ Dyspareunia ○ Cervical motion tenderness ■ Treatment ● Uncomplicated ○ Rocephin 250 mg IM x one dose PLUS ○ Azithromycin 1 g PO once OR ■ Doxycycline 100mg BID x 7d ● Complicated (PID, Salpingitis, Tubo-ovarian abscess, disseminated, asymmetric arthritis and maculopapular rash ○ Rocephin 250 mg IM once PLUS ○ Doxycycline 100 mg BID x 14d WITH OR WITHOUT ■ Metronidazole 500mg BID x 14d ■ Disseminated Gonococcal infection refer to EMERGENCY DEPARTMENT for ID consult. ● Give rocephin 1g IM or IV q 24hrs ■ Prevention ● Screen all high risk ppl sexually active women age 25 or less ● Use condoms ● Sex partner w/ in 60 days evaluate to tx that sex partner ● > 60 days tx most recent sex partner ● NB receive erythro ointment after delivery ○ Trichom*oniasis ■ Caused by flagellated protozoan, mobile ■ Prevention ● Condoms ● decrease # of sex partners ● vulvular hygiene ■ Sx ● purulent malodorous d/c w/ burning itching ● Dysuria ● Frequency ● painful sexl. ● Postcoital bleeding may occur foamy white green d/c ● strawberry appearing cervix ■ Dx ● motile flagellated organisms on saline wet smear, Affirm ■ Tx ● Metronidazole 2g PO single dose OR tinidazole 2 gm in single dose ○ Candidiasis ■ white curd like discharge ■ Common after antibiotic use. ■ Dx ● potassium hydroxide prep---distinct presence of hyphae ■ Tx ● topical azole drugs or PO fluconazole ○ BV ■ most prevalent vagin*l infection. ■ * Loss of lactobacilii and increase in vagin*l pH ■ fishy odor ■ Risk factors ● multiple sex partner ● Douching ● lack of condom use ● lack of vag lactobacilli ■ Prevention ● condom use ● no douching ■ Sx ● 3 of 4 Amsel criteria ■ Dx ● Gram stain is gold standard ○ saline wet mount with “clue cells” ● Amsel criteria: need 3 of 4 to be dx. ○ thin hom*ogenous white/yellow discharge ● Erosions, fissures, and ulcerations ● Vulvar skin is thin, wrinkled, and white if chronic ■ HIGH rate of SQUAMOUS CELL cancer. ● Biopsy all new lesions ○ Dx ■ Fixed labia ■ Adhesions ■ Vulvar biopsy to confirm. ○ Treatment ■ Medications ● Oral antihistamines ● Clobetasol dipropionate 0.05% is recommended at the start for immediate relief BID x 2 wks then SID x 2 wks then twice weekly for 2 wks. ○ Decreases incidence of vulvar carcinoma ○ Treat as needed for rest of woman’s life. ● Vulvodynia-Long one...pg 635 got info from FB file ○ persistent pain/burning ○ Sx ■ introital pain on vestibular or vag entry (entry dyspareunia) vestibular tenderness ○ Commonly affects 20-30 yr ○ Tx ■ pelvic floor PT ■ maintain vulvar hygiene ■ avoid constricting clothes and irritating agents. ■ 5% lido cream for pain relief ■ topical estrogen prep ■ after 3 months and no relief tx w/ TCA ● Lichen Simplex Chronicus ○ Clinical Findings ■ Epithelial thickening ■ Hyperkeratosis ■ Usually form chronic irritation from scented pads or chronic vulvovagin*l infections. ■ Itching causes the thickening and humid environment causes maceration. ■ Raised white lesion develops and may spread to adjacent thighs, perineum, or perianal skin. ○ Biopsy necessary. ○ Does NOT have inflammatory infiltrate like Lichen Sclerosus ○ Treatment ■ Sitz baths ■ Oral antihistamine ■ Lubricants ■ Medium-potency steroids twice daily. ● Betamethasone dipropionate 0.05% ● Betamethasone valerate 0.1% ● Fluocinolone 0.025% ● Triamcinolone Acetonide 0.1% ■ Intractable cases ● Antidepressants ● subQ intralesional injections of steroids considered. ● Amenorrhea pg 889 ○ Primary (no menses by 13 w/o 2ndary sex characteristics OR 15 w/ secondary sex; causes- chromosomal defect, anatomic anomalies, hormone imbalance, tumor, trauma) ○ absence of menses ○ Pregnancy is most common cause & must be considered in every pt for eval. ○ Primary ■ No menses by age 13 in absence of normal growth or secondary sexual dev. OR ■ No menses by 15 w/ normal growth & secondary sex dev. ● Usually from chromosomal dx such as Turner syndrome ○ Secondary ■ No menses x6 mo ■ pelvic pathology ■ most common cause=pregnancy ■ eating disorder most frequent etiology ■ no menses for 3 or more cycles OR 6 consecutive months in previous menstruation. ○ Causes ■ pregnancy (most common) ■ hypothalamic amenorrhea ■ pit amenorrhea ■ androgen disorders (PCOS, adult onset adrenal hyperplasia), ■ galactorrhea-amenorrhea syndrome. ■ female athlete triad (anorexia, amenorrhea, osteoporosis) ● ASCUS/HSIL results from