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NURS 352 CH 5,6

question

What is the most prevalent vaginal infection in the US?
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Bacterial vaginosis
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What predisposes a woman to bacterial vaginosis?
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Frequent intercourse without condom use, trauma from douching, having a new sexual partner or multiple partners, and lesbian couples
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What occurs that ultimately results in bacterial vaginosis?
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A change in the normal vaginal flora, an overgrowth of vaginal anaerobes and subsequent change in pH
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What is indicative of bacterial vaginosis?
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Infected woman notices thin water white or gray vaginal discharge with a foul odor (described as fishy) Addition of 10% potassium hydroxide to vaginal secretions called the whiff test releases a strong fishy amine like odor
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What is the second most common vaginal infection?
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Vulvovaginal candidiasis
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What predisposes a woman to vulvovaginal candidiasis?
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glycosuria, use of oral contraceptives, use of antibiotics, pregnancy, DM, and use of immunosuppressant drugs
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What is indicative of vulvovaginal candidiasis?
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Woman complains of thick white curdy vaginal discharge, sever itching, dysuria, and dyspareunia Speculum examination usually reveals thick white tenacious curd like patches adhering to the vaginal mucosa
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What can occur if a woman has vulvovaginal candidiasis at the time of birth?
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The infant may become infected and get thrush
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Who is at the lowest risk for an STI?
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Individuals are at the lowest risk for an SSTI if they abstain from sexual intercourse or if they are in a long term monogamous relationship with a partner who is free of infection
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What is Trichomoniasis?
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A commonly occur STI caused by Trichomonas vaginalis, a microscopic protozoan that thrives in alkaline environment – the most curable STI
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How is Trichomoniasis acquired?
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Most infections are acquired through sexual intimacy. Fomite transmission by shared bath facilities, wet towels, or swimsuits may also be possible but is rare
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What is indicative of Trichomoniasis?
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Odorous, yellow/green frothy discharge from the vagina Vulvar itching, dysuria, and dyspareunia
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What is diagnosis of Trichomoniasis based on?
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microscopic identification of trichomonads, increased WBC, vaginal pH of shift of 0.5 or higher, positive whiff test, the OSOM and Affirm tes
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What is the treatment for Trichomoniasis?
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Metronidazole or tinidazole Woman should be cautioned against drinking alcohol within 72 hours of taking tinidazole and 48 hours of taking metronidazole
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What is the most common bacterial STI in the US?
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Chlamydia
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How is Chlamydia transmitted?
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Vaginal sex
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In a woman what can Chlamydia result in?
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PID, infertility, and ectopic pregnancy, increased risk of acquiring and transmitting HIV
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Why do we use erythromycin in babies eyes?
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Gonorrhea is the biggest reason, Chlamydia is second biggest
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What is the second most common bacterial STI in the US?
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Gonorrhea
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If Herpes is present in the genital tract what can result in?
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it can result in neonatal herpes, so a C-section is often performed to prevent this
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What virus causes Herpes?
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Herpes genitalis
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When does Herpes reappear?
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During times of stress (pregnancy is a stressor)
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What causes Syphilis
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Treponema pallidum
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What are the 3 stages of syphylisss
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o During the early stage a chancre appears where T. pallidum entered the body symptoms include slight fever, loss of weight and malaise, the chancre persists for 4 weeks then disappears. o In 6 weeks to 6 months secondary symptoms appear, skin eruptions called condlymata lata, which resemble wartlike plaques are highly infections appear on the vulva – other symptoms are acute arthritis, enlargement of the liver and spleen, nontender enlarged lymph nodes, iritis, and chronic sore throat with hoarseness o A latent phase with no lesions may be followed by a tertiary phase
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Can the baby get syphilis from the mother, if so what happens to the baby?
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Yes it is transmitted transplacentally The baby exhibits the second stage of syphilis May cause intrauterine growth restriction, congenital anomalies (including deafness, neurologic impairment, and bone and teeth abnormalities), preterm birth and stillbirth
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How are women with Syphilis treated?
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Women are treated with Penicillin G and those allergic and non pregnant doxycycline and tetracycline can be given
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What is the largest risk factor associated with HPV?
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Cervical and endometrial cancers
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How is diagnosis made with HPV?
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made by visual appearance, however vaginal and cervical warts are more common and only by colposcopy
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What are the qualities of the warts associated with HPV?
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Women seek healthcare after noticing multiple soft grayish pink cauliflower like lesions in her genital area The warts are often asymptomatic though they may cause itching or be easily friable depending on their size and location
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What causes pediculosis pubis
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-Caused by Phthirus, a grayish parasitic crab louse that lays egg that attach to the hair shaft, transmission is primarily by sexual contact, though shared towels and bed lines are also possible sources
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What is the major symptom of pediculosis pubis?
