Premenstrual Syndrome

• Why is PMS know as a syndrome and not a disease?

a Group of physiological and

psychological symptoms

Premenstrual SyndromePremenstrual Syndrome

• What are the symptoms?

• Remember – these can vary from month to month?

Premenstrual SyndromePremenstrual SyndromeTreatment and Nursing Treatment and Nursing

CareCare• 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 SyndromePremenstrual SyndromeTreatment and Nursing Treatment and Nursing

CareCare• 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. 

MenopauseMenopause

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

MenopauseTreatment 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

MenopauseTreatment 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, weight-bearing 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

– Dysmenorrhea, pelvic pain– Dyspareunia, dysuria– Infertility– Chocolate cysts in ovaries

• Diagnosis– Laproscopy

EndometriosisHow 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

Diagnosed – Pelvic Ultrasound

Estrogen/ testosterone

progesterone

Polycystic Ovaries• Signs and Symptoms

– 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 Diagnostic Testing

Pelvic Examination

• What are the duties of the nurse in assisting with a

pelvic exam?

Pap Test

Colposcopy LUMA Cervical Imaging System

ConizationLoop Electrosurgery Excision

Procedure

Endometrial Biopsy

Teach what to “Call the Doctor” for.

Cervical CancerCervical CancerCervical CancerCervical 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 EstrogenEstrogen

• Other Risk factors– Age - >60– Infertility – Diabetes– Family history, other cancers– Lifestyle – obesity, smoking

Endometrial Cancer

What brings a woman to her doctor?

Endometrial CancerTreatment 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 CancerOvarian 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 CancerDiagnosis

• 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/ovariancancer/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

Problems with Pelvic Support

Uterine Prolapse

• Downward displacement of uterus into vagina

First degree Second 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!