paper test report ○ ASCUS ■ < 20 yoa: repeat cytology/Pap in 12 months ■ 21-24: repeat pap in 12 months (ok to reflex HPV test) ■ 25-29: preferred is to reflex to HPV. Acceptable is repeat pap in 12 months ■ 30+: if oncogenic HPV positive (subtypes 16 & 18), refer for colposcopy. If HPV negative, repeat co-testing in 3 years. ■ Per CDC: ● For non-pregnant women between 25 and 65 years of age with ASCUS cytology who have not had HPV co-testing already, HPV testing is the preferred next step (high-risk HPV testing only). ● With a negative HPV test (either on co-test or after cytology), repeat co-testing every three years is recommended. ○ HSIL ■ Suggests more serious changes in the cervix than ISIL. More likely to be associated with precancer and cancer. ■ Ages 21-24: refer for colposcopy with cervical biopsy ■ 25+: refer for immediate excisional treatment. ● LEEP or cervical conization surgery. ● Pelvic Mass- not in book wondering if they just want us to know how to work it up. ● Vulvar Carcinoma pg 796 in book - from fb file ○ post menopausal women, pruitus ○ 4th most common gyn malignancy ○ 90% of tumors are squamous cell carcinoma ○ disease in postmenopausal women 60-70 yrs ○ Sx ■ vulvar itching ■ Mass ■ vulvar bleeding/pain ■ tumor found incidentally during pelvic ○ Dx ■ biopsy ○ Tx ■ surgery, removal of tumor ● Molluscum Contagiosum ○ Benign epithelial poxvirus-induced tumors ○ Transmit ■ direct person-to-person contact, sexual contact w/ affected ○ Sx ■ Dome shaped ■ Up to 1cm (pin size up to eraser size) ■ Multiple contagious lesions ■ Look-a-likes of Chondylomata Acuminata ■ Have inclusion bodies (molluscum) under microscope ■ have small indentation (umbilication) ■ Itchy ■ may be seen on genitals ■ lower abd and inner thighs if was spread sexually ○ Prevent ■ wash hands ■ avoid touching bumps ■ avoid sexual contact ■ cover bumps ○ Treatment ■ Individual lesions ■ Desiccation ■ Freezing ■ Curettage ■ Chemical cauterization ■ Topical imiquimod ○ Scarring is frequent ● Condyloma Acuminate (Genital Warts) ○ Verruciform warts ○ Soft flesh pedunculated, flat, papular growths that are keratinized ○ High-risk oncogenic types ■ 16 & 18 ■ Any age ○ Cervical HPV usually asymptomatic and appears normal ○ HPV vaccine given at age 11-12 boys and girls ■ 2 doses 6-12 months apart ■ Recommended for gay men ○ Warts may appear on the vagin*, external genitals, urethra, anus, penis, nasal mucosa, oropharynx, conjunctiva ○ Medications ■ Podofilox 0.5% gel or cream BID x 3d Hold tx x 4d then repeat up to 4x. ● NOT in Pregnancy ■ Imiquimod (Aldara) 5% or Zyclara 3.75% ● NOT in Pregnancy ● Apply 3x wk at bedtime for 16 wks ● Leave on skin for 6-10 hrs then wash off ■ Sinecatechins 10% (External Warts only) ● Apply to each wart while wearing glove 3x/d x 16wks ● Wash off for sexual contact or before inserting tampons ● Weakens condoms and diaphragms ○ Other Tx ■ Corry Laser ■ Electrocautery ■ Bichloracetic or Trichloroacetic Acid surgical excision in clinic. ● Condyloma Lata (Secondary Syphilis) see syphilis ○ Generalized maculopapular rash on trunk and proximal extremities and spreads to entire body including palms, soles and scalp. ● Androgen insensitivity/resistance Syndrome ○ Tx ■ empirically with presumptive dx. ■ Rocephin 250 IM AND doxycycline 100 mg BID x14 PLUS metronidazole 500 mg BID x14 ● Pyelonephritis- 484 and 364 ○ bacteria in urine culture/ bacterial infection of kidney ○ Sx ■ Fever ■ Shaking ■ Chills ■ CVA tenderness ■ N/V ■ HA ■ increased urinary frequency ■ dysuria ■ –pyuria on UA w/ WBC casts….absence of pyuria should raise suspicion for other dx. ○ Dx ■ UA w/ culture ○ Tx ■ (outpt) Bactrim 14-21 days ■ antipyretics for fever ● Cervical Cancer Screening - 609? Or 819 ○ Screening Methods for Average-Risk Asymptomatic Women ■ Age 21 to 29: Every 3 years with cytology (Pap testing), regardless of age of onset of sexual activity or other risk factors. ■ Age 30 to 65: Every 5 years with HPV co-test (Pap + HPV test) OR every 3 years with cytology. ○ When NOT to Screen ■ Younger Than Age 21: Screening is not recommended for women younger than age 21. ■ Older Than Age 65: No screening past age 65 if adequate prior screening can be assessed accurately (three consecutive negative cytology results or two consecutive negative HPV results within 10 years before screening cessation, with