This Lesson Plan is regarding Breast Feeding-Introduction, Definition, Anatomy of Breast, Physiology of Lactation, Hormones, Reflexes in the baby, Advantages, Contraindications, composition of Human Milk, the types of milk,Breast Feeding Positions,Breast Feeding Pattern, Good and Poor attachment of the baby.
nurses/doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
This Lesson Plan is regarding Breast Feeding-Introduction, Definition, Anatomy of Breast, Physiology of Lactation, Hormones, Reflexes in the baby, Advantages, Contraindications, composition of Human Milk, the types of milk,Breast Feeding Positions,Breast Feeding Pattern, Good and Poor attachment of the baby.
nurses/doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
Health education on Antenatal care include definition,aim, objectives, registration, antenatal check up, immunization, iron & folic acid, diet, bowel care, cleanliness, clothing, shoes, dental care, care of breast, sleep, exercise, coitus, travel, smoking & alcohol, family support & dangers signs during pregnancy.
NORMAL LABOR.. (EUTOCIA) ABNORMAL LABOR ALSO EXPLAINED. Series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called LABOR.
The care of older adult is crucial in the present scenario. there are changes that occur in all aspects in the late years of life. the presentation explains the comprehensive changes and their effective management by health care personal.
Health education on Antenatal care include definition,aim, objectives, registration, antenatal check up, immunization, iron & folic acid, diet, bowel care, cleanliness, clothing, shoes, dental care, care of breast, sleep, exercise, coitus, travel, smoking & alcohol, family support & dangers signs during pregnancy.
NORMAL LABOR.. (EUTOCIA) ABNORMAL LABOR ALSO EXPLAINED. Series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called LABOR.
The care of older adult is crucial in the present scenario. there are changes that occur in all aspects in the late years of life. the presentation explains the comprehensive changes and their effective management by health care personal.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. Medical and Surgical Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Medical and Surgical Nursing Abejo1
MEDICAL AND SURGICAL NURSING
Female Reproductive System
Lecturer: Mark Fredderick R. Abejo RN, MAN
Anatomy and Physiology of the Female Reproductive System
2. Medical and Surgical Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Medical and Surgical Nursing Abejo2
Internal Female Reproductive System
Vagina
Birth canal
Muscular tube (8 cm)
Connects cervix of the uterus to the exterior
Receives erect stimulus during sexual intercourse
Opens to outside
Cervix
Neck-like part
Entrance to uterus
Capable of very wide dilation during childbirth
Uterus (womb)
Virtually at a right angle to the vagina
Specialized to allow the embryo to become implanted in its
inner wall and to nourish the growing fetus from the
maternal blood
3 layers:
Peritoneum (outer)
Myometrium (middle) – labour, cramps
Endometrium (inner) – sloughed off every 28 days
during menstrual cycle
Fallopian Tube (oviducts)
Found at the top of the uterus on each side
Function is to conduct ova (eggs) from the ovary to the
uterus
Not physically attached to the ovaries
Fimbraie (finger-like projections) help draw the egg
into the fallopian tubes
Right arm = fallopian tube, right hand = fimbraie,
left fist = ovary
Fertilization occurs near the ovarian end of the fallopian
tube (must take place within 24 hours of ovulation)
Movement of the egg down the fallopian tube is through
peristalsis
Ampulla: site for fertilization
Isthmus : site for tubal ligation
Ovaries (female gonads)
Main female reproduction organs
Produces egg cells which are nonmotile
Produces steroid hormones (estrogen and progesterone)
Held in place by ligaments
Each ovary contains numerous follicles (“shell”) each
containing an egg
Follicle serves as the endocrine gland
All immature eggs are produced before birth
30th
week of gestation – 7 million eggs
At birth – 2 million
Puberty – 300 000 – 400 000
300 to 400 mature eggs released in a life time
At puberty, 1 mature egg is released every 28 days
Will occur usually until the age of 45-50
When female has no more eggs to release she goes
into menopause
(physiological)
Fertilization must take place to complete meiosis II
As many as 20 follicles can begin development at
the beginning of the menstrual cycle
Older eggs have more chances of having problems
with the baby
External Female Reproductive Parts
Mons Pubis
Soft fatty tissue, lies directly over symphysis pubis &
becomes covered w/ hair just before puberty
It is where the pubic hair grows.
