↑

Chapter
3 : Women's Health Promotion Across the Lifespan
-

women tend to
put their healthcare needs last
women maintain her
can improve health
by :
healthy

S
eating
-

maintaining weight
-

a normal

T
exercising daily
-

-practice Safe Sex

avoid tobacco products

limit alcohol intake

-

Obtaining preventive care (Pap smears , pelvic exams , mammograms)

T women
-
-
-
mmigrant
Access to healthcare for
can be
challenging immigrants
-

language & cultural differences

lead to
misunderstandings mistrust delays diagnoses
-

can ,
,
errors in
,

and appropriate come

-
less likely to receive reproductive care

can lead to
unplanned pregnancy
+ cervical cancer

enstrual
Disorders
Amenorrhea: absence of menstrual periods
Primary : failure of menses
by age 16
Secondary
: Cessation of menses sometime after 1st period
of
puberty has occurred
lasting 3 consecutive cycles
or a time period of more than 6 months

Primary
-
: usually the result of a
genetic or anatomical condition

female reproductive either fail to develop normally during fetal

organs
-

development or do not function

normally when
puberty should begin
-

diseases of the pituitary or

hypothalamus can prevent stimulation

of the reproductive organs

,
 Secondary : may
-
be due to excess
weight loss , excess exercise, premature overy failure

disorders of the pituitary/hypothalamus ,

or emotional stress
.

T
Diagnostics
-

blood tests , hormone levels ;

prolactin , follicle-stimulating hormone (FSt) estrogen , thyroid stimulating
hormone (TSH) , dehydroepiandrosterone (DHEA) ,
↓ testosterone

treatment : hormone therapy

Imaging : pelvic ultrasound, xray ,
CT ,
MRI; to detect anomalies of the reproductive tract
treatments based on
findings

Dysmenorrhea:
-
painful menses .

-
menstival cramps that occur
immediately before or during the
early part of .
period
felt lower abdomen back, be mild severe
.
-

in or can or

·
associated /s : malaise , fatigue , n/v ,
lower backache , headache
.

-
-

Prostaglandins :
responsible for assisting
&
the uterus to contract a shed the living
.
-

↑ levels can cause severe cramping

-

cramping of the uterine muscle can cause the blood supply to the vterus to

be temporarily decreased, a pain does

results when the muscle not
get
enough oxygenated .
blood

Severe
dysmenorrhea be caused
by can

endometriosis : Uterine tissue growing outside of the uterus

.

infection the reproductive organs

-

in

-stenosis of the Cervix

-fibroids (benign tumors) in the inner wall of the uters

ysfunctional
Uterine Bleeding the absence
:
irregular bleeding that occurs in

of pelvic disorder medical disease or

pregnancy
a
, ,

bleeding unpredictable

Diagnostics!
-
CBC, Thyroid function tests
,
Liver function tests ,
Hormone Panels , pap smear

pelvic exams , coagulation tests

, pelvic ultrasound , endometrial biopsy (cancer)

Endometrial ablation ; procedure to destroy the uterine

lining
-
 apain
German wordsfor middle

-
Mittelschmerz : pain that occurs midway through the menstrual cycle

Premenstrual
- Syndrome (PMS) : a recurrent condition associated with the luteal

phase of the menstrual cycle ; women experience physical psychological ,

and

behavioral changes
enough
severe interfere with
to interpersonal

relationships and normal

activity
5/5 :
difficulty sleeping irritability crying spells depression weight gain
, ,
, ,

acne,
dysmenorrhea not flashes angry feelings tense feelings mood swings
, ,
, , ,

headache ,
abdominal
bloating ,
breast tenderness
, swelling of

the extremities , cravings for

sweet/salty food , general achest pains
Treatment: not definitive, lifestyle changes are recommended ,
nutritional
/
supplements recommended studied for their
being
of
effectiveness
NSAIDS are

ices heat of PMS

symptoms ,

-Calcium to relieve &

cravings depression
Magnesium reduce headaches
-

to

-Vitamin Ba to reduce moodiness , anxiety , a

bloating

Premenstrual Dysphoric
Disorder Severe form of PMs (PMDD) -

-
severe form of PMS : labile mood ,
irritability anger, anxiety
-

additional s/s: decreased interest in usual activities ,

difficulty
marked lack of
concentrating energy hypersomnia insomnia
feeling
or
, , ,

out of control overwhelmed marked change

of
being or ,
in

appetite with
overeating ,
abdominal bloating
Treatment: similar to treatment for PMS ,
more emphasis on meds
.
-

