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NR 602 Final Exam Study Guide (Version 2, Latest update, ) / NR602 Final Exam Study Guide: Chamberlain College of Nursing | Download to Score “A”|$15.49
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NR 602 FINAL EXAM STUDY GUIDE
Week 8:
ACOG guidelines regarding well women exams
ACOG Pap smear guidelines
Start @ 21, every 3
Age 30+ PAP & HPV repeat every 5 if negative (co-test) or 3 yr no co-test
@65 may stop if (-) hx for 10 yrs or hysterectomy w/o hx of cancer
Amenorrhea (Primary and Secondary)
Primary and Secondary Amenorrhea
Primary amenorrhea: No menarche by the age of 15 years (with or without development of secondary sexual
characteristics). Half of cases are caused by chromosomal disorders (50%) such as Turner syndrome.
Puberty is delayed if there is no breast development by age 13 years, absence of pubic
hair at age 14 years, and no menarche by age 15 years.
Secondary amenorrhea: No menses for three cycles, or 6 months if previously had menses. Most
common cause is ).
Secondary Amenorrhea Associated With Exercise and Underweight
Excessive exercise and/or sports participation have a higher incidence of amenorrhea (and infertility) due to relative
caloric deficiency
"Female athlete triad"; anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis
Labs
Pregnancy test (serum human chorionic gonadotropin [hCG])
Serum prolactin level (rule out prolactinoma-induced amenorrhea)
Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing hormone (LH; rule out
premature ovarian failure)
If amenorrhea for more than 6 months, measure bone density
Treatment Plan
Educate about increasing caloric intake and decreasing exercise
Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin E 400 IU daily
Complications
Osteopenia/osteoporosis (stress fractures)
Myocardial atrophy, arrhythmia (sudden death), bradycardia, hypotension
Hypoglycemia, dehydration, electrolytes
Lanugo (fine downy hair), telogen effluvium (hair loss), xerosis (dry skin), infertility
Low body mass index (BMI), cachexia, anemia, respiratory failure
American Cancer Society recommendations
Breast cancer recommendations: Baseline mammogram: Start at age 50 years and repeat every 2 years until the age
of 74 years
Age 75 years or older: Insufficient evidence for routine mammogram
Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial breast cancer, history chest
radiation at a young age or previously diagnosed with high-risk breast lesion who may benefit from starting
screening in their 40s
NOTE: Age 40 to 49 years (individualize based on risk factors, if done). The American Cancer Society
recommends starting routine screening at age 40 years.*U.S. Preventive Services Task Force (USPSTF)
Recommendation Statement (January 2016).
Cervical Cancer Screening
Age Group. Recommendations for Pap/Liquid Cytology
Age 20 years or younger Do not screen (even if sexually active with multiple partners). Cervical cancer is rare
before age 21 years.
Age 21 to 65 years Baseline at age 21 years. Screen every 3 years.
Age 30 to 65 years Another option starting at age 30 years is to screen with combination of cytology plus
human papillomavirus (HPV) testing every 5 years.
Had hysterectomy with removal of cervix If hysterectomy with cervical removal was not due to cervical
intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening.
, 2
Women older than 65 years who had adequate prior screening Do not screen if history of adequate prior
screening and is otherwise not at high risk for cervical cancer.
Source: USPSTF (2012).
Notes*
These recommendations do not apply to women who are immunocompromised (i.e., Hiv infection), had in
utero exposure to diethylstilbestrol (DES), or have a diagnosis of high-grade precancerous cervical lesion or
cervical cancer.
*USPSTF Screening Recommendations for Cervical Cancer (July 2015).
Ovarian cancer- ACS RECOMMENDATIONS - The typical patient is a middle-aged or older woman with vague
symptoms of abdominal bloating and discomfort, low-back pain, pelvic pain, and changes in bowel habits. Look for
family history of having two or more first- or second-degree relatives with a history of ovarian cancer or a
combination of ovarian cancer, especially women of Ashkenazi Jewish ethnicity with a first-degree relative (or
second-degree relatives on the same side of the family) with breast or ovarian cancer (American Cancer Society,
U.S. Preventive Services Task Force [USPSTF], 2012). Very-high-risk women with suspected BRCA 1/BRCA
2 mutations should be referred for genetic counseling pre- and posttest. The screening starts at age 30 years (or 5 to
10 years before the earliest age of first diagnosis of ovarian cancer in a family member).
Androgen insensitivity/resistance syndrome
description/features
Inability of body to respond properly to male sex hormone, produced during pregnancy
Sx-
genetic make up is male but physical traits of woman
Vagina but no cervix, inguinal hernia w/ testes, normal female breasts, testes in abd or other place of body
ASCUS/HSIL results from Paper Test Report
(atypical squamous cell undetermined significance) from CDC---
For non-pregnant women between 25 and 65 years of age with ASCUS cytology who have not had HPV co-testing
already, HPV testing is the preferred next step (high-risk HPV testing only). With a negative HPV test (either on co-
test or after cytology), repeat co-testing every three years is recommended.
Normal Pap and Negative HPV Rescreen in 5 years.
