Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 NUR 6111 Week 6 Women's Health
- Institution
- William Paterson University
NUR 6111 Adv Nursing Practice 1 NUR_6111_Week_6_Women_s_Health
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● Breast Mass/Breast Cancer○ Case Study
■ A 44-year-old female has made an appointment with an APN. She is in
good health, has no major medical problems, and does not take any
prescription medications. She admits to a high-fat diet on occasion and is
moderately overweight; she has several alcoholic drinks per week.
Menarche is 10 years old, and she has never been pregnant. During the
intake, the patient stated that she palpated a single, firm, non-tender,
ill-defined lump in her right breast.
○ Diagnostic Studies
■ Mammography
■ Breast ultrasound
■ Refer pt?
● Yes to Breast Specialist
■ Needle biopsy - Excisional biopsy
● The most reliable diagnostic test is when the staging of the tumor
is done.
○ Breast Cancer
■ most commonly diagnosed cancer in women in the U.S.
■ 2nd leading cause of cancer death in American women
■ 2 main risk factors
● Female
● Advancing age
■ Other factors
● Family history of breast cancer and ovarian cancer
● Known gene mutations
● Early menarche, late menopause, nulliparity
● Alcohol consumption, smoking, higher body mass index
○ Breast Cancer - Management
■ Secondary prevention
● Clinical breast exam every 3 years to age 40 & every 1-2 years
over age 40 (ACOG)
● Mammography is performed annually, beginning at age 40 or 10
years before the age of diagnosis in women with 1st-degree family
history
● https://www.acog.org/news/news-releases/2017/06/acog-revises-b
reast-cancer-screening-guidance-ob-gyns-promote-shared-decisio
n-making
● https://www.uspreventiveservicestaskforce.org/uspstf/recommend
ation/breast-cancer-screening.
■ Tertiary prevention
● Referral to the oncology team is required
● Dependent on the tumor stage, the presence of hormone
receptors, and the patient’s symptoms and preferences.
,● Cervical Screening/HPV
○ Pap Smear
■ https://www.youtube.com/watch?v=i2YZYUYqjEY
■
○ Cervical Screening
■ Similar to Pap smear
■ Look specifically for Human Papilloma Virus (HPV) infection
● #1 cause of cervical cancer
■ Guidelines
● Women aged 21-29 years should have a Pap test alone every 3
years. HPV testing is not recommended.
● Women aged 30-65 years have 3 options:
○ Pap test only. Normal results can wait 3 years.
○ HPV test only. Normal results can wait 5 years.
○ HPV & Pap test (preferred) Normal results can wait 5
years.
○ HPV Vaccine
■ Protects against the types of HPV that most often cause cervical cancers.
HPV can also cause other kinds of cancer in both men and women
■ HPV vaccination is recommended for all aged 11–26 who have not been
previously vaccinated (can be given as early as 9 years)
■ In 2018, the FDA approved the vaccine for women and men up to age 45.
While many adults have been exposed to some strains of HPV, most
have not been exposed to all 9 types covered by the vaccine.
■ HPV vaccine does not treat existing infections or diseases
■ Screening should be continued even if a person is vaccinated
○ Condyloma (HPV) “Genital warts”
■ May need
● Biopsy to r/o dysplasia or carcinoma
● Test for other concurrent STIs
■ Treatment
● Podofilox gel 0.5%
● TCA (Trichloroacetic acid)
● Cryotherapy
, ■
● Menopause
○ Etiology & Incidence
■ Menopause occurs when ovarian function declines and the menstrual
cycle ends
■ Menopause is determined once amenorrhea occurs for 12 months
■ It occurs in all women, generally ages 45-55
■ Approximately 1.3 million people become menopausal each year in US
■ The average age of onset is 51 in the US
■ Age of onset impacted by multiple factors
● Natural decrease of hormones
● Primary ovarian insufficiency (POI)
● Undergoing a hysterectomy
● Taking chemotherapy drugs or radiation therapy
○ Impact
■ Sleep disturbance
● Early menopausal transition: 32-40%
● Late menopausal transition: 38-46%
■ Depression
● Menopausal transition: 2.5 times more likely
■ Estrogen deficiency
● Vaginal dryness
● Sexual dysfunction
○ Types of Menopause
■ Spontaneous Menopause
● Naturally occurring cessation of the menstrual cycle for 12 months
● Ovarian follicular function ends (end of fertility)
● Spontaneous vs Induced
■ Perimenopause
● The transitional period between reproductive years & menopause
● Often many years long
● Symptoms vary: shorter menstrual cycles, irregular cycles, night
sweats
■ Premature Menopause
● Spontaneous or Induced menopause occurs at age 40 or younger
● Causes: genetic, autoimmune, metabolic
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