Chapter 28: Promoting the Safety of Women and Families

 Intimate partner violence-physical, sexual, or psychological harm or social isolation

 Perpetrated by current or former partner
 Risk factors
o Low self-esteem
o Low income
o Low academic achievement/low verbal IQ
o Young age
o Unemployment
 Physical Violence
o Spitting, Scratching, Kicking, Punching, Pushing, Shoving, Throwing, Grabbing
o Biting, Burning, Choking, Shaking, Slapping, Strangling, Using a weapon, Using restraints
 Sexual Coercion
o Victim is coerced to carry out sexual intercourse or other sexual activities
o May also include:
 Forced participation in an early initiation of sexual activity
 Forced participation in sexual activity viewed as humiliating or degrading
 Forced participation in sexual activities with others
o Not consueuel or manipulation by consent
 Psychological (Emotional) Violence
o Includes acts such as coercion, making threats, and stalking
o May verbally abuse the victim with criticism, insults, put-downs, or name-calling
o Facial expressions or gestures may be used to intimidate and instill fear
 Threatening look and gesture
o May involve threats of harm to children, family members, or pets
 Isolation
o A tactic used to limit victim’s contact and time spent with family and friends or even
stop working so will not have any ally at work
 Abuser may:
 Require victim to obtain permission to leave the house
 Require a detailed account any time spent away from the abuser
 Listen to victim’s conversations with other people and read emails
 Stalking
 Economic Abuse
o The abuser controlling all aspect of the victim’s finances
o Refusing to share money
o Forcing the victim to account for any money spent
o Forbidding the victim to work outside the home
o Forcing the victim to miss work
o Jeopardizing the victim’s work ethic and job security
 Phases of Abuse
o Tension-building phase
  Period of increasing tension (Starting to get really bad)
o Acute violence/explosion (Discharge Anger -Physical, Name calling)
 Abuser discharges pent-up tension
 May be triggered by an internal response in the abuser or by an external crisis
o Honeymoon period (OMG, I am soo sorry, I love you)
 Tranquil, loving period of calm and remorse
 Special Populations: Pregnant Women
o Pregnancy: Vulnerable state, as violence can start or get worse
o Unintended pregnancy is often an outcome of an IPV relationship (Nonconseual sex)
o IPV often increases during a pregnancy
o IPV is linked to traumatic consequences
o IPV may be detrimental to the health of a pregnancy
o May result in fetal effects
 Placenta abruption
 Special Populations: Older Population
o Elder abuse: single or repeated act, or lack of appropriate actions, which results in harm,
risk of harm, or distress to an individual 60 years or older
o May not report the abuse for fear of getting their family member in trouble
o May have suffered IPV in the past and have problems with poor self-image and guilt
o May be dependent upon abusive partner
 Special Population: LGBTIGI Communities
o Experience the same types of abuse that heterosexual partners do
o May experience different acts of violence
 Threats to “out” the victim’s sexuality or gender
o Many do not seek care for IPV
o Difficulties seeking shelter services
 Two females may go to the same shelter
 A transgender woman may be unable to seek services because of gender
 Special Populations: Immigrant Communities
o Cultural values within some immigrant communities shape views, tolerance, and
treatment of IPV
o Some may believe the husband has the right to abuse his wife
o Victim may be pressured by her own family to stay within the marriage and submit to
her husband
o It is not our job as a nurse to help people and not report people
 Special Populations: Adolescents
o May occur:
 Within a dating relationship
 In the home environment
 Within another type of relationship
o High risk among
 Homeless youths
 Youths from families with domestic violence
  Youths who use substances
o Adolescent victims often fail to report the violence
 Screening for IPV
o “Universal screening” means that all patients are assessed for IPV, regardless of the
presence or absence of any abuse indicators. (EVERYONE IS SCREEN)
o The majority of abused patients do not present with obvious signs and often will not
openly disclose a history of abuse.
o IPV patients are more likely to disclose abuse and seek assistance if the environment is
safe and the health-care provider is someone they can trust.
o Routine screening can facilitate early identification of IPV when signs and symptoms
may not be readily apparent.