-
meds: hormone
therapy (drospirenone d estrogen) anxiolytics tantianxiety)
, mood stabilizers.
antidepressants

Endometriosis : Common in women in their 30s & 40s

-

lining of uterus outside the Uters

grows .
-

-
cause unknown
,
but it is believed that small pieces of the endometrium

travel back through the fallopian tubes into the pelvic cavity
,
on the
gettingtrapped & tissue begins to
grow outside of the

, (cervix ,
reproductive organs Vagina ,
volva , bladder , rector
tissue responds to thehormonal influences that cause menstrual cycle
.
 Endometriosis
SIS: painful menstrual , chronic
cramps low back pain , pain during
or after intercourse
, painful bowel movements
,or urination

during menstrual period bleeding

, spotting between menstrual
or

period , nuld bloating or constipation during menstrual

period .

-Diagnostics : endometriosis is
usually diagnosed by symptoms , pelvic examination
ultrasound ,
MRI a abdominal laparoscopy
,
,

Treatment : No cure , medical

-
management
may include
extended
cycle oral

contraceptives to reduce number of menstrual periods , Surgical

management involves removing the patches of endometrial tissue

outside the uterus .

menstrual Disorders.
Nursing Care
-
for women with
-

teaching about normal periods.

keeping record of abnormal bleeding episodesf
number of
pads/tampons
·

Avoiding Caffeine PMS

salt
Sugary foods these can contribute to
symptoms
-

, , ,

-importance of adequate nutrition & avoiding excessive exercise (hours per day
a low calorie intake cause
if exercise
body fut to drop below
·

16 %, ↑ risk of amenorrhea
.

eming
Planning
natural , barrier methods ,
hormonal contraceptives
.

Emergency Contraceptive
-
:
drug a or a device to prevent pregnancy after

unprotected Sex.

Fermanent
contraceptioan ent sterilization for women .
(Crisation or laparoscopic
Vasectomy :
permanent sterilization for men
 Infertility : failure to conceive after 1
year of unprotected sex
.

smoking (mendwomen
-

Risk factors : maternal

age greater
than 35 ,

Stress ,lafrects hormones

responsible for ovulation) scar tissue (caused by 57)
alcohol use ,
obesity ,
low BMI (low estrogen storage) excessive

exercise (causes a release of endorphins that stimulate prolactin

,

can suppress fertility

Testing Diagnostics
general blood

E
a to evaluate overall health
physical exam with pelvic exam tests
&
Blood tests to evaluate hormone levels & ovulation
(xray Edge)
women hysterosalpingography to visualize uterus &
fallopian tubes for abnormalities
·

hormone test : thyroid o pituitary

·

pelvic ultrasound : view reproductive organs .

Laparoscopy to identify a endometriosis

·

remove

E
N
semen analysis

men Hormone testing for testoster one levels

·

scrotal ultrasound to visualize the testicles

.

·
testicular biopsy

cuses
of Infertility :
early menopause ovulation problems
E
, ,

Women reproductive tract abnormalities endometrios is ,

thyroid problems Cancer treatment ,

men E
inadequate sperm production , problems with
of sperm , exposure to toxins, exposure
delivery
to excessive heat , cancer treatment

Treatments : correction of
lifestyle issues
(smoking obesity, , tub/
hot
-
Sauna use , excessive exercise
,
medications for infection
hormones (thyroid estrogen
, , progesterone)
Surgery to repair reproductive tract disorders
.

stimulating ovulation
drugs, intrauterine
with

insemination ,
Assistive reproductive technology (donor
 Menopause. cessation of menstrual
A confirmed
activity when a woman has

(1)
-

missed her period for 12 consecutive months .