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Itching (especially in the pubic area
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How is pediculosis pubis treated?
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with 1% permethrin liquid or mousse, permethrin is applied to clean hair, saturating the hair, removing it after 120 minutes with warm water, some providers recommend combing the pubic hair with a fine toothed comb Or with- OTC such as RID, Nix, and malathion lotion
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What causes scabies
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Sarcoptes scabiei, a parasitic itch mite, that burrows under the skin to deposit her eggs
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What are the major symptoms of scabies
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itching that worsens at night or when the individual is warm, noticeable erythematous lesions or furrows may be present
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What is the treatment for scabies
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Recommended treatment is permethrin cream 5% applied to all bodies areas from the neck down and washed off after 8 hours, treatment is repeated in 7 days if live mites still existed Sexual contacts and close household contacts need to be examined as well Clothing and bed lines should be washed in a hot dry, dry cleaned, or sealed in a plastic ag for a minimum of 72 hours
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PID
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Definition = infection of pelvic structures Cause = Chlamydia, GC S/S = abd. cramping, fever, chills, flu-like sx., vaginal discharge Diagnosis = clinical exam/cultures Treatment = antibiotic
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Who should have mammograms?
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Women over 40
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What is the effect of fibrocystic breast disease?
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Changes may produce a asymptomatic mass but more often are accompanied by pain or tenderness and some nipple discharge – fluctuations in size and appearance or disappearance is common
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What can the woman do to alleviate symptoms?
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Reduce sodium intake Take a mild diuretic Take oral contraceptives Hormone inhibitor can be helpful but has undesirable side effects
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What contributes to fibrocystic disease?
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Caffeine containing products, and tobacco
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What symptoms may the woman exhibit if she has fibrocystic breast disease?
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– IF the lump is large and fluid filled the woman is likely to experience a localized painful area the capsule containing the accumulated fluid distends coincident with her cycle – if she has many small cysts she may experience a diffuse tenderness
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What is a fibroadenoma?
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Acommon benign tumor most often seen in women in their teens and early twenties – it is an asymptomatic mobile, well defined painless palpable mass with a rubbery texture
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What is galactorrhea?
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Nipple discharge not associated with lactation, is common problem, and often occurs in women how have fibrocystic changes in the breast
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What is intraductal papillomas?
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tumors growing in the terminal portion of a duct or sometimes throughout the duct system within a section of the breast – symptoms include a unilateral mass or a spontaneous and often bloody nipple discharge Small ball like lesions that may be detected on the mammography but often are nonpalpable
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Are care providers concerned for a woman with intraductal papillomas
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Intraductal papillomas are typically benign but usually excised to rule out the possibility of cancer
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What type of discharge would a woman with intraductal papillomas expect?
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discharge that is serosanguineous or brownish-green
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What is duct ectasia?
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Inflammation of the ducts behind the nipple: commonly occurs during or near the onset of menopause and is not associated with malignancy
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Who usually gets duct ectasia?
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Menopausal women who have borne and nursed children
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What characterizes duct ectasia?
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Thick sticky, nipple discharge of various colors and burning pain, pruritus and inflammation
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Where do most malignancies develop?
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The upper outer quadrant
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What are the characteristics of breast cancer?
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Painless, non-tender, non-mobile lump that may or may not cause retraction of the skin
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How prevalent is breast cancer?
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29 % of cancers in women making it most prevalent cancer in women
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What are predisposing factors for breast cancer?
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Increases with Age Female History of breast cancer BRCA 1 or BRCA 2 gene First degree relative with breast cancer Long term hormone therapy Alcohol No pregnancy till 30 Never breastfeed Longer reproductive phase High dose radiation to chest Physical inactivity
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What are the four stages of psychological adjustment with breast cancer
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o Shock – women doesn’t understand why it is happening to her o Reaction – woman is compelled to face what hs occurred and begins to take in what happened – coping mechanisms begin o Recovery – Begins during convalescence following the completion of medical treatment – resumes former activities or depression and social isolation set in o Reorientation – Women acknowledges that breast cancer is part of her lie yet living has returned to its former fullness and meaning
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How can a woman avoid breast cancer?
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Avoid obesity Exercise regularly Reduce dietary fat Limit intake of processed and red meat Limit alcoholic intake
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What can lead to vulvitis
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-Using sprays, harsh soaps, perfumed toilet paper, creams, foams, suppositories, douching, tight clothing, synthetic clothing, condoms
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What is vitiligo of the vulva
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depigmentation of the skin resulting in white patchy areas because of the absence of melanin – can cause significant disfiguring cosmetic changes
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What is a bartholin gland cyst?