Labia Majora
W/ hair outside but smooth inside
fatty skin folds from MONS PUBIS to PERINEUM and
protects the labia minora , urinary meatus & vagina
Labia Minora
Thin, pink, smooth, hairless, extremely sensitive to
pressure, touch and temperature.
The glands of labia minora lubricate the vulva.
It is formed by the frenulum and the prepuce of the
clitoris which is also very sensitive
Clitoris
Composed of glans & shaft that is partially covered by
prepuce
GLANS is small and round and is filled w/ many nerve
endings and rich blood supply
SHAFT is a cord connecting the glans to the pubic bone;
w/in it is the major blood supply of clitoris
Urethral Meatus
Entrance of urethra, opens approximately 1cm below
clitoris
Skenes Gland
lubricates the external genitalia
Bartholins Gland
alkaline in ph, helps improve sperm survival
FEMALE REPRODUCTIVE DISORDER
OVARIAN CYSTS
Cysts are nonneoplastic sacs that contain fluid or
semisolid material.
Ovarian cysts are usually small and produce no
symptoms, ovarian cysts should be thoroughly
investigated as possible sites of malignant change.
Common types include:
Follicular,cysts, which are usually very small,
semitransparent, and fluid-filled
Lutein cysts, including corpus luteum cysts, which
are functional, nonneoplastic enlargements of the
ovaries
Theca-lutein cysts, which are commonly bilateral
and filled with clear, straw-colored fluid
Polycystic (or sclerocystic) ovary disease is part of
the Stein-Leventhal syndrome.
Ovarian cysts can develop any time between puberty and
menopause, including during pregnancy.
Corpus luteum cysts occur infrequently, usually during
early pregnancy.
3. Medical and Surgical Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Medical and Surgical Nursing Abejo3
Cause / Risk Factors
Follicular cysts arise from follicles that over distend
instead of going through the atretic stage of the menstrual
cycle.
Corpus luteum cysts are caused by excessive
accumulation of blood during the hemorrhagic phase of
the menstrual cycle.
Theca-lutein cysts are commonly associated with
hydatidiform mole, choriocarcinoma, or hormone
therapy.
Polycystic ovary disease results from endocrine
abnormalities.
Clinical Manifestation
Usually small cysts produces no symptoms, unless
torsion or rupture causes signs of acute abdomen.
Low back pain
Mild pelvic discomfort
Dyspareunia ( difficult and or painful intercourse)
Abnormal uterine bleeding
Acute abdominal pain (similar to that of appendicitis) -in
ovarian cysts with torsion
In corpus luteum cysts appearing early in pregnancy, the
patient may develop unilateral pelvic discomfort and
(with rupture) massive intraperitoneal hemorrhage.
In polycystic ovary disease, the patient may develop
amenorrhea ( abnormal absence or stoppage of menses),
Oligomenorrhea (abnormally infrequent menstruation), or
infertility secondary to the disorder as well as bilaterally
enlarged ovaries.
Collaborative Management
Follicular cysts usually don't require treatment because
they tend to disappear spontaneously within 60 days.
If they interfere with daily activities,
Clomiphene citrate P.O. for 5 days or
progesterone I.M. for 5 days, reestablishes the
ovarian hormonal cycle and induces ovulation.
Oral contraceptives may also accelerate involution of
functional cysts (including both types of lutein cysts and
follicular cysts).
Treatment for corpus luteum cysts that occur during
pregnancy is symptomatic because these cysts diminish
during the third trimester and rarely require surgery.
Theca-lutein cysts disappear spontaneously after
elimination of hydatidiform mole or choriocarcinoma, or
discontinuation of HCG or clomiphene citrate therapy.
Polycystic ovary disease treatment may include; drugs,
such as clomiphene citrate to induce ovulation or if drug
therapy fails to induce ovulation, surgical wedge
resection of one-half to one-third of the ovary.
Surgery may become necessary for both diagnosis and
treatment.
ENDOMETRIOSIS
Endometrial tissue appears outside the lining of the
uterine cavity.
This ectopic tissue usually remains in the pelvic area,
most commonly around the ovaries, uterovesical
peritoneum, uterosacral ligaments, and the cul-de-sac, but
it can appear anywhere in the body.
Active endometriosis usually occurs between ages 30 and
40, more so in women who postpone child-bearing.
Endometriosis usually becomes progressively severe
during the menstrual years, and subsides after
menopause.
Infertility is the primary complication.
Spontaneous abortion may also occur.