 Key Documenting Elements
o Description of the person who abused the patient
o Date and time of incident or abusive situation
o Patient’s account of what happened, all detail should be included
o Specific details about the abuse, using quotations to indicate when the statements
represent exactly what the patient said (Subjective Data)
o Note referrals made for follow-up
o Mandatory reporting and corresponding safety planning
o Injuries should be documented with detailed descriptions and measurements and
pictures should be taken if possible (Head to Toe Assessment; Use wounds with
measurement)
o Note patient’s coping and responses to the abuse (Closed mind or crying)
o Type of injuries sustained or official reports
o Note safety measures taken and safety assessment
 If you go home right now, is your safety ensure or will you be killed;
Immediate situation how dangerous it will be
 Reporting IPV
o State laws about IPV reporting (Mandatory Reports)
o Be familiar with mandatory reporting requirement in practice state
o May be required to report certain types of injuries to law enforcement
o Mandatory reporting violates the framework which the ethical codes of nursing are
based
o Mandatory reporting laws place the responsibility of the victim’s safety on health-care
professionals, who, in turn, must rely on law enforcement and the courts to provide
safety for the victim.
 The system is flawed and there needs to be a better way to take care of these
victims
 Nursing Interventions
o Education and counseling
 Essential nursing role in IPV care
o Safety cards to facilitate IPV screening and education
o Leaving a IPV relationship
  Consult and refer to experts
 THE ABCDES OF TRAUMA-INFOMRED CARE FOR THE IPV VICTIM
o A—Reassuring the woman that she is not alone
o B—Expressing the belief that violence directed against the woman is unacceptable and
not her fault (This is your fault but in contrast it is not their fault)
o C—Confidentiality of the shared information will be maintained
o D—Documentation—Descriptive documentation includes quoted statements, accurate
descriptions of all injuries, and photographs
o E—Education about the cycle of violence and community and national resources
o S—Safety
 Sexual Violence
o Medical treatment
 Prophylactic treatments
 Sexually transmitted infections (Sexual Violence)
 Pregnancy testing and prophylaxis
o Mental healthcare-PTSD
o Mandatory reporting
 Cases where the patient is a minor, elder, or protected disabled person warrant
the health-care provider to file a mandatory report.

Chapter 29: Promoting Premenstrual, Perimenopausal, and Menopausal Health

 Premenstrual Syndrome (PMS)

o Affects many women during the reproductive years
o Presence of behavioral, emotional, and physical symptoms
o Occur during the luteal phase of the menstrual cycle
 One of the defining diagnostic factor
o Cease within a few days after the onset of menses
 Time is the priority in order to diagnosis this
 Phases of the Uterine Cycle
o First phase: follicular or proliferative phase
 From the end of menses through ovulation
o Luteal phase
 Begins at ovulation and ends with the onset on menses
o Menstrual phase
 Degeneration of the endometrium and onset of menses
o These phases last from different people as not everybody has a 28 days cycle; they can
be shorter or longer from individual people
 Prevalence and Economic Impact of PMS
o Estimated that more than 80% of childbearing-age women experience various emotional
and physical changes during the premenstrual period
 o Significant impact on everyday function
o Higher absenteeism from work
o More visits to ambulatory health-care facilities
 Symptoms of PMS
o Symptoms
 Occur in a cyclical pattern
 Occur 5 days prior to menstruation
 End within 4 days after the start of menstruation
 Are not caused by any underlying physical or mental condition
 Keep the individual from enjoying or doing some normal activities (it needs to
be severe enough to do normal things)
o More than 100 symptoms have been reported
 Premenstrual Dysphoric Disorder (PMDD)
o Most severe form of PMS
