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Assessment and
Management of Female
Physiologic Processes
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Women’s Health
• Evolving area of health care
• Role of the nurse
• Emphasis on health promotion
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Review of Anatomy and Function
• Function of the female reproductive system
– Ovulation (periodic discharge of mature ovum)
– Menstrual cycle
• Significant hormones and hormonal changes
– Estrogens (ovarian follicle, secondary sex char.)
– Progesterone (changes in uterus, endometrium)
– Androgens (follicular development, libido)
– Follicle-stimulating hormone (FSH) and
luteinizing hormone (LH)
• Perimenopause and menopause (45-52)
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External Female Genitalia
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Internal Female Reproductive
Structures
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Menstrual Cycle
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Health History and Sexual
Assessment
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Menstrual history and history of pregnancies
History of exposure to medications
Pain with menses or intercourse
Vaginal discharge, odor, or itching
Urinary and bowel function
Sexual history, including sexual or physical abuse
History of STDs, surgeries, or procedures
Chronic illness or disabilities that affect health/selfcare
• Family and genetic history
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Sexual Assessment
• Include subjective and objective data.
• Purpose is to obtain information to picture a
woman’s sexuality and sexual practices to
promote sexual health.
• May move from less sensitive areas of general
health history/assessment to more sensitive areas
• Ask for permission to discuss these issues.
• Do not assume sexual preferences.
• Asking the patient to label herself as married,
single, etc. may be interpreted as inappropriate;
asking about current meaningful relationships may
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be less offensive.
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Diagnostic Examinations and
Pelvic examination Tests
– Inspection
– Bimanual palpation
– Cervical, uterine, adnexal, vaginal/rectal
• Pap smear
– Colposcopy and cervical biopsy
• Endometrial biopsy
• Dilation and curettage (diagnostic or therapeutic)
• Laparoscopy (pelvic peritoneoscopy)
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Speculum Examination of the
Vagina and Cervix
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Bimanual Examination of the
Pelvis
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Menstrual Disorders
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Premenstrual syndrome
Dysmenorrhea
Amenorrhea
Abnormal uterine bleeding
– Menorrhagia
– Metrorrhagia
– Postmenopausal bleeding
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Menopause
• Permanent physiologic cessation of menses
associated with declining ovarian function (see
table 54-6)
– Perimenopause (40s)
– Menopause (45-58)
– Postmenopause
• Changes in menstruation
• Clinical manifestations
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Hot flashes, night sweats
Sleep disturbances
Fatigue
Forgetfulness
Weight gain
Irritability
Pubic hair thins
Labia shrinks
Vaginal secretions
decrease 13
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Menopause
• Physiologic changes
– Increased risk of osteoporosis
– Increased risk of atherosclerosis
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Menopause
• Psychological considerations
– Role confusion r/t loss of reproductive capacity
– Relief that child bearing phase is over
– Individual responses
• Medical management: Hormone Replacement Therapy;
risks and benefits
– WHI demonstrates that risks outweigh benefits
• Increased risk of breast cancer
• Increased risk of heart attack, stroke and blood clots
– Benefits include reduced risk of osteoporotic fractures and
management of menopausal symptoms
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Menopause
• Medical Management; HRT
• With a uterus: estrogen and progestin
• Without a uterus: estrogen alone
– HRT is contraindicated in breast CA,
thrombosis, liver disease, and
undiagnosed vaginal bleeding
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Nursing Teaching for the Patient
Approaching Menopause
• View as natural life change, a new phase with
potential for growth and new activities.
• Promote general good health, including diet and
exercise.
• Note that fatigue and stress may worsen hot
flashes.
• Nutrition: decrease fat and calories and increase
calcium, whole grains, fiber, fruit, and vegetables.
Calcium and vitamin D supplementation may be
helpful.
• Address sexual activity and prevention or
management of common problems.
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