Cause / Risk Factors
Trasportation---during menstruation, the fallopian tubes
expel endometrial fragments that implant of the ovaries
or pelvic peritoneum
Formation in situ--inflammation or a hormonal change
triggers metaplasia (differentiation of coelomic
epithelium to endometrial epithelium)
Induction--this is a combination of transportation and
formation in situ and is the most likely cause. The
endometrium chemically induces undifferentiated
mesenchyma to form endometrial epithelium
Clinical Manifestation
Dysmenorrhea (painful menstruation)-- Pain usually
begins 5 to 7 days before menses reaches its peak and last
for 2 to 3 days. It is less cramping and less concentrated
in the abdominal midline than primary dysmenorrheal
pain.
Lower abdominal pain and in the vagina --
Pain to posterior pelvis and back
Multiple tender nodules on uterosacral ligaments or in the
rectovaginal system. They enlarge and become more
tender during menses. Ovarian enlargement may also be
evident.
Other symptoms depend on the location of the ectopic
tissue:
Ovaries and oviducts--infertility and profuse menses
Ovaries or cul-de-sac--deep-thrust dyspareunia (painful
intercourse)
Bladder--suprapubic pain, dysuria (painful or difficulty
urinating), hematuria (Presence of blood in the urine)
Rectovaginal septum and colon--painful defecation,
rectal bleeding with menses, pain in the coccyx or sacrum
Small bowel and appendix--nausea and vomiting, which
worsen before menses, and abdominal cramps
Cervix, vagina, and perineum--bleeding from endometrial
deposits in these areas during menses
Diagnostic Test
Laparoscopy may confirm the diagnosis and determine
the stage of the disease
Barium enema rules out malignant or inflammatory
bowel disease.
Collaborative Management
For young women who want to have children
includes: androgens, such as danazol, which produce a
temporary remission in Stages I and II. Oral
contraceptives and progestins also relieve symptoms.
Stage III and IV (when ovarian masses are present), they
should be removed to rule out cancer.
The patient may undergo conservative surgery, but the
treatment of choice for women who don't want to bear
children or who have extensive disease (StageIII and IV)
is a total abdominal hysterectomy performed with
bilateral salpingo-oophorectomy.
UTERINE LEIOMYOMAS ( Myomas / Fibromyomas )
These neoplasms (tumor; any new and abnormal growth)
art the most common benign tumors in women.
They usually occur in the uterine corpus, although they
may appear on the cervix or on the round or broad
ligament.
Cause / Risk Factors
Uterine Leiomyomas are usually multiple and usually
occur in women over age 35
They affect blacks three times more often than whites.
The cause is unknown, but excessive levels of estrogen
and human growth hormone (HGH) probably influence
tumor formation by stimulating susceptible fibromuscular
elements.
Large doses of estrogen and the later stages of pregnancy
increase both tumor size and HGH levels.
4. Medical and Surgical Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Medical and Surgical Nursing Abejo4
When estrogen production decreases, uterine leiomyomas
usually shrink or disappear (usually after menopause)
Clinical Manifestation
Pain
Submucosal hypermenorrhea (excessive menstrual
bleeding, but occurring at regular intervals and being of
usual duration)
Possibly other forms of abnormal endometrial bleeding
Dysmenorrhea (abnormally painful menses)
If tumor is large, the patient may develop a feeling of
heaviness in the abdomen;
Increasing pain
Intestinal obstruction
Constipation
Urinary frequency or urgency
Irregular uterine enlargement
Diagnostic Test
Blood studies/ anemia will support the diagnosis
D&C (dilatation and curettage)
Submucosal hysterosalpingoraphy - detects submucosal
leiomyomas
Laparoscopy - visualizes subserous leiomyomas on the
uterine surface
Collaborative Management
Treatment of choice for women who desire to have
children - A surgeon may remove small leiomyomas that
have caused problems in the past or that appear likely to
threaten a future pregnancy
Tumors that twist or grow large enough to cause
intestinal obstruction require a hysterectomy, with
preservation of the ovaries if possible
Pregnant patient: If a patient uterus no larger than a 6
month normal uterus by the 16th week of pregnancy, the
outcome for the pregnancy remains favorable, and
surgery is usually unnecessary. However if a pregnant
woman has a leiomyomatous uterus the size of a 5 to 6
month normal uterus by the 9th week of pregnancy,
spontaneous abortion will probably occur, especially with
a cervical leiomyoma. If surgery is necessary, a
hysterectomy is usually performed 5 to 6 months after
delivery (when involution is complete), with preservation
of the ovaries if possible
Appropriate intervention depends on the severity of
symptoms, the size and location of the tumors, and the
patient's age, parity, pregnancy status, desire to have
children, and general health.