(40-58 , average

perimenopause
-
: transitional phase from regular periods to menopause , lasting 4-10yrs-
Physical Changes : not flashes-caused by *
estrogen that signals hypothalamus to
-

dilate blood vessels in skin to cause the

heat to disperse
.

night sweets vaginal atrophy (thinningadrying of vaginal walls

,

dyspareunia- painful sex (caused by vaginal atrophy) dry skin

dit lack of collagen & ↓ in oil production difficulty ,

sleeping , mental Jogginess/forgetfulness dlt Nestrogen

loss normal
decreased vaginal lubrication , dryness ,
of

Vaginal flora ,
which is replaced by diverse flora
that infections
can cause UTI's &
vaginal .

loss of pelvic muscle tone osteoporosis

general ,

Treatment : depends on the woman a

severity of S/S .

therapy (HRM
-

·
low dose hormone replacement
with
estrogen
-

SSRI's (effexor ,
Paxil
,
prozac) to help control not flashes
-

Clonidine to help control hot flashes

-

Gabapentin to
help control not flashes (moderately
Intravaginal DHEA to
manage moderate to severe

dyspareunia

=
emale Reproductive TractDisorders tomor that can cause

abnormal menstrual
bleeding/infertility
.
-

fibroids akA :
myomas/leiomyomas of they develop from the
smooth muscular tissue of the myometrium .

Fibroids
-

usually shrink during menopause

Risk factors: Hereditary , race (African American) lifestyle(a diet

high in red meet , alcohol and low

vegetables can
encourage
fibroid development .
Fibroids
As heavy menstrual bleeding ,
severe menstrual
cramping
passing of
large clots during prolonged
menses
,
menstrual
periods , pelvic pressure or pain , infertility
.

Diagnostics:
-
pelvic exam ultrasound hysterosonography (saline infused
, ,

hystero sulpingography Hyster scopy ,

Treatment
-
if small
, nothing unless
grow a start causing
they
issues ·
If fibroids are
large prescribed meds to inhibit
,

estrogen shrink fibroids

progesterone to ,
prescribing
oral ⑭
contraceptives or dangzol to decrease menstrual

bleeding performing ,
uterine
artery embolization , surgery
to remove fibroids or a
hysterectory
.

lys
.
Tran
-

① follide cyst : forms when the follicle does not break open the egg & keeps growing
-not painful , usually ruptures in 1-3 months.

② corpus luteum : after the

egg is gone ,
the follicle is supposed to shrink

into a mass of cells called corpus loteum

.

-makes hormones to
prepare for the next egg but
a
cyst can

our if the follicle say does not shrink ,

instead the

reseals & with fluid.

sac
begins to fill

twist the
grow larger
it may
may disappear
-

or ,

&
ovary cause pain
Most Common cause of ovarian cysts are hormonal imbalances

or endometriosis
.

small ,
numerous cysts in ovaries (PCOS)

If a large cyst ruptures ,

it will cause sudden severe

lower abdominal pain on one side . If the cyst is twisting

the
ovary I
it will cause abdominal pain
along with
narsed & vomiting
.
 Ovarian cyst:

Sls : pressure/swelling in abdomen

, problems emptying bladder/bowels
.

dull aching in lower back , pain during sex , painful menstrual periods ,
abnormal bleeding

Diagnostics : made by symptoms a

by a
pelvic or
transvaginal ultrasound.

Polycystic
Ovarian Syndrome (PCOS)
-causedby different factors working together in the body
-effects entire body not just reproductive tract ,

Typical characteristics : increased levels of androgens insulin resistance ,

irregular menstrual periods.

sls :
irregular or absent menstrual periods ,
extra hair growth on
face
acce that is difficult to resolve ,
weight a
gain difficulty losing
weight , patches of dark
, velvety brown skin on the neck,

&
groin ,
underarms
.

Medical
~ Management : ultrasound of ovaries
,
obtaining baseline
hormone levels for correction
, fasting glucose ,
Ale & lipid levels
to determine if metabolic syndrome is
occurring , prescribing
hormonal
therapy in the form of oral Contraceptives , vaginal ring or

transdermal patch , metformin for elevated blood

glucose , spironolactone
to lessen hair
growth encouraging weight loss for overweight
,
or obese patients
.

lifestyle changes (increase exercise , heart healthy diet), screening for

anxiety
and depression

Infections
of
Reproductive tract
STI : Table 3 2 .