o Severe and disabling emotional symptoms (You can do anything; not even getting out
of bed)
o Most frequently report abdominal bloating, anxiety, tension, breast tenderness, crying
episodes, depression, fatigue and a lack of energy, irritability, difficulty concentrating,
appetite changes, thirst, and swelling of the extremities
 Facilitating Appropriate Referrals
o Take any report of suicidal thoughts or other indicators of extreme mood change
seriously
o May need referral to a qualified mental health professional
o Need to rule out illness that may be the source of symptoms
o Pay careful attention to the cyclical timing of symptoms
 Might be related to other symptoms and not just PMDD
 Identifying Populations at Highest Risk for PMS
o Women in their late 20s to late 40s most frequently report symptoms of premenstrual
disorders
o Symptoms often worsen as the woman approached the menopausal transition
o Symptoms are not dependent on the presence of monthly menses
 Causes of Premenstrual Disorders
o Cause if multifactorial
 Variations in hormones
 Genetic predisposition
 Run in the family
 Biological factors
 Psychosocial factors
 Sociocultural factors
 Neurotransmitters
 Diagnostic Work-up for PMS/PMDD
o A detailed history with a focus on the medical, psychosocial, psychosexual, and
substance abuse histories
 o A complete physical examination
o Laboratory tests as appropriate to rule out other disorders such as hypothyroidism
o A record of the woman’s symptoms over a two-to-three month period
 Diagnostic Criteria for PMS and PMDD
o At least one of the following:
 Anger or irritability
 Anxiety, edginess, nervousness
 Depressed mood
 Moodiness
o At least 5 additional symptoms:
 Appetite changes or cravings
 Decreased interest in usual activities
 Difficulty concentrating
 Fatigue
 Feelings of being overwhelmed or out of control
 Insomnia or hypersomnia
 Physical symptoms
 Cramping, back pain and stomach pain
o Patient Care Management of PMS Symptoms
 Physical activity
 Non-pharmacological treatments
 Rest, relaxations and bubble baths
 Nonsteroidal anti-inflammatory drugs
 Oral contraceptives
 Antidepressants
 Other medications
o Climacteric
 Transitional time in a woman’s life
 Marked by declining ovarian function
 Decreased hormone production
 Begins at the onset of ovarian decline and ends with the cessation of
postmenopausal symptoms
 Menopause -last menstrual period and can be dated with certainty when there
has been at least 1 whole year without menstruation.
o Phases of Menopause
 Premenopause
 Time from the beginning of perimenopause
 Time up to the last menstrual period
 Perimenopause
 Time preceding menopause
 This can last of several years
o Hot flashes
 Menopause
 Last menstrual period
  At least one whole year without menstruation
 Postmenopause
 After this is over
o Symptoms of Menopause
 Hormonal changes
 Menstrual cycle changes
 Hot flushes/flashes, night sweats, and sleep disturbances
 Insomnia
 Vaginal changes
 Vaginal dryness
 Genitourinary tract changes
 Skin and hair changes
 Hair changes/thinning
 Breast changes
 Adipose tissue is looser
o Long-Term Effects
 Cardiovascular disease
 Increase in blood pressure
 Lipid changes
 Atherosclerosis(higher risk)
 Musculoskeletal effects
 Rapid bone loss
 Osteoporosis – not a women’s disease as men can get it also; causes
issue calcium storage in the bone
o Complementary and Alternative Medicine
 Alternative medical systems
 Biologically based treatments
 Hormonal therapies
 Considerations and choices
 The nursing role in menopausal hormone therapy counseling
 Educating patients about hormone therapy options
 Bioidentical compounds
 Nonhormonal prescription medications
o Menopausal Therapy
 Estrogen therapy (ET) —unopposed estrogen prescribed for postmenopausal
women who have had a hysterectomy.
 Estrogen plus progestogen (EPT) —a combination of estrogen and progestogen
 Like our contraceptive
 Hormone therapy (HT) —encompasses both ET and EPT. The FDA refers to EPT
as HT.
o Patient Education
 Vaginal bleeding and spotting are most likely to occur in the first 3 months after
initiation of therapy.