Normal Pap and Positive HPV Repeat co-test in one year or do HPV DNA typing now (see ASCCP guidelines above).
ASCUS Pap, No HPV Test Repeat cytology in one year or do HPV test now (see ASCCP guidelines above).
ASCUS Pap and Negative HPV Repeat Pap and co-test at interval as per ASCCP guidelines.
LSIL Pap and Negative HPV
ASCUS Pap and Positive HPV Colposcopy and/or referral to gynecologist.
LSIL Pap and Positive or Unknown HPV
ASC-H Pap
HSIL Pap
,3
Bartholin glands and cysts
If a Bartholin duct gets blocked, fluid builds up in the gland. The blocked gland is called a Bartholin gland cyst
Bartholin Cyst: common at what locations? 4 and 8 o'clock
Bartholin cyst: MC org? E. Coli
Bartholin Cyst: txI&D packing, marsupilization
Bartholin cyst: tx
duration of word catheter placement? 4-6 wks
Where are Bartholin's glands and ducts situated? Under the labia minor
What do they secrete?- Thin lubricating mucus during sexual excitation
How does a cyst form?- If the duct blocks
How does an abscess form? If the cyst become infected --> hugely swollen, red labium
Investigations- Exclude gonococcus
Management- Permanent drainage by marsupialization or by balloon catheter insertion
BMI
BMI Weight Status
Below 18.5 Underweight
18.5 – 24.9 Normal or Healthy Weight
25.0 – 29.9 Overweight
30.0 and Above Obese
CDC recommendations regarding STDs and PID
CDC FOR STD’s
Routine annual screening of all sexually active females aged 25 years or younger for Chlamydia
trachomatis and gonorrhea
If infected, retest for chlamydia and gonorrhea 3 months after treatment (to check for reinfection,
not for test-of-cure)
Annual testing for syphilis, chlamydia, and gonorrhea in persons with Hiv infection
Minors do not need parental consent if the clinic visit is related to testing or treating STDs and birth
control; no state requires parental consent for STD care
Men Who Have Sex With Men (MSM)
Annual screening for chlamydia and gonorrhea at sites of contact (urethra, rectum) regardless of condom
use. Screen every 3 to 6 months if at increased risk.
Annual screening recommended for pharyngeal gonorrhea (throat). Screen every 3 to 6 months if at
increased risk.
Annual testing recommended for Hiv, syphilis, and for HBsAg. Retest more frequently if at risk.
Pregnant Women
Screen pregnant women for Hiv, chlamydia, gonorrhea, syphilis, and hepatitis B surface antigen (HBsAg)
at first prenatal visit.
Pregnant women treated for chlamydia and/or gonorrhea should have a test-of-cure within 3 to 4 weeks
after treatment.
Retest at 3 months for chlamydia and gonorrhea (check for reinfection, not test of cure).
CDC FOR PID
72 hr post tx, chlamydia annual screen <25
[PID] – presumptive tx for PID should be given to sexually active women & @ risk women experiencing
pelvic/lower abd pain and no cause for illness and one or more of the following: cervical motion tenderness, uterine
or adnexal tenderness
Criteria to dx PID: endometrial bx, transvag US, laprascopy
Tx- Recommended Intramuscular/Oral Regimens
Ceftriaxone 250 mg IM in a single dose
PLUS
, 4
Doxycycline 100 mg orally twice a day for 14 days
WITH* or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
OR
Cefoxitin 2 g IM in a single dose and Probenecid, 1 g orally administered concurrently in a single
dose
PLUS
Doxycycline 100 mg orally twice a day for 14 days
WITH or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
OR
Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime)
PLUS
Doxycycline 100 mg orally twice a day for 14 days
WITH* or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
Cervical cancer screening
The USPSTF (2012) and the American College of Obstetricians and Gynecologists (ACOG; 2015) provide the
following guidelines for cervical cancer screening:
USPSTF: Cervical cancer is rare before age 21 years. Therefore, the USPSTF (2012) does not recommend Pap tests
or human papillomavirus (HPV) testing before age 21 years (do not co-test for HPV before age 21). At the age of 30
years, can perform Pap test with co-testing (HPV testing). Can space routine Pap smears to every 5 years if co-
testing (except if abnormal Pap).
ACOG: Hiv-positive women are the exception to the recommendation against cervical
cancer screening before age 21 years. But ACOG is still against co-testing if younger
than age 30 years.
Risk Factors for Cervical CA:
- HPV
- early onset sexual activity
- high number of partners
- smoking
- synthetic estrogen exposure (DES)
- STIs
- immunosuppresion
what is the MC cause of Cervical & Vulvar CA?
HPV 16 & 18
S/Sx of Cervical CA:
- Post-coital bleeding/spotting
- metorrhagia
- pelvic pain
+/- watery vaginal discharge
what diagnostic tests would you do for Cervical CA?
1st = Pap smear w/cytology = screening
2nd = Colposcopy w/bx
3rd = cold knife conization w/bx
NAAT
what is the tx for Cervical CA?
-referral to gynecologic oncologist
-cold-knife conization (fertility sparing)
-total hysterectomy
-radiation or chemo
Cervix/Uterus examination
locations/ description
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