Vulvovaginitis : term used to describe

many types of
vaginal infections

E
33
Table that involve the Vagina & vulva
.

-
most commons vulvovaginal candidiasis , atrophic vaginitis and ,
contact
dermatitis
 TShock Syndrome (TSS) :
oxic rare , life
threatening illness
usually caused

by Staphylococcus aureus or
group
A Streptococcus . Toxins produced by these

bacteria cause symptoms

associated with the use of super absorbent tampons and
usually develops
-

within menstruation
5 days after the onset of

S/S high a chills,

fever flu-like
Symptoms ,
hypotension, vomiting a diarrhea

muscle aches , change in mental status ,

headache ,
redness of
eyes, mouth , throat,
petechiae signs ,
of sort tissue infection , rash that resembles a Sunburn

that
on palmsa soles eventually peels or

pts will become

a do not respond
severely hypotensive quickly
IV fluids
to
, leading to renal
dysfunction eventually ,

infecting other organs, causing multi organ system failure

death
leading to .

Pelvic
Floor Disorders
-involve a prolapse (dropping down) of bladder ,
urethre
, small intestine
, rector
,

Vaginal wall the

,
or utews because of a weakness or injury to
ligaments,
connective and muscles the
tissue of
pelvis .

Contributing
- factors : Childbirth obesity hysterectomy ,
, , aging engaging in

the abdomen
activities that increase pressure in such as
heavy
straining during bowel movements
lifting or .

2
event
types of pelvic floor disorders: leaking of urine when laughing
or coughing
↑
·

cystocele : blacker drops down + protrudes through the Vagina causing

bladder
stress incontinence
P
cannotempty completely
-

overflow in continence (passing wrine when bladder is too full) urinary retention

rectocele : rector drops a

down protrudes into the back wall of the vagina
-

making it difficult to have a bowel movement .

prolapse of uterus : the uterus drops down into the vagina because of
-

the
weakening of the connective tissue and
ligaments causing pain ,

lower back and making urination difficult

in
, pain with
walking
,
.

prolapse of the
Vagina ; the upper part of the drops into the lower

vagina inside
partcausing
,
the to turn out This
. causes pain while sitting
it difficult to urinate
or
walking ,
a
may also make or defecate
.

Treatment
: Kegel exercises pessaries (device shaped
,
like a
diaphragm , , or don't inserted in the
cube
V

Vagina to support prolapsed organ)

surgical repair
Chapter
& : Human
Reproduction & Fetal Development
reproductive system
Female
internal the female
-consists of external
organs , female pelvis breasts
+
organs , ,

reproductive cycle
External
organs
-

- mons publis : a pad of fat that lies over the Symphysis publis After .

puberty ,
the mons is covered with hair

-
labia majora: 2 folds of tissue that extend from the mons publis to either side of

the vulva , develop and

during puberty are also covered in hair .
After

menopause hormonal decline

,
causes some
atrophy in the labia

-
labia Minora : 2 smaller folds of tissue that form a hood-like structure called the prepuce

which surrounds the has sebaceous

clitoris .
It also sweat
a
glands to

lubricate the surface

.

Clitoris sensitive erective tissue front of the

: small organ containing
-

a lies in
,

vulva and below the mons pobis .

Vestibule : area between the labia minora t where the Urethra Vagina open .

-Bartholin glands : located on either side of the

vagina under the labia majora .
Their ducts

fluids to valuat facilitate

open to secrete
lubricating moister the

Sexual intercourse

-perineum : skin from the

vaginal to the it lies muscles & fibrous tissue
opening anus ,
over

that separate the

vagina Frectum .

Internal
Organs
-

Ovaries : 2 located either side of the uterus slightly behind and

small
glands on

below the fallopian tubes ,

attached to the broad ligament ,
a suspensory ligament
and the ends of the fallopian tubes and
,
are about the size & shape of

almonds , o
they store approximately 112 million and also secrete the
eggs. ,

hormones
estrogen/progesterone during each reproductive cycle
.