 After starting the hormonal therapy
  Follow-up visits should be scheduled at 1 and 3 months—and improvement in
symptoms should be noted at that time.
 It is important to promptly report the following symptoms:
 Call the doctor if persistent bleeding; bleeding that stops but then starts
again; or the presence of blood clots in the vaginal discharge.
o It is never normal as it can lead to DVT or a CVA
o Osteoporosis
 In the U.S., women typically reach menopause around age 51, and most bone
loss occurs during the first 5 to 7 years after cessation of menses.
 BMD (Bone Mineral Density) testing should be recommended to all
postmenopausal women aged 65 years or older regardless of risk factors
 (BMD) to be reassessed every 3 to 5 years
 FRAX, a risk assessment tool that estimates your 10-year fracture risk, can be
used in women younger than 65 if they are postmenopausal and have other risk
factors for fracture
 How like you are going to have a facture
 If you have risk facture, they might start medication
 The older you are, the higher the risk

Chapter 30: Promoting Breast Health

 Anatomy of the Breast

o Breast tissue:
 Glandular tissue
 15 to 24 lobes
 Each lobe contains several lobules
 Composed of numerous alveoli clustered around tiny ducts
 Fibrous tissue
 Adipose tissue
o Nipples, areolae, and Montgomery tubercles
 More pronounced in the pregnant woman and the breastfeeding woman to help
moisten the nipple and areolae in the breakdown of breastfeeding
 Benign Breast Masses (Most masses are benign)
o Commonly affect women between ages 30 and 50
o Breast cysts – You are able to feel it
 Fluid filled
 Solid
o Fibrocystic changes
 Tender and fluctuate in size with the menstrual cycle
o Fibroadenomas (Most common breast mass; more in the younger woman)
 solid cysts composed of stromal (connective) and glandular tissue. They are
usually moveable and nontender. Fibroadenomas are the most common benign
 breast tumor, occurring in 25% of women and usually located in the upper outer
quadrant of the breast.
 This tumor occurs most often in women in their 20s and 30s. The use of oral
contraceptives (OCs) before age 20 has been linked to the risk of fibroadenomas
(Stachs et al, 2019).
o Intraductal papillomas
 Small, white growths in the lining of the milk ducts near the nipple
 These rare, benign tumors usually produce a clear or bloody nipple discharge.
They may be felt as a small lump behind or next to the nipple.
 They can occur at any time and any ages
o Mammary duct ectasia (Not as common)
 Inflammation of the ducts located behind the nipple
 Preventive Health
o Breast self-awareness
 Can also assist in early detection
o Lifestyle choices and breast health
 Moderate alcohol consumption, weight maintenance, avoiding smoking
 Clinical Breast Examination (When you go to the physician)
o Perform at least every 3 years, ages 20-39
o Perform annually after age 40
o Enhances early detection of cancer
o Provides opportunity to discuss breast awareness/BSE (Provide education to the
patient)
 Mammography
o Aids in early diagnosis of cancer
o Screening - women with no s/s of cancer
o Diagnostic - assess for cancer after a lump or symptom has been identified
o Initiate at age 40
 Assuming if you do not have any risk factor
 Those who have risk factor, will need to be seen sooner
 Preparing for Mammography
o Choose an accredited facility
o Schedule when breasts are non-tender
 Think about your menstrual cycle
o Avoid powder, deodorant, perfume
o Request a soft breast pad for comfort
o Take mild analgesics as needed
 Take an Tylenol or Ibuprofen
 Evaluating Breast Symptoms – Not Normal
o Nipple discharge
 Unlike breast milk, nothing should be discharve
 Galactorrhea (pregnancy, medication, tumor)
 Bloody (intraductal papilloma, infection, cancer)
 o Skin changes
 Erythema, peau d’orange (orange appearance on the breast)
o Pain
o New lump in the breast or underarm
 Breast cancer usually start on the breast and even mastitis
o Thickening or swelling of part of the breast
o Pulling in of the nipple or pain in the nipple area
 Risk Factors
o Advancing age – Older you are, the higher the risk
o Gender – Women and Men but it is more prevalent in Women
o Ethnicity – Caucasian and Asian
o Previous breast cancer diagnosis
o Positive family history
o 70%-80% of women who develop breast cancer have none of the known risk factors
 Demographics and Personal Health History
o Advancing age
o More prevalent in women than in men
o White women more likely to develop breast cancer than Black women
o Black women have a higher fatality rate and more likely to be diagnosed with higher-
