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Chapter - 006 Powerpoint Fall 2015

Chapter_006 Powerpoint Fall 2015

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Chapter - 006 Powerpoint Fall 2015

Chapter_006 Powerpoint Fall 2015

Uploaded by

RosemaryCastro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Chapter 6

Reproductive System Concerns

Copyright 2016 by Elsevier Inc. All rights reserved.

Learning Objectives

Describe and differentiate signs and symptoms of


common menstrual disorders.
Develop a nursing care plan for a woman with
primary dysmenorrhea.
Describe premenstrual syndrome (PMS) and
premenstrual dysphoric disorder (PMDD).
Relate the symptoms of endometriosis to the
associated pathophysiology.
Develop a nursing care plan for a woman with
endometriosis.
Summarize the therapies for menstrual disorders and
menopausal symptoms, including risks and benefits.
Copyright 2016 by Elsevier Inc. All rights reserved.

Learning Objectives (Cont.)

Differentiate the various causes of abnormal


uterine bleeding.
Identify health risks of perimenopausal women.
Describe the common signs and symptoms of
perimenopause.
Develop a teaching plan for managing symptoms
in menopausal women.
Examine the risks and benefits of menopausal
hormone therapy.
Summarize client teaching strategies for
prevention of osteoporosis.
Copyright 2016 by Elsevier Inc. All rights reserved.

Common Menstrual Disorders

Amenorrhea

Absence of menstrual flow


Clinical sign of a variety of disorders
The absence of both menarche and secondary sexual
characteristics by age 14 years
Absence of menses by age 16, regardless of presence of
normal growth and development (primary amenorrhea)
A 3- to 6-month absence of menses after a period of
menstruation (secondary amenorrhea)

Although amenorrhea is not a disease, it is often


the sign of one.

Copyright 2016 by Elsevier Inc. All rights reserved.

Common Menstrual Disorders


(Cont.)

Hypogonadotropic amenorrhea

Problem in central hypothalamic-pituitary axis


Results from hypothalamic suppression
Assessment
Counseling and education

Exercise-associated amenorrhea
Management of amenorrhea

Copyright 2016 by Elsevier Inc. All rights reserved.

Common Menstrual Disorders (Cont.)

Cyclic perimenstrual pain and discomfort


(CPPD)

This concept includes:


Dysmenorrhea
Premenstrual syndrome (PMS)
Premenstrual dysphoric disorder (PMDD)
Symptom clusters that occur before and after the
menstrual flow starts

CPPD is a health problem that can have a


significant effect on a womans quality of life.

Copyright 2016 by Elsevier Inc. All rights reserved.

Common Menstrual Disorders


(Cont.)

Dysmenorrhea

Pain during or shortly before menstruation


Primary dysmenorrhea
A condition associated with ovulatory cycles
Excessive release of prostaglandins causes pain
Alleviating discomfort: various methods
Secondary dysmenorrhea
Acquired menstrual pain that develops later in life than
primary dysmenorrhea, typically after age 25 years
Diagnosis and treatment

Copyright 2016 by Elsevier Inc. All rights reserved.

Common Menstrual Disorders


(Cont.)

Premenstrual syndrome (PMS) and


premenstrual dysphoric disorder

Cyclic symptoms occurring in luteal phase of


menstrual cycle
PMS: cluster of physical, psychologic, and behavioral
symptoms
Premenstrual dysphoric disorder (PMDD)

Severe variant of PMS

Management

Diet and exercise


Herbal therapies

Copyright 2016 by Elsevier Inc. All rights reserved.

Common Menstrual Disorders


(Cont.)

Endometriosis

Presence and growth of endometrial tissue


outside of the uterus
The overall incidence of endometriosis is 5% to
15% in reproductive-age women, 30% to 45% in
infertile women, and 33% in women with chronic
pelvic pain (Lobo, 2012b).
Major symptoms
Dysmenorrhea
Deep pelvic dyspareunia (painful intercourse)
Management
Drug therapy
Surgical intervention
Copyright 2016 by Elsevier Inc. All rights reserved.

Copyright 2016 by Elsevier Inc. All rights reserved.

10

Common Menstrual Disorders


(Cont.)

Alterations in cyclic bleeding

Oligomenorrhea
Hypomenorrhea
Metrorrhagia
Menorrhagia (hypermenorrhea)
Dysfunctional uterine bleeding

Copyright 2016 by Elsevier Inc. All rights reserved.