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Infection of the Bartholin gland resulting in the inflammation of the gland itself Infection is often due to gonorrhea or stapylococcus
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What symptoms would someone with a bartholin gland cyst display?
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Unilateral pain, swelling of the bartholin gland
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What is vulvar vestibulitis?
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Local irritation and inflammation of the vulvar vestibule
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What are the symptoms of vulvar vestibulitis?
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Severe pain with vaginal penetration, burning and itching, urinary frequency or dysuria
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What are precipitating factors of vulvar vestibulitis?
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Recurrent vaginal infections, oral contraceptives, exposure to destructive treatments
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How do tumors of the vulva present
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with pruritus, a lump or flat lesion, or HPV related lesions, but may be relatively asymptomatic
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Who is at risk for vulvar tumors?
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Chronic vulvar inflammation, immunosuppression due to steroids, diabetes, HPV infection or HIV
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What is the treatment for vulvar vestibulitis?
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Involves surgery to remove the lesions and the tissue surrounding the lesion
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What causes cervicitis?
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Usually caused by gonorrhea or chlamydia Other causes include use of intravaginal feminine hygiene products, frequent tampon se, frequent intercourse, presence of a foreign body
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What are the symptoms of cervicitis?
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Yellowish, white vaginal discharge or copious purulent discharge
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What is the Bethesda system
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standardized method of reporting cytologic pap smear findings and is the most widely used method in the US
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What is the main cause of cervical cancer?
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HPV
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What is a colposcopy?
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Direct detailed visualization and examination of the cervix
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What makes abnormal epithelial cells easier to see on a colposcopy and what do they look like?
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A 3% acetic acid solution applied on the cervix causes the abnormal epithelial cells to take a white appearance
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What is a endocervical curettage?
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involves a scraping of the endocervix from the internal OS to the external Os to obtain Endocervical cells for cytology – some women may experience moderate to severe cramp like pains during and after the biopsy or ECC
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What is LEEP?
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Loop electrosurgical excision procedure A small electrically hot wire loop is used to excise the entire lesion, squamocolumnar junction and transformation zone – the cutting effect is created by a steam envelope that develops between the wire loop and water laden tissue
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What are the side effects of LEEP?
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Complications are minimal and is virtually painless and bloodless Women can expect slight bleeding and possibly a malodorous dark brown discharge for up to 2 weeks after the procedure Heavy bleeding is abnormal
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What is cryosurgery?
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carbon dioxide or nitrous oxide freeze tissue and results in destruction and necrosis
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What is the most common method for treating abnormal cytology in the cervix?
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LEEP
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What is laser surgery
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A laser is used to treat intraepithelial lesions, the laser is used when all boundaries are visible and when ECC is negative – The laser boils and explodes the cells
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What is conization
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A cone shaped section of cervical tissue is excised – the amount depends on the lesion
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WHen is conization performed?
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When entire lesion cannot be visualized or when ECC is positive
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What criteria must be met for diagnosis of toxic shock?
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Fever (greater than 38.9 C(102 F) Hypotension (systolic less than 90 mmHg Rash Multisystem involvement
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In what order do symptoms present in toxic shock
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Fever and rash present first, followed by desquamation of the skin, especially the palms and soles
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What symptoms are associated with toxic shock?
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Fever and rash, desquamation of skin Alterations in consciousness, disorientation, and coma may occur BUN, creatinine, AST, and ALT, and total bilirubin levels are often elevated Platelets are often less than 100,000
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Where is the most common location for endometriosis?
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Pelvic cavity
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What characterizes endometriosis?
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Presence of endometrial tissue outside the uterine cavity
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What is the most common symptom of endometriosis?
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Pelvic pain (which is often dull and cramping)
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What is the treatment for endometriosis?
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For minimal disease: analgesics, and NSAIDs For advanced cases: surgery may be done
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What happens in endometriosis?
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Endometrial tissue escapes the fallopian tubes an implants outside of the uterine cavity This tissue still responds to hormonal changes in the menstrual cycle and bleeds in a cyclic fashion, this bleeding results in inflammation, scarring of the peritoneum and formation of adhesions
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What is polycystic ovarian syndrome
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endocrine disorder of ovarian dysfunction that is evidenced by menstrual dysfunction, signs of androgen excess (hirsutism, cane) and infertility
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What are the most common signs of PCOS?
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Menstrual dysfunction – ranging from total absence to intermittent, or infrequent periods, anovulation Hyperandrogenism – women have consistently elevated serum androgen levels leading to hirsutism, acne, deepening voice and increased muscle mass Obesity – about half are clinically obese – increased hip to waist ratio mostly Hyperinsulinemia – May be insulin resistance characterized by failure of insulin to enter cells, placing women at increased risk for DM and impaired glucose tolerance Infertility – some degree o infertility related to anovulation