Call your doctor immediately if there is any abnormal
bleeding or pelvic pain
PELVIC INFLAMMATORY DISEASE (PID)
Recurrent, acute, subacute, or chronic infection of the
oviducts and ovaries, with adjacent tissue involvement.
PID may refer to inflammation of the cervix, uterus,
fallopian tubes, and ovaries, which can extend to the
connective tissue lying between the broad ligaments
(parmetritis).
Early diagnosis and treatment prevent damage to the
reproductive system.
Complications of PID may include potentially fatal
septicemia, pulmonary emboli, shock and
infertility. Untreated PID may be fatal.
Clinical Manifestation
Clinical features vary with the affected area.
They may include profuse, purulent vaginal discharge
Low-grade fever
Malaise
Lower abdominal pain
Three Types of PID
Salpingo-oophoritis (fallopian tubes, and ovaries):
Acute: sudden onset of lower abdominal and pelvic pain,
usually after menses,
increased vaginal discharge
fever
malaise
lower abdominal pressure and tenderness
tachycardia
pelvic peritonitis
Chronic: recurring acute episodes
Cervicitis (inflammation of the cervix):
Acute- purulent, foul-smelling vaginal discharge;
Vulvovaginitis, with itching or burning
Red, edematous cervix
Pelvic discomfort
Sexual dysfunction
Metrorrhagia; infertility; spontaneous abortion
Chronic- cervical dystocia, laceration or eversion of the
cervix, ulcerative vesicular lesion (when cervicitis results
from herpes simplex virus type II)
Endometritis (inflammation of the uterus):
Acute- mucoopurulent or purulent vaginal discharge
oozing from cervix
Edematous, hyperemic endometrium, possible leading to
ulceration and necrosis
Lower abdominal pain and tenderness
Fever
Rebound pain
Abdominal muscle spasm
thrombophlebitis of uterine and pelvic vessels
Chronic- recurring acute episodes (more common from
multiple sexual partners and sexually transmitted
infections)
Cause / Risk Factors
PID can result from infection with aerobic or anaerobic
organisms.
Any sexually transmitted infection
More than one sex partner
Conditions or procedures, such as cauterization of the
cervix, that alter or destroy cervical mucus, allowing
bacteria to ascend into the uterine cavity
Any procedure that risks transfer of contaminated
cervical mucus into the endometrial cavity by
instrumentation such as use of a biopsy curet
Infection during or after pregnancy
Infectious foci within the body, such as drainage from a
chronically infected fallopian tube
Treatment:
Effective management eradicates the infection, relieves
symptoms, and avoids damaging the reproductive system.
Aggressive therapy with multiple antibiotics begins
immediately after culture specimens are obtained.
Infection may become chronic if treated inadequately
Supplemental treatment of PID may include bed rest,
analgesics, and I.V. therapy
Narcotics may be needed, NSAID's are preferred for pain
relief.
Development of a pelvic abscess requires adequate
drainage. A ruptured pelvic abscess is a life-threatening
condition. If this complication develops, the patient may
need a total abdominal hysterectomy, with bilateral
salpingo-oophorectomy
5. Medical and Surgical Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Medical and Surgical Nursing Abejo5
VAGINAL PROBLEMS
Vaginitis Inflammation of the vagina
Most common:
Candida vaginitis (yeast infection): Studies shows approximately
75% of all women will have a yeast infection at least once in their
lifetime. Some will suffer form recurring yeast infections. Vaginal
yeast infections may cause pain during urination and or during
sexual intercourse.
Symptoms of yeast infection - itching, soreness and may have a
white, cottage-cheese-like discharge.
Bacterial vaginosis: For reasons unknown there may be a change
in the balance of naturally occurring bacteria in the vagina that
allows disease causing bacteria to dominate. It occurs commonly
during reproductive years.
Symptoms - Many women with this infection exhibit no symptoms,
but the predominate sign of this condition is a fishy smelling gray
discharge.
Trichomonas vaginitis: (produces a refractory vaginal discharge
and puritis) - causes itching and irritation of the vulva with
increased vaginal discharge that may be green and frothy.