the most recent test occurring within 5 years) and not otherwise at high risk for cervical cancer. ■ No Cervix: No screening if the cervix was removed for a benign reason. ● USPSTF recs regarding breast exams ○ Women, Age 50-74 Years ■ The USPSTF recommends biennial screening mammography for women 50-74 years. ○ Women, Before the Age of 50 Years ■ the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. ○ Women, 75 Years and Older ■ The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older. ○ All Women ■ The USPSTF recommends against teaching breast self-examination (BSE). ● BMI ○ Below 18.5 = Underweight ○ 18.5-24.9 = Normal ○ 25.0-29.9 = Overweight ○ 30.0+ = Obese ● Cervix/Uterus examination ○ Cervix ■ firm structure 3-4 cm diameter ■ projects into vagin*. ■ Multiparous may have laceration ■ irregular shape or nodularity may be r/t nabothian cyst ■ Firm may be tumor or cancer ■ Normally mobile can be moved 2-4cm w/o pain ● restricted movement could mean inflammation ○ Friable cervix ■ easily irritated ■ prone to bleeding esp after intercourse ■ suspicious for cervical cancer firm and easily friable ○ Uterus ■ 1/2 size of pt’s fist ■ Pear shaped thick walled organ between base of bladder and rectum. ■ 2 portions ● The body ● smaller cervix below. ● Gravida/Para ○ Gravida = total number of pregnancies, regardless of outcomes ○ Para= number of births ■ Broken down into ● Full-term ● Preterm at or beyond 20 wks ● Abortions pregnancy ending before 20 wks either induced or spontaneous ● Living Children ● Mammogram ○ Breast US & mammo reason ○ screening method for breast ca. ■ Cancer may be id 2 yr before size detected via palpation. ○ US ■ not recommended for screening in general population. ■ IS AN ADJUNCT TO ABNORMAL MAMMO. ■ May be added to high-risk woman. ■ Can help decrease false-neg rate of mammo and eval mammographically occult palpable breast mass ● Bartholin Glands Abscess and Cysts ○ Enlargement in postmenopausal pt may reflect malignant process. ○ Blockage of main duct of bartholin gland resulting in retention of secretions and cystic dilatation. ■ Infection ■ Congenital narrowing ■ Inspissated mucus ○ Secondary infection may result in recurrent abscess formation ○ Dx by clinical exam ○ Clinical findings ■ Pain ■ Tenderness ■ Dyspareunia ■ Difficulty walking ■ Surrounding tissues may become inflamed and edematous ■ Fluctuant tender mass palpable ○ Treatment ■ Drainage of infected cyst by marsupialization or inserting Word catheter. ■ Incision made by vestibule. ■ May need to remove entire cyst, especially in postmenopausal ■ Abx ■ Sitz Bath ■ Warm Compresses ● Skene’s Glands ○ Large paraurethral gland that opens beside the external urethral orifice in the vestibule. ○ located on the anterior wall of the vagin* around the lower end of the urethra. ○ secrete a fluid that helps lubricate the urethral opening, and are surrounded with tissue that swell with blood during sexual arousal ● Nabothian Gland and Cyst ○ Gland of the cervix that secretes mucus ○ Cysts ■ When a cleft or tunnel of columnar endocervical epithelium becomes covered by squamous metaplasia. ■ Appear translucent or yellow ■ Carry in diameter up to 3cm. ■ don’t cause pain, discomfort, or other symptoms ■ No treatment unless very large ● Excision ● Electrocautery ablation ● Cryotherapy ● Contraceptives- i’ll do monday ○ IUD ■ Mechanism of action thought to be ● Spermicidal ● interferes w/ normal dev of ova or fertilization ● causes cervical mucus to thicken ■ T shaped frame. ■ Can cause anovulation ■ Contraindications: ● Active PID or hx PID within last yr ● Suspected or confirmed pregnancy or has STD ● Uterine or cervical abnormality ● Undiagnosed vagin*l bleeding or uterine/cervical cancer ● History of ectopic pregnancy ■ Increased Risk ● Ectopic pregnancy ● Spontaneous abortion ○ If pregnant with device in place then 50/50 chance of abortion ○ Removal of device while pregnant reduces the spontaneous abortion rate by 50% ● Endometrial and pelvic infections ● Perforation of the uterus ● Heavy or prolonged menstrual periods ■ Education ● Pt to check for missing or shortening of string periodically, esp after each menstrual period. ● If no string order pelvic ultrasound ■ Good for: ● wanting less menses flow (increased initially, but then decreases by 70%) ● experience dysmenorrhea ● have DUB.