11

Menopause

Complete cessation of menses


Physiologic characteristics

Anovulation occurs more frequently.


Menstrual cycles increase in length.
Ovarian follicles become less sensitive to
hormonal stimulation from FSH and LH.
Ovulation occurs with less frequency.
Progesterone is not produced by the corpus
luteum.
FSH values are elevated.

Copyright 2016 by Elsevier Inc. All rights reserved.

12

Physiologic changes

Menstrual cycles increase in length


Ovarian follicles sensitivity to LH/FSH
No corpus luteum development means
progesterone not produced
Fsh elevates in attempt to make follicle
produce estrogen

Copyright 2016 by Elsevier Inc. All rights reserved.

13

Physical changes

Bleeding
Genital changes
Vasomotor instability
Mood and behavior responses
Osteoporosis
CHD

Copyright 2016 by Elsevier Inc. All rights reserved.

14

Bleeding

Spotting-bleeding-spotting
Common d/t corpus luteum functioning
Estrogen production decreases but androgen
continues, and converts to estrone
Androgens converted to estrone in liver and
fat cells
Obese women commonly have increased
dysfunctional bleeding

Copyright 2016 by Elsevier Inc. All rights reserved.

15

Genital changes

Atrophy of the vagina and urethra d/t


decreased estrogen
Vaginal tissue thins, decreased moisture, less
lubrication/ smaller vagina
Sexually active women have less
atrophy/dysparunia
Thin women symptoms /less estrogen
Increased vaginal PH increased vaginitis

Copyright 2016 by Elsevier Inc. All rights reserved.

16

Treatment options for genital changes

OTC lubricants: k-Y, Astroglide, Lubrin, Moist again


Consider vaginal estrogen creams
Allow time / foreplay
Keep sexually active to stimulate natural lubrication

Copyright 2016 by Elsevier Inc. All rights reserved.

17

Vasomotor instability

Fluctuating estrogen: hot flashes, night


sweats, hot flush
Hot flashes: 75-90 % of women lasts 1-5
years
May be precipitated by alcohol, crowded
rooms,hot drinks, spicy foods, stress
Night sweats : may cause insomnia, fatigue,
loss of sleep, soak linen

Copyright 2016 by Elsevier Inc. All rights reserved.

18

Treatment options for vasomotor


changes

Layer clothing
Avoid spicy, hot foods, alcohol
HRT 90%
Progesterone 80%
Soy 45%
Antidepressants 50%
Deep breathing 50%
Black cohosh
phyoestrogens

Copyright 2016 by Elsevier Inc. All rights reserved.

19

Mood and behavioral responses

No concrete evidence estrogen causes


mental health problems
Epidemiological studies have not found an
association with depression
Women c/o fatigue, insomnia, depressed
mood, emotionally labile
Life stressors: teenagers, aging parents,
widowed, divorced, major illness/disability
Cultural status: aging issues, loss of status,
function, role identity

Copyright 2016 by Elsevier Inc. All rights reserved.

20

Care Management

Plan of care and interventions

Sexual counseling
Nutrition
Exercise
Medications for osteoporosis
Midlife support groups
Nurses should be familiar with local resources and direct
women to classes that supply appropriate information
and support.

Copyright 2016 by Elsevier Inc. All rights reserved.

21

Nursing Assessment

Menstrual history
Risks for osteoporosis, CHD
Womens perception of this stage
Knowledge base
sexuality
Support
Cultural influences
Practices/ remedies the women has tied

Copyright 2016 by Elsevier Inc. All rights reserved.

22

Risks and HRT

Health risks

Osteoporosis
Coronary heart disease

Menopausal hormonal therapy

Decision to use hormone therapy


Side effects
Treatment guidelines
Bioidentical and custom-compounded hormones
Alternative therapies

Copyright 2016 by Elsevier Inc. All rights reserved.

23

Hormone Replacement Therapy

HRT most effective tx for menopausal


symptoms
Should not be taken for disease prevention
Short term 1-3 years benefits may outweigh
risks
Cumulative risks

Increased risk of blood clots/stroke during first


year
Increased BR CA after 4 years
Women with high risk of BR CA shouldnt take

Copyright 2016 by Elsevier Inc. All rights reserved.