Fallopian Tubes attached to the uterus at one end and at the opposite end they ,

curve over the ovaries with

fringe-like projection . Its

function is to provide a channel for the sperm to travel to

the & to transport the fertilized into the uterus

.
egg egg
 ·

Uterus a muscular , triangle shaped organ located

between the rectur and bladder
providing the
environment for the of fetus The top portion
growth
a .

of the uterus is called the fundus ,

and the lower portion that

is
projects into the
Vagina called Cervix
the

t stretch to
cervix : elastic canal has the
ability to allow
-

for childbirth .

elasticity is due to
high fibrous & collagenous
content of the supportive tissue o the
large number of
folds the cervical The cervical canal contains
in
lining
.
mucus

secreting glands . to prevent the

growth of bacteria , lubricate the

vaginal canal ,
and to provide an alkaline environment to protect
from the
sperm acidic
vaginal secretions
.

the uters loats

has a Muscular coat with longitudinal and circular fibers

and an inner mucous membrane ,

which is in folds (rugal
-Blayers
of the uterus

① endometrium : mucous membrane that lines the carity of the uterus ,

the site

where the
embryo implants after arriving in the . uterus .

② myometrium's middle layer of smooth muscle that contracts & expels

the fetus placenta during childbirth
&

③ epimetriums Smooth transparent membrane that lines most of the

external surface
.

Reproductive Cycle
Female
Follicular Phase ? Anterior lobe of the
pituitary Secretes follick-stimulating
hormone (FSH) which stimulates the development of
a follicle in the ovary .
As the
egg folicle matures

the
it begins to secrete estrogen ,
which causes

endometrium in the uterus a

to thicken
prepare
for

the fertilized egg to implant . When the level

of estrogent ,
it prevents FSH from further secretion

responds to the decrease

The
pituitary gland in

FSH &
begins
to release (H
(luteinizing hormone)
Luteal Phases begins the
day the is released
.
on
egg
The levels of
luteinizing hormone (LH) peak approximately
day 14 of the
cycle causing
,
ovulation or the release of

the from the follicle After the follicle the

egg . on

ovany releases an
egg , LH converts the ruptured follicle
into the corpus loterm , which secretes
progesterone ·

Progesterone completes the development of the uterine

fertilized
lining in preparation for a
egg . If the

egg is Not fertilized the , corpus l term

begins to
degenerate
the levels of decrease , which
causing progesterone t
estrogen to

leads to the
shedding of the uterie
lining The menstrial
.

cycle begins again. If fertilization & implantation

occur ,
the endometrium does not
degenerate↑
the is .
woman
pregnant

Fertilization
-

if fertilization the does to

occurs
lining of the uteros not
begin
-

degenerate + provides a place for the

zygote to implant
estrogen a progesterone remain high t human chorionic gonadotropin (nCG)
-

placenta
The

is produced to
support the development of the embryo (hCG is made by the cells that forms
elevated heG levels can be first detected
by a blood test 11 days after
urine
&

conception o 12-14 conception

in
days after

zygote begins to divide

immediately by + continues
mitosis to

from & multiplies until to

produce
grow 2 cells it reaches 32 cells an
embryo
the fertilized fetus
-embryo-stage of development between ovum t

blastocyst-maturing embryo in which cell

some differentiation has occurred .

in the blastocyst stage embryo will implant 7-10 days after fertilization into the thickened
-

,
the

vascular uterine endometrium

the placenta develops at the site of implantation .

-placenta: that provides the fetrs with and nourishment from the maternal blood
organ oxygen

during the
gestational period.
 ges
of Fetal Development

E
-

Fetal Circulations Oxygen from the mothers blood crosses the placenta , enters the fetus's

blood
blood &
passes through the umbilical vein .
Oxygenated bypasses the liver through
o
A the ductus a
venosus combines with
deoxygenated blood in the inferiorvena cara

& and empties into the

right atrium . Pressure is
greater in the
right atrium

than the left atrium ,

so most blood will more through the foramen orale

⑳ A small amount of blood does travel from the

the
atrium to the ventricle into

the but most pulmonary

primonary system by passes arteries and move

o directly into the aorta through the ductus arteriosus ·

and out the rest of

↳ the body. Deoxygenated blood returns to the placenta through the umbilical arteries

F Trimester /Week
u 1 Week 12) -

Morphogenesisa cell differentiation establish layers

3
germ

S
in the within 2 WKs after fertilization 3 layers These
embryo .

are the foundation for the tissues

forgans of the body o
tab
verti ① Ectoderm : Outer
layer ,
becomes the nervous system , epidermis ,
tooth

enamel , a the lens a cornea of the

eye
.