Vaginismus: involuntary spastic constriction of the lower vaginal
muscles, usually from fear of vaginal penetration. If severe, this
disorder may prevent intercourse ( a common cause of
unconsummated marriages). Vaginismus affects females of all ages
and backgrounds. Patients usually experience muscle spasm with
constriction and pain on insertion of any object into the vagina,
such as a vaginal tampon, speculum or diaphragm. *Note -
Vaginismus usually has a psychological origins. It occurs usually
after sexual trauma such as rape or incest. Please seek counseling
and see your doctor.
Vaginal cancer: usually occurs primarily in women over the age of
50, vaginal cancer is very rare, studies shows approximately 2% of
all gynecological cancers. Once cancer appears on the vagina, it
may spread to surrounding tissues, including the bladder, rectum,
vulva and the pubic bone. Diagnosis is made by your doctor with
thorough examination with a colposcope and biopsy of any
suspicious-looking areas.
Vulvitis: Inflammation of the vulva. May cause itching, burning
and or pain. Pelvic examination and blood test or tests to check for
any STD ( sexually transmitted disease )
Symptoms:
Vaginitis: Increased vaginal discharge with an offensive odor,
burning, itching and pain
Vaginal Cancer: Abnormal discharge and bleeding, firm lesion on
any part of the vagina (possible cancer)
Vaginismus: muscle constriction, spasm and pain on insertion of
any object into the vagina
Vulvitis: if your vulva is inflamed and itches
Treatment:
Your doctor will determine the course of treatment. Treatment for
most vaginal disorders is aimed at maintaining proper bacterial
balance and treating your irritation and discomfort.
Bacterial vaginitis and trichomonas: Your doctor may prescribe a
topical cream and or oral medication
Vaginismus: Your doctor may want to refer you to a doctor who
specialize in psychology, and or one who specialize in sexual
therapy.
Candida vaginitis (yeast infection) topical cream .
PREMENSTRUAL SYNDROME: Also called PMS -The
effects of this disorder ranges from minimal discomfort to severe,
disruptive behavioral and somatic changes. Symptoms usually
appear 7 to 14 days before menses and usually subside with its
onset.
Cause: Direct cause unknown, PMS may result from a
progesterone deficiency in the luteal phase ot the menstrual cycle
or from an increased estrogen-progesterone ratio. Approximately
10% of patients with PMS have elevated prolactin levels
Symptoms:
Behavioral changes: Mild to severe personality
changes
Nervousness
Hostility
Irritability
Agitation
Sleep disturbance
Fatigue
Lethargy
Depression
Somatic changes :
Breast tenderness or swelling
Abdominal tenderness or bloating
Joint pain
Headache
Edema
Diarrhea or constipation
Patient may also experience exacerbations of skin
problems such as; ache - respiratory problems such
as asthma, and neurologic problems such as
seizures.
Treatment:
Treated symptomatically: treatment may include;
Antidepressants, NSAID's (nonsteroidal anti-
inflammatory drugs),
Vitamins
Tranquilizers
Sedatives
Progestins
Treatment may require; a diet that is low in simple
sugars, caffeine, and salt, with adequate amounts of
protein, high amounts of complex carbohydrates,
and possibly, vitamin supplements formulated for
PMS
There is also a self - help groups that exist for
women with PMS check in your local area.
MENOPAUSE: The mechanisms of menstruation cease to
function. Menopause results from a complex, long term syndrome
of physiologic changes, the climacteric-cause by declining ovarian
function.
Cause: Physiologic menopause, the normal decline in ovarian
function caused by aging, begins in most women between ages 40
and 50 and results in infrequent ovulation, decreased menstruation,
and eventually, cessation of menstruation ( usually ages 45 - 55)
6. Medical and Surgical Nursing
Lecture Notes on Female Reproductive System System
Prepared By: Mark Fredderick R Abejo R.N, MAN
Medical and Surgical Nursing Abejo6
Pathologic menopause (premature menopause), the gradual or
abrupt cessation of menstruation before age 40, cause unknown,
however certain disorders, especially severe infections and
reproductive tract tumors, may cause pathologic menopause by
seriously impairing ovarian function. Other factors that may incur
pathologic menopause include malnutrition, debilitation, extreme
emotional stress, excessive radiation exposure, and surgical
procedures that impair ovarian blood supply.
Artificial menopause is the cessation of ovarian function following
radiation therapy or surgical procedures.
