Premenstrual Syndrome (PMS)

• PMS is a group of physiological and psychological symptoms

Causes: • Related to release of serotonin, estrogen and

progesterone and nutritional deficiencies

Premenstrual SyndromePremenstrual SyndromeManifestationsManifestations

• Headache• Breast discomfort• Peripheral edema• Abdominal bloating• Sensation of weight gain• Binge eating • Depression, Anxiety, Irritability

Premenstrual SyndromePremenstrual SyndromeTreatment and Nursing CareTreatment and Nursing Care

• Stress Reduction Techniques

• Initiation of an Exercise Program

• Diet Therapy ??

Premenstrual SyndromePremenstrual SyndromeTreatment and Nursing Treatment and Nursing

CareCare• Drug Therapy

– Selective Serotonin reuptake inhibitors • Fluoxetine hydrochloride • Sertraline hydrochloride

– Diuretics - Spironolactone– Prostaglandin inhibitors - Ibuprofen– Antidepressants, antianxiety – Alprasalom – Oral contraceptives

Dysmenorrhea

• Discomfort associated with menstruation

• Cause - excessive prostaglandins

• Signs and Symptoms– Abdominal pain- colicky, radiates to lower back and

upper thighs– Nausea, diarrhea, – Fatigue– Headache, light-headedness

Dysmenorrhea

• Treatment and Nursing Care– Drug Therapy

• NSAIDS• Oral Contraceptives

– Relaxation Techniques– Heat Therapy– Exercise– Others

Abnormal Vaginal Bleeding

• Oligomenorrhea – long interval between menses

• Amenorrhea - absence of menses

• Menorrhagia – prolonged menstrual bleeding

• Metrorrhagia – irregular bleeding

– Complication is low hemoglobin

Complications of Vaginal Bleeding

• Anemia• 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 ??

Abnormal Vaginal Bleeding

• Treatment and Nursing Care– Drug Therapy

• Oral Contraceptives

– Balloon 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

Perimenopause

• Irregular menses• Vasomotor instability

• Atrophy of genitourinary tissue

• Stress incontinence• Breast Tenderness• Mood changes

Menopause

• Cessation of menses• Occasional vasomotor

symptoms• Atrophy of genitourinary

tissue• Stress incontinence• Osteoporosis• Sleep disturbances

Menopause

• Bleeding becomes irregular rt:– follicles no longer respond to FSH

– ovarian production of estrogen and progesterone declines

OR• Surgically induced

MenopauseTreatment and Nursing

Care• Drug Therapy

– NO longer use Hormone Replacement Therapy – Why?

– Antidepressants– Selective estrogen receptor modulators

• raloxifene (Evista)

MenopauseTreatment and Nursing

Care• Non-hormonal Therapy

– Cool environment– Loose fitting clothing– Moisturizing soaps and lotions– Health diet with vitamin D

– Calcium supplements; vitamin E and B6

– Exercise – weight bearing and aerobic

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 – antibiotics– Bedrest in Semi-fowlers position– Force fluids– Heat to abdomen or Sitz bath– Patient teaching – ??

Presence of normal Endometrial Tissue outside the uterine cavity

Endometriosis• Clinical Manifestations

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

• Diagnosis– Laparoscopy

Endometriosis

• Treatment and Nursing Care– Drug Therapy

• Oral contraceptives• Androgens• Gonadotropin-releasing hormone agonists

– leuprolide (Lupron)– Nafarelin (Synarel)

Endometriosis

• Treatment and Nursing Care• Surgical Therapy

– Conservative • Laparoscopic laser surgery / laparotomy• Used in women who ??

– Definitive• Hysterectomy• Used in women who ??

As a nurse caring for a patient with endometriosis, what would be expected

in the diagnostics?– 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

• Signs and Symptoms– Most do NOT have symptoms– Abnormal uterine bleeding– Pain, pelvic pressure

Uterine Fibroids (Leiomyomas)

• Diagnosis– Enlarged uterus distorted with nodular masses

• Treatment and Nursing Care– Myeomectomy, hysterectomy– Cryosurgery– ExAblate 2000 system

Chronic endocrine disorder

resulting in:Insulin resistance

Hyperandrogenism Altered gonadotropin functioning

Polycystic ovaries

Diagnosed – Pelvic Ultrasound

Polycystic Ovaries

Polycystic ovaries

• Treatment and Nursing Care– Drug therapy

• Oral contraceptives• GnRH agonist• Metformin (Glucophage)

– Surgery• Oophorectomy

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

Cervical CancerCervical CancerCervical CancerCervical Cancer

Cervical cancer

• Risk factors– In situ 25-40 years old– Invasive 40-60 years old– Dysplasia– DES exposure– Lifestyle– STD exposure

• HPV, HSV II

Staging and Treatment

Endometrial Cancer

Endometrial Cancer

• Major Risk factor– Prolonged exposure to EstrogenEstrogen

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

• Clinical Manifestations– Abnormal vaginal bleeding

Endometrial CancerTreatment and Nursing

Care• Diagnosed

– Endometrial biopsy

Treatment:• Surgical Therapy

– Hysterectomy – first choice of treatment

• Chemotherapy

• Radiation - brachytherapy

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 ?? • 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

Ovarian CancerManifestations

• General abdominal discomfort• Sense of pelvic heaviness• Loss of appetite• Feeling of fullness• Change in bowel habits• Abnormal vaginal bleeding

Clinical Manifestations• As malignancy grows, there can be an

– Increase in abdominal girth– Bowel and bladder dysfunctions– Persistent pelvic or abdominal pain– Menstrual irregularities– Ascites

Ovarian CancerDiagnosis

• Exploratory laparotomy to diagnose and stage disease

• 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

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– Teachings

Vulvar Cancer• Risk Factors

– 50 plus– Chronic irritation– History of HPV or Herpes 2

• Manifestations– Pruritis– Burning – Enlarged inguinal lymph nodes– Asymmetry– Lesions or mass– Change in color

Treatment options for all Cancers

• Surgery– Oophorectomy, Panhysterectomy– Pelvic Exenteration

• Chemotherapy

• Radiation– External– Brachytherapy

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 ??

Lunch Time!