grade tumors
 Connection between early intervention vs no intervention at all
o Previously diagnosed with cancer in one breast
 Lifestyle Factors
o Women who have had no children or who had their first child after age 30
o Slightly greater risk in women who have used oral contraceptives
o Increased risk with postmenopausal combined hormone therapy
o Increased risk with being overweight or obese
o Vitamin D deficiency
 Gene Effects
o BRCA1
o BRCA2
o Related to 10% of ovarian and 3% of breast cancer cases
o Those who are BRCA-positive also have a 50% chance of passing the mutation on to
their offspring
o Refer for clinical genetic testing for gene mutations
 They might do preventive measure like going to the doctor or even having
surgery
 Ductal Carcinoma In Situ (DCIS) and Lobular Carcinoma In Situ (LCIS)
o Ductal carcinoma in situ
 Most common type of noninvasive breast cancer
 Confined to the ducts
 Has not spread into the surrounding breast tissue
o Lobular carcinoma in situ
  Begins in the milk-producing glands
 Does not penetrate the walls of the lobules
 Higher risk of developing an invasive cancer
 Invasive (Infiltrating) Ductal Carcinoma (IDC)
o Originates in the lobules
o Spreads to the surrounding breast tissue
o Can metastasize to other parts of the body
o More likely than those with other cancers to have bilateral disease
 Both breast are detected
o May be harder to detect by mammography
o Breast MRI is often helpful in diagnosis
 Inflammatory Breast Cancer (IBC) – Not very common
o Rare neoplasm that occurs more often in younger women and women of color
o Grown more aggressively than the more common types of breast cancers
o Usually no lump or tumor
o Skin often exhibits changes similar to infectious process
o Peau d’orange: edematous thickening and pitting of the skin
 Axillary Nodes
o Axillary node involvement is an important indicator for breast cancer prognosis
o Pathological staging of the lymph nodes is an essential step in the development of the
treatment plan
o Disease prognosis worsens as the number of positive lymph nodes increases
o Higher rates of recurrence when there is lymph node involvement
 Tumor Size – The bigger size, the worse it is
o Direct relationship between the size of the tumor and risk of recurrence
o Tumors of 1 cm or less have a low risk of recurrence
o Tumors of 5 cm have a moderate risk of recurrence
o Tumors greater than 5 cm have a high risk of recurrence
 Cancer Staging System
o Clinical staging
 Physical exam, biopsy, and imaging tests
o Pathological staging
 Addition of the results of surgery
o T = Tumor: size (cm) and spread within the breast and to nearby organs
o N = Nodes: spread to the lymph nodes
o M = Metastasis: spread to distant organs
o Proper assessment
 Physical exam, biopsy of the tumor, imaging studies like mammogram and MRI
o Pathological staging – we will do this with the biopsy; once removed, send it to
pathology to be stage; it will be a little bit more accurate
 Breast Cancer Treatment
o Multi-treatment approach
o Surgery
  Lumpectomy – Remove the nodule of the breast
 Simple mastectomy – Remove some of the tissue
 Radical mastectomy – Remove all the breast tissue
o Radiation
o Chemotherapy
o Hormone therapy
 Cancer Recurrence
o Local
 Cancer is in the same place as original cancer or very close by
o Regional
 Tumor has grown into the lymph nodes or tissues as original cancer
o Distant
 Cancer has spread to organs or tissues far from the original cancer
 Complementary and Alternative Medicine for Cancer Patients
o Imagery
o Aromatherapy
o Meditation
o Music therapy
o Journal writing
o Hypnosis
o Acupuncture
o Yoga
o Tai chi
 Cancer Survivorship Care Plans
o Summary of treatment
o Possible short- and long-term effects of treatment
o Late toxicity monitoring
o Monitoring for primary recurrence or a second cancer
 Getting regular checkups
o Identification of provider responsible for survivor care
o Community support resources
o Recommendations for preventative care

Chapter 31: Promoting Reproductive Health: Various Gynecological Disorders

 Amenorrhea
o Lack of menstruation
o Primary amenorrhea
 Menstruation never takes place
o Secondary amenorrhea
 Menstruation starts and then stops
  Absence of menses for at least 3 months in a woman with previously regular
menses
 Absence of menses for 6 to 12 months in a woman with previously irregular
menses
 Abnormal Genital Bleeding
o Menorrhagia
 Menorrhagia is excess bleeding (80 mL or more, or bleeding that lasts longer
than 7 days) during the expected time of menstrual flow.