Symptoms:
Declining ovarian function and decreased estrogen levels
accompanying all forms of menopause produce various
menstrual irregularities;
Decrease in the amount and duration of menstrual flow
Spotting
Episodes of amenorrhea (absence or abnormal stoppage
of menses) and polymenorrhea (abnormal frequent
menstruation) (possible with hypermenorrhea)-excessive
menstrual cycle
These irregularities may last only a few months or may
persist for several years before menstruation ceases
permanently.
Changes in the body's systems usually don't occur until
after the permanent cessation of menstruation
Reproductive system: changes may include; shrinkage of vulval
structures and loss of subcutaneous fat, possible leading to atrophic
vulvitis; atrophy of vaginal mucosa and flattening of vaginal rugae,
possibly causing bleeding after coitus or douching; vaginal itching
and discharge from bacterial invasion; and loss of capillaries in the
atrophying vaginal wall, causing the pink, rugose lining to become
smooth and white. Menopause may also produce excessive vaginal
dryness and dyspareunia due to decreased lubrication from the
vaginal walls, and decreased secretion from Bartholin's glands; a
reduction in the size of the ovaries and oviducts; and progressive
pelvic relaxation as the supporting structures of the reproductive
tract lose their tone from the absence of estrogen
Urinary system: Atrophic cystitis, resulting from the effects of
decreased estrogen levels on bladder mucosa and related structures,
may produce pus in the urine (pyuria), painful or difficulty
urinating (dysuria), and urgency, and incontinence. May have on
occasion have blood in the urine (hematuria)
Breasts: Menopause may cause reduced breast size
Integumentary system: Estrogen deprivation may lead to loss of
skin elasticity and turgor. The patient may have slight alopecia
(balding), and may experience loss of pubic and axillary hair.
Autonomic nervous system: Hot flashes and night sweats. Patient
may experience vertigo, syncope, tachycardia, dyspnea, tinnitus,
emotional disturbances such as irritability, nervousness, crying
spells, and fits of anger. Patients may also experience and
exacerbation of preexisting neurotic disorders such as; depression,
anxiety, and compulsive, manic, or schizoid behavior
Vascular and musculoskeletal systems: Menopause may also
induce atherosclerosis and osteoporosis.
Artificial menopause, without estrogen replacement, produces
symptoms within 2 to 5 years in 96% of women. Since
menstruation in both pathologic and artificial menopause often
ceases abruptly, severe vasomotor and emotional disturbances may
result.
Menstrual bleeding after 1 year of amenorrhea may indicate
organic disease
Treatment:
Since physiologic menopause is a normal process, it may
not require intervention.
Atypical or adenomatous hyperplasia requires drug
therapy
Cystic endometrial hyperplasia doesn't require treatment
If osteoporosis occurs, calcium is given
Estrogen therapy
Women who take estrogen must be monitored regularly
to detect possible cancer early. If the uterus remains
progestin is recommended in addition to estrogen.
FEMALE NFERTILITY: Infertility may be caused by any defect
or malfunction of the hypothalamic - pituitary - ovarian axis, such
as certain neurologic diseases. Other possible cause include:
Cervical factors, such as infection and possibly cervical antibodies
that immobilize sperm
Psychological problems
Ovarian factors
Tubal and peritoneal factors, such as tubal loss or impairment
secondary to ectopic pregnancy
Uterine abnormalities, such as; congenitally absent, double uterus;
leiomyomas or Asherman's syndrome, in which the anterior and
posterior uterine walls adhere because of scar tissue formation
Approximately 15% of all couples in the US cannot conceive after
regular intercourse for at least 1 year without contraception. 45 to
50% of all infertility is attributed to the female.
Symptoms:
Diagnosis requires a complete examination and health
history. Questions includes patient's reproductive and sexual
function, past diseases, mental state, previous surgery, types of
contraception used in the past, and family history
Treatment:
Intervention aims to correct the underlying abnormality
or dysfunction within the hypothalamic-pituitary-ovarian
complex.
Hormone therapy may be necessary in hyperactivity ;or
hypoactivity of the adrenal or thyroid gland
Progesterone replacement for progesterone deficiency
Anovulation requires treatment with clomiphene citrate
If mucus production decreases (an adverse effect of
clomiphene citrate), small doses of estrogen may be
given concomitantly to improve the quality of cervical
mucus
Surgical restoration may correct certain anatomic causes
of infertility, such as fallopian tube obstruction
Artificial insemination has proven to be an effective
alternative strategy for dealing with infertility problems
In vitro (test tube) fertilization has also been successful