② Mesoderm : Middle layer ,

becomes the connective tissue skeleton
, ,

skeletal muscles
, circulatory system Kidney ,
cortex
,
dermis

③ Endoderm" . Inner
layer ,
becomes the digestive tract ,
accessory organs
bladder
respiratory tract,
,
endocrine
glands .

GWeek 13-28)
Second Trimester
>

& structures continue

organs develop as
to a woman becomes

of her fetus Table 4 2

more aware
growing . .

Third
-
Trimester (Week 29-week 40)
Fetus
gains weight , matures ,
prepares
for life outside
the uters Table 4 . 3
 teratogens any substance that may cause a birth defect .

Fetal susceptibility
. depends on the period of development
-
.

& Skeleton
brain at risk
are for
damage by teratogens
-

from the 3rd week of

gestation to the end of pregnancy
-

heart is more susceptible to

injury during the 3rd & 4th
week of gestation
-

genitaliz are more sensitive to

injury during the

8th + 9th week of gestation

should avoid medications

by their HCP
-

pregnant women unless directed

lead ↓ street
,pesticides bacteria ,
Substances such
Teratogenic as
mercury drugs
-

, ,

can
adversely affect the
growth &
development of the fetus
.

cocaine leads retardation

use
during pregnancy growth
to
-

and microencephaly (small head & brain)

cocaine
Depending when use occurs
during pregnancy
-

the fetus's
genitals , kidneys , brain
may
have abnormalities
.

has been associated with

-cocaine use
during pregnancy
increase risk of placental abruption and neurobehavioral
abnormalities that are exhibited after birth
.

-
Opioid interphere with the function of the
use can

placenta and expose the fetus to periods of withdrawal

opioids cross the placente o can lead to neonatal
-

addiction and withdrawal after birth

symptoms
Adverse outcomes:↑ risk of premature birth ,
low
intracrania
birth
weight hypoglycemia
,
,

the uters, neonatal

hemmorhage in

abstinence Syndrome (NASL

-

methamphetamines :↑ heart rate , trisk of preterm labor

↑ risk of
placental abruption .

Marijuanas affects the of newborn

.
neurological development
ter
~
5:
Physical &
Psychological Changes in
Pregnancy
Diagnosisof
Pregnancy
s/s of pregnancy are
generally grouped in 3 categories
① presumptives subjective signs ,
least reliable
-

first signs amenorrhea

-
within 2 wks of
missing a
period
other /s present
-

N/u , fatigue ,
urinary frequency ,
breast

enlargement t fenderness
-
most women notice Fetal movement & 20wKs

first pregnancy it
may be 18-21wks
>
- with .

-in
subsequent pregnancy, may feel
quickening
Hetal movement) as
early as 15-1wks
.

② probable :
sign objective signs ,
blood or urinatest
.
-
Goodell's sign; softening of the Cervix
-
Chadwick's sign! bluish-purple coloration of the
and cervix
vaginal mucosa

of the lower
Hegar's sign: softening uterine
·

Segment .

HCP pushes the

Ballottement:
against cervix
-

and the fetus

can feel
floating
away from Cervix
the
-

Positive
Pregnancy test : HCG detectable by
day 11 of gestation
③ positiveSigns attributed only to presence of fetos
.

-
Fetal heart sounds by doppler
-

fetal movement
- .
ultrasound
 Changes
Thysiological
most
changes occur the result of the effects of
progesterone
-

as

and estrogen o
increasing demands of the fetus

Tables show the different changes pgs 70-78

Different fumily members also haveto adjust to changes