Ch 32 Women’s Healthcare Continued

Ch 32 Women’s Healthcare Continued
Menopause means the stop of menstruation and your book defines it as two consecutive months
without menses but you can find other sources that say a woman has to go 12 months without
menses. For testing purposes we will use the consecutive
2 months but want you to be aware because most other sources do use 12 months. One of the key factors we need to educate
on this is once a women has reached menopause, she needs to report any unplanned vaginal
bleeding because it is highly suggestive of endometrial cancer. Age varies when menopause occurs but it is
common between 45-50. During premenopause the ovaries are less fertile
and pregnancy is harder to achieve. The women can experience less vaginal lubrication
can occur and can cause painful intercourse. A lack in estrogen can cause atrophic changes
in the bladder and urethra which basically means she looses tone and can have some stress
incontinence. Hot flashes are a common finding as well. They tend to be more frequent at night which
can cause fatigue from having interrupted sleep pattern. Psychological responses can vary between women. Some women are happy they can no longer conceive
children while others grieve this issue. Depression, mood swings, irritability and
agitation can occur but no reason why these can occur is noted. Insomnia and fatigue are common as well. There is just no rhyme or reason why some
women can experience all of the changes and some very severe and the next person may only
have a few and are very mild. Therapy includes managing the symptoms. Many women just deal with the symptoms and
don’t seek any treatment. Hormone therapy used to be prescribed but
much research was done and it is not an effective treatment for many due to the increased risk
of certain cancers. Nursing considerations include education on
the effect of perimenopause and menopause. If the woman is choosing hormone therapy then
we must provide education on the importance of compliance and the risks and side effects
that can occur. A few non drug choices include using a water
soluble lubricant to help with painful intercourse, providing education on kegel exercises to
help with muscle tone of the pelvic muscles, drinking at least 8 glasses of water a day
to help decrease the concentration of urine to help decrease bacterial growth. Osteoporosis is one of the greatest risk concerns
for postmenopausal years. Predisposing factors include family history
of the disease, late menarche, early menopause and a sedentary lifestyle. Also women who drink alcohol, smoke or consume
excessive amounts of caffeine are at risk. Corticosteroids and some anticonvulsants will
also increase the risk. It is known as the “silent thief” because
it take place gradually over the course of many years without symptoms. The first signs that are noticed are the loss
of height and back pain that results from a collapsed vertebrae. Next the Dowager’s hump occurs when the
vertebrae can no longer support them. The abdomen will start to protrude and the
loss of the waist line as well. The major goal is to prevent osteoporosis. There are different medications that can be
prescribed to help reduce the osteoporosis. Calcium does not prevent bone loss but other
therapies will not work as well if there is a calcium deficiency. Vitamin D is necessary for the absorption
of calcium. Weight bearing and resistance exercise have
been shown to increase bone density and build muscle mass for women. High impact exercises should be avoided. Swimming or water based exercises improve
cardiovascular and respiratory maintenance while helping with weight control but they
do not limit bone loss. 30 minutes of exercise daily is recommended. Nurses can help educate on proper nutrition
and proper dietary guidelines. They can also educate on proper exercise and
educate on reducing the risk for falls for women who are at risk. Candidiasis is also known as a yeast infection
caused by a change in the vaginal pH increases the growth of bacteria. This change in the pH can occur with pregnancy,
diabetes, oral contraceptives and systemic antibiotics. The main symptoms include itching and some
can have pain with urination. Treatment can be prescription or non-prescription
medications and typical treatment is 3-7 days depending on the medication. Woman should seek medical care for the first
infection or if she has recurrent yeast infections. There are a variety of sexually transmitted
diseases that can occur. We will discuss a few of the more common ones. Some can be transmitted via sexual activity
so being sure to educate the women and her partner on treatment measures is needed. Trichomoniasis is a protozoa that thrives
in an alkaline environment. Symptoms include a purulent vaginal discharge
that is thin or frothy, malodorous and yellow-green or brownish gray. Treatment includes metronidazole or inidazole
and they need to avoid alcohol when using these medications. No intercourse until treatment is completed. All partners need to be treated as well. Bacterial vaginosis does not have a known
cause but tissue damage and vaginal intercourse can be contributing factors. The main symptoms include thin, greyish white
vaginal discharge that typically has a fishy smell. Treatment with metronidazole or clindamycin
. She should refrain from sexual intercourse or her partner should use a condom. Treatment of the partner is not shown beneficial. Chlamydia is high in sexually active teen
and young adults. They many times can be asymptomatic in men
and women so diagnosis can be difficult. The women may have a yellowish vaginal discharge
and painful urination. If it is untreated it can move from the cervix
up to the fallopian tubes and is the main cause of tubal scarring that result in pelvic
inflammatory disease (PID), infertility or ectopic pregnancy. Treatment includes azithromycin or doxycyline. Treatment of all sexual partners is needed
to prevent further spread. Use of condoms should be a priority until
a cure is established. Gonorrhea is often asymptomatic in women but
if they do have symptoms it is usually purulent discharge, dysuria and painful intercourse. It is also associated with PID which can increase
risk for infertility or ectopic pregnancy. Treatment will include treating for chlamydia
drugs as well as ceftriaxone or cefixime. All sexual partners need to be treated as
well and intercourse avoided until it is cured and use of a condom until it is cured as well. Herpes Genitalis is caused by the Herpes Simplex
virus known as HSV. Within 2 to 12 days after the primary infection
takes place, vesicles appear in clusters on the vulva, ,perineum or perianal areas. These lesions can cause great vulvar pain
and tenderness and painful intercourse. The lesions can also occur on the cervix or
in the vagina. The vesicle will rupture in 1-7 days and form
ulcers which take 7-10 days to heal. Once symptoms are gone , the virus lies dormant
and can return especially in times of stress. No cure is available but anti-viral meds (acyclovir)
can be used for treatment. No sexual intercourse while lesions are active. HPV are small wart like growths that can resemble
cauliflower. Common sites are the vagina, labia, cervix
and perineal area. There is an association between certain forms
of HPV and cervical cancer. The goal is to remove the wart and this can
be done by certain topical medications or they may need cryotherapy which basically
uses cold to freeze off the warts. Even with these treatment she can still have
recurrences. All sexual partners need to be treated as
well. Sexual intercourse should be avoided until
the lesions are healed. There are vaccines out there to reduce the
occurrence but there is a lot of controversy regarding the safety of these medications
so many are not choosing to vaccinate against HPV. Nursing considerations include education on
prevention of STD’s. We must teach signs and symptoms, explain
the testing procedures and treatment guidelines. Pelvic inflammatory disease is known as PID
and is an infection of the genital tract that causes chronic pelvic pain. The primary sources are the bacteria that
causes STI’s including chlamydia and gonorrhea. The bacteria can cause an inflammatory response
which in turn can cause scarring of the fallopian tubes and pelvic cavity. Some women experience very few symptoms while
others will have pelvic pain, nausea, anorexia and irregular vaginal bleeding. Therapeutic management includes treatment
of symptoms. IF a women is having a serious infection she
may be febrile, abdominal pain and leukocytosis and may be admitted to the hospital. They are treated with IVF and antibiotics
and surgery may be needed if she develops an abscess. Outpatient therapy works for most women. Nursing considerations include education on
ways to prevent STI’s and educating on limiting the number of sexual partners and avoiding
those that have multiple partners and also the importance of using condoms to reduce
the risk for STI’s. Also about signs and symptoms they need to
report to their provider and if any symptoms occur to contact their provider right away
for treatment.

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