GYN Stuff

 

Health Screening Recommendations= Early Detection

Blood Pressure	Every visit- but at least every 2 years
Cholesterol Test	Every 5 years- but more often if high-risk
Bone mineral density	Start at age 65; younger women with risk for osteoperosis may need periodic screens
Fasting Blood Glucose test	Annually with fmly hx of diabetes or gestational diabetes or if significantly obeseEvery 3-5 years for all women older than 45.
Breast Cancer Screening (mammogram)	Annually q 1-2 years starting at age 40 unless family hx.If mother, sister or daughter was dx, should start mammograms 10 years before age at which they were diagnosed. (ex: mother dx at 45- should start mammograms at 35).
Breast self exam	Done monthly at end of menses.
Pap Test	Every 1-3 years starting at age 21
Pelvic Exam	Annually from start of sexual activity until age 70
Chlamydia	As needed yearly until age 25
Colorectal Health	Fecal occult blood test annually starting at age 50.Flexible sigmoidoscopy q5 years starting at age 50.
Thyroid screening	Every 5 years, starting age 35
Mole exam	Monthly self-exam; by a doctor q 3 years
Influenza	Annually after age 65
Tetanus-Diptheria booster	Every 5-10 years after primary series
Eye exam, hearing test, dental checks	Every 1-2 years
Risk Groups=  FBS, STI, TD

Breast Cancer Screening

Triad of screening techniques:

            1- Breast self-exam

                        – Should be done AFTER menses (some lumpiness normal during period)

                        – If no period, should be done at same time every month

                        – BSE should be done starting at midadolescence on.

                        – Should include looking and feeling.

                                    – Looking for any dimpling, discharge, skin rash, mottling, etc

                                    – Feeling for lumps.

                                                – Cysts- fluid-filled, painful to palpate- usually benign

– Fibroadenomas- firm- fiber-filled masses- not assoc. with cancer. Caffeine, chocolate, coffee, sodas will exacerbate.

                                    – Self exams will usually pick up nodules 1cm or larger

            2- Clinical exam

            3- Mammography

                        – Can pick up lumps <1cm

                        – Start at age 40- every 1-2 years.

Papanicolaou Smear (Pap Smear)

• Used for early detection of cellular changes associated with premalignant or malignant conditions
• Also used to identify fungal and viral infections and to monitor effects of hormonal therapy
• If hysterectomy- she still needs to have pap smear annually.
• Done annually when woman becomes sexually active or turns 21
  • More often in high risk group
• Make sure she has not douched, used vaginal medications, or had sexual intercourse for 24-48 hours before procedure.

Menopause

• The actual permanent cessation of menstrual cycles; so diagnosed after 1 year without menses
• Declining estrogen levels
• Average age= 35-60
• Effects seen in breasts (atrophy, soft/pendulous), bone (increased risk for osteoperosis d/t decreased calcium), mucous membranes (increased risk for UTI’s d/t stress incontinence), heart (increased risk for heart disease d/t loss of estrogen), neuroendocrine system (hot flashes), reproductive organs (uterus and ovaries decrease in size).
  • If woman is having a hard time coping with sx, she may be put on estrogen therapy.
• Perimenopause– Time before cessation of menses- period before menopause. Ovarian function declines, ova slowly diminish, and menstrual cycles are non-ovulatory- resulting in irregular, regular, or heavy bleeding.
• Usually lasts 5-10 years

Self-care:

• Weight-bearing exercises- adequate calcium intake
• Teaching about Sexual relations – lubrication
• Hormone replacement therapy if indicated
  •  
    • Reduces incidence and severity of vasomotor disturbance
• Health promotion
  •  
    • Breast self-exams, mammography
    • Bone mineral density testing
    • Yearly physical exam
    • Screening for colon cancer, cholesterol, diabetes

Contraception

Is the intentional prevention of pregnancy during sexual intercourse.

Assessment:

            Frequency of coitus                                        Current health practices

            Number of sexual partners                              Religious and cultural factors

            Level of contraceptive involvement               Partner’s objections to any methods

            Willingness and ability to use methods correctly and consistently

Discuss: Dependence of method on health care system         Method cost

            Effect of method on partner                                       Information and help with second method

            Teaching in regard to STI’s