o Metrorrhagia
 Known as intermenstrual bleeding, is bleeding that occurs at abnormal times
during an ovulatory cycle. Vaginal bleeding occurs more frequently than every
21 days
o Menometrorrhagia
 Heavy menstrual bleeding, is a combination of the previous two bleeding
abnormalities. The woman experiences excessive and frequent bleeding at
abnormal times during the cycle.
o Polymenorrhea
 bleeding that occurs at short intervals (less than 21 days
o Oligomenorrhea
 bleeding that occurs less frequently than every 35 days
 Dysmenorrhea
o Painful menstruation
o One of the most common gynecological conditions
o Pain develops during or shortly after the onset of menses
o Can cause significant disruption with daily activities
o Primary: intrinsic and early onset
o Secondary: results from other physical causes
 Bacterial Vaginosis
o Most common vaginal infection in women
o Not considered to be a specific STD
o Related to a lack of hydrogen peroxide-producing lactobacilli
o Dramatic overgrowth of the vaginal resident bacterium
o Risk Factors
 Having a new sex partner or multiple sex partners
 Having sex with someone with BV
 Using vaginal products such as douching
 Using feminine products such as washes and gels
 Using products not designed for the vagina such as creams, lotions, and gel
sanitizers
 Using an IUD
o Signs and symptoms
 Women with BV may be asymptomatic.
  A thin white or gray adherent vaginal discharge with a “fishy” amine odor, and
women often report that the odor is worse after intercourse and following
menses.
 Pain, burning or itching around the vagina, and/or burning with urinating.
 The diagnosis is made on the basis of a positive finding on the “whiff” test
o Wet Mount
 To perform this test, the clinician inserts a speculum and uses a moist cotton
swab to take a sample of the discharge from the posterior vaginal fornix. The
discharge is then placed on a glass slide and viewed under a microscope.
 Alternately, a dry swab may be used: The sample is placed in 1 mL of saline,
mixed, and placed on a slide, or a drop of saline is placed on a slide and the
sample is added to it. A cover slip is then applied and the slide is promptly
viewed.
o Candidiasis
 Yeast infection
 Generally caused by Candida albicans
 Signs and symptoms
 Intense vulvar pruritus and irritation and a thick, white, cottage cheese–
like vaginal discharge that may have a sour odor.
 Treated with antifungal medication
 Toxic Shock Syndrome
o Rare, sometimes fatal condition
o Bacterium Staphylococcus aureus
o Believed to be associated with tampon use during menses
o Diagnosis: physical examination findings and symptoms, complete blood count
o Treatment: immediate hospitalization with fluid replacement and aggressive antibiotic
therapy
 
 Urinary Tract Infections
o Causative organisms-Escherichia coli
o Risk factors
 Extremes of age, altered immunity, anatomical anomalies, diabetes, urinary
tract obstructions, pregnancy, sexual activity, and diaphragm use
o Signs and symptoms
 Dysuria, Urinary urgency and frequency, Hematuria
o Treatment: antibiotic therapy given over a 3-day course
 Void frequently
 Empty the bladder before and after intercourse
 Remain hydrated to keep bacteria flushed out of the urinary tract system.