24

Nursing assessments

Ability to cope with stressors


Persons perception/understanding of life
cycle
Support system
Coping mechanisms
Cultural implications: in US, loss of youth and
value; in India, Far East, South pacific Island
increased status

Copyright 2016 by Elsevier Inc. All rights reserved.

25

Copyright 2016 by Elsevier Inc. All rights reserved.

26

Health risks: osteoporosis

Ageing causes progressive in bone mineral


density
Osteoporosis: generalized metabolic disease
characterized by bone density and
incidence of bone fractures
Osteoporosis affects 25 million women older
than 45

Copyright 2016 by Elsevier Inc. All rights reserved.

27

Sobering thoughts.

During 1st 5-6 years after menopause women


lose 6X more bone than men
Increased osteoporosis related fractures in
the last 20 years
Of those with hip fractures12-20 die within 1
year
50% unable to return to independent living

Copyright 2016 by Elsevier Inc. All rights reserved.

28

Women at risk

Post menopausal
Caucasian, Asian
Small bones, thin
Family history
Smoking
Excess alcohol
Deficient calcium intake
High phosphorous (soda)
Steroid dependency

Copyright 2016 by Elsevier Inc. All rights reserved.

29

Preventing Osteoporosis

Osteoporosis: Weight bearing exercises


Calcium, magnesium, Vit D

milk, yogurt, cheese, Non dairy sources legumes,


leafy green vegetables, tofu, nuts and foods
where bones are consumed such as sardines and
salmon
Supplements
bisphosphonates
Dexa scan screening for women at risk, or over 65

Copyright 2016 by Elsevier Inc. All rights reserved.

30

Copyright 2016 by Elsevier Inc. All rights reserved.

31

Loss of height often first sign

Copyright 2016 by Elsevier Inc. All rights reserved.

32

Coronary heart disease

Increased risk after menopause


Other risk factors: obesity, smoking,
sedentary lifestyle, high cholesterol, family
history, diabetes mellitus, hypertension,
alcohol abuse

Copyright 2016 by Elsevier Inc. All rights reserved.

33

CHD prevention

Diet
Exercise
Lipid management (medications)
Estrogen decreased LHL and total
cholesterol, increases HDL, and has direct
anti atherosclerotic effects on the arteries

Copyright 2016 by Elsevier Inc. All rights reserved.

34

Key Points

Menstrual disorders diminish the quality of life


for affected women and their families.
Amenorrhea is most commonly a result of
pregnancy.
Dysmenorrhea is one of the most common
gynecologic problems in women.
PMS is a disorder with symptoms that begin
in the luteal phase of the menstrual cycle and
end with the onset of menses.

Copyright 2016 by Elsevier Inc. All rights reserved.

35

Key Points

Endometriosis is characterized by secondary


amenorrhea, dyspareunia, abnormal uterine
bleeding, and infertility.
The perimenopause is a normal developmental
phase during which a woman passes from the
reproductive to the nonreproductive stage.
During the perimenopause women seek care for
symptoms that arise from bleeding irregularities,
vasomotor instability, fatigue, genital changes, and
changes related to sexuality.

Copyright 2016 by Elsevier Inc. All rights reserved.

36

Key Points (Cont.)

Menopausal hormonal therapy, if used,


should be taken at the lowest effective dose
for the shortest possible time.
Alternative therapies are beneficial in
relieving discomforts associated with
menstrual disorders and menopause.

Copyright 2016 by Elsevier Inc. All rights reserved.

37

Key Points (Cont.)

Osteoporosis, a progressive loss of bone


mass that results from decreasing levels of
estrogen after menopause, can be prevented
or minimized with lifestyle changes and
medication.
Postmenopausal women are at increased risk
for coronary artery disease because of
changes in lipid metabolism.
Sexuality and the capacity for sexual
expression continue after menopause.

Copyright 2016 by Elsevier Inc. All rights reserved.

38

Question
1. A woman complains of severe abdominal
and pelvic pain around the time of
menstruation that has gotten worse over the
past 5 years. She also complains of pain
during intercourse and has tried
unsuccessfully to get pregnant for the past
18 months. These symptoms are most likely
related to:
a.
b.
c.
d.

Endometriosis
Premenstrual syndrome (PMS)
Primary dysmenorrhea
Secondary dysmenorrhea
Copyright 2016 by Elsevier Inc. All rights reserved.

39

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