 Wipe the urethral meatus and perineum from front to back after voiding.
 Wear cotton underwear; avoid tight-fitting underwear and pants.
 Take showers instead of baths if able.
 Endometriosis
o Growth, adhesion, and progression of endometrial glands and tissue outside the uterine
cavity
o Risk factors for developing endometriosis include early age at menarche, short
menstrual cycles (less than 27 days), low birth weight, nulliparity, and heavy, prolonged
menstrual periods and infertility.
o Signs and symptoms-Pelvic pain
o Diagnosis: vaginal ultrasound
o Treatment options
  Medical therapy:
 GnRH-agonists and gonadotropin inhibitors
 Contraceptive medications
 Surgical treatment
 Laparoscopy with biopsy of the lesions is the only accurate method to
diagnose and determine the severity of endometriosis.
 Leiomyoma (Fibroids)
o Most common solid pelvic tumors in women
o Leading indication for hysterectomy
o Signs, symptoms
 Bleeding and pelvic pressure.
o Treatment
 Drug therapy
 Uterine artery embolization (UAE)
 Myomectomy and hysterectomy
 Laser surgery, electrocauterization, and MRI-guided focused ultrasound surgery
 They will come back if removed as it is estrogen dependent
 Abnormal Uterine Bleeding
o May be associated with major disruptions in daily functioning
o Causes
 PALM: structural causes
 Polyps, Adenomyosis, Leiomyomata, Malignancy
 COEIN: nonstructural causes
 Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet
classified
o Treatment
 Depends on the cause, medication or surgery
 Hysterectomy
o Surgery to remove the uterus
o Abdominal hysterectomy
o Vaginal hysterectomy
o Laparoscopic hysterectomy
o Laparoscopically assisted vaginal hysterectomy
o Robotic surgery
 Ovarian Tumors
o Dermatoid cysts
 Originate from a potential germ cell
o Follicular cysts
 Develops during the first half of the menstrual cycle
o Corpus luteum cysts
 Forms from the corpus luteum during the second half of the menstrual cycle
 Polycystic Ovary Syndrome (PCOS)
o Occurs when an endocrine imbalance results in:
  Elevated levels of estrogen, testosterone, and luteinizing hormone
 Decreased secretion of follicle-stimulating hormone
o First-line interventions
 Diet, exercise, and weight loss
o Medications
 Associated with insulin resistance, the use of insulin-lowering or insulin-
sensitizing therapy may help to improve ovarian function and menstrual
cyclicity.

o
 Bartholin’s Gland Abscess
o Bartholin’s glands are located deep within the posterior portion of the vestibule
o Normally secrete clear mucus that moistens and lubricates the vagina during sexual
arousal
o Obstruction of the duct leads to enlargement and formation of a cyst
 Vulvar Self-Examination
o While bending her knees, she leans backward. The mirror and flashlight should be
positioned for optimal visualization.
o External inspection of the genital area
o Using her fingers, the woman should gently spread the labia and inspect the vaginal
vault. The vaginal walls should be pink and contain small folds or ridges.
o The vaginal discharge should be evaluated at this time as well. Normal vaginal discharge
is clear to cloudy and white, with a slightly acidic odor; it may be thick or thin,
depending on the timing of the examination with regard to the menstrual cycle.
o Findings that need to be reported to the health-care provider: presence of thickening,
ulcers, sores, or growths on the labia or vaginal walls; an unpleasant odor and changes
 in the color of the vulvar skin, Sores, redness, abnormal growths, malodorous or
excessive vaginal discharge
 The Nurse’s Role in Promoting Vulvar Health
o Be aware of common vulvar irritants and allergens
o Nurses can teach women to:
 Wear cotton underwear
 Keep the vulvar area clean and dry
 Avoid douching
 Perform vulvar self-examination