from Ma'am Asio.

1. NURSING CARE OF CLIENTS WITH SPECIFIC HEALTH PROBLEMS RELATED TO REPRODUCTION AND SEXUALITY STD (Sexually Transmitted Dses.) > STDs. Are those dses. Spread through sexual contact. > The range in severity from easily treated infections such as trichomoniasis, to HIV, w/c is life threatening.

2. > If these dses. Occur in young children, the possibility of sexual abuse must be considered. > Abstinence or condom use provides the best protection against STDs.

3. Educate adolescents about safe sex practices including the need for condom use. Reinforce with them that little immunity develops from STDs, which means such dses. Can be contracted repeatedly. STDs are becoming more difficult to treat bec. These organisms are becoming more and more resistant to antibiotics.

4. Gonorrhea Gonorrhea - is transmitted by Neisseria gonorrhoea, a gram-negative diplococcus that thrives on columnar transitional epithelium of the mucous membrane. Symptoms, which begin after a 2-7 day incubation period, in males include urethritis (pain on urination and frequency of urination) and urethral discharge. Without tx., the infection may spread to the testes, scarring the tubules and causing permanent sterility.

5. Untreated, the infection is easily spread among sexual partners. Although symptoms of gonorrhea in females are not as visible, there may be a slight yellowish vaginal discharge.

6. If left untreated, the infection may spread to pelvic organs, most notably the fallopian tubes (PID). Tubal scarring can result in permanent sterility. In both males and females, untreated gonorrhea can lead to arthritis or heart dse. From systemic involvement.

7. Therapeutic Mgt. The tx. Of gonorrhea is one IM inj. Of ceftriaxone (Rocephin) plus oral doxycycline (Vibramycin) for 7 days. This tx. Regimen is effective for both gonorrhea and chlamydia. Sexual partners should receive the same tx.

8. Approximately 24H after tx., the gonorrhea is no longer infectious. Approximately 7 days after tx. The client should return for follow-up culture to verify that the dse. Has been completely eradicated (few people take this precaution).

9. A sexually active client should be given a serologic test for syphilis along with the gonorrheal culture. Although the dose of ceftriaxone and doxycycline is also effective tx. For syphilis. Most states require; adolescents are asked to name sexual contacts.

10. Syphilis Syphilis - is a systemic dse. Caused by the spirochete Treponema pallidium. It is transmitted by sexual contact with a person who has an active spirochete-containing lesion.(papillomatous digital dermatitis)-is a dse. Involving inflammation & lesion dev’t.)

11. Like gonorrhea and chlamydia, it must be reported to public health departments. After an incubation period of 10-90 days, a typical lesion appears, generally on the genitalia (penis or labia) or on the mouth, lips or rectal area from oral-genital or genital-anal contact.

12. The lesion (termed a chancre) is a deep ulcer and generally painless despite in size. A lesion in the vagina may not be immediately evident. Without tx., a chancre lasts approximately 6 wks. And then fades.

13. Approximately 2-4 wks. After the chancre disappears, a generalized, macular, copper-colored ash appears. Unlike many other rashes, it affects the soles and the palms.

14. The next stage is a latency period that may last from only a few yrs. To several decades. The only indication of the dse. Is serologic (studies of blood serum for evidence of infxn. By eval. Antigen-antibody reactions) test, which continues to yield a positive result. The final stage of syphilis is a destructive neurologic dse. That involves major body organs such as the heart and the nervous system.

15. . Typical symptoms are blindness; paralysis; severe crippling (partially disabled- unable to use a limb/s) neurologic deformities; mental confusion; slurred speech; and lack of coordination. The third stage must be identified before it becomes fatal

16. Therapeutic Mgt. Benzathine penicillin G given IM in two sites is effective therapy. For the adolescent sensitive to penicillin, either oral erythromycin or tetracycline can be given for 10-15 days. As with gonorrhea, sexual partners are treated in the same way as the person with the active infection.

17. Bec. Syphilis can be treated so easily, one would think it would be easy to eradicate. In reality, however, bec. The primary chancre is painless, many people are either unaware of it or choose to ignore it, thereby transmitting the dse. To unsuspecting partners.

18. Adolescents, in particular, need accurate information about syphilis to become aware of the symptoms. They should believe they can report the dse. To health care personnel and they can name sexual contacts without fear of being criticized. If a woman develops syphilis during pregnancy, the dse. Can be spread to the fetus.

19. Breast and Uterine Cancers Breast Cancer – unregulated growth of abnormal cells in breast tissue ETIOLOGY: A. Cause is unknown, but many risk factors influence dev’t. Female gender and white/caucasian race Family hx. Of mother or sister with breast Ca

20. 3. Medical hx. Of Ca of other breast, endometrial Ca, or atypical hyperplasia 4. Menarche before age 12 (early) or menopause after age 50 (late) 5. First birth after 30 yrs. Of age, oral contraceptive use (early or prolonged), prolonged use of estrogen replacement therapy.

21. Lifestyle factors: high-fat diet, obesity, high socioeconomic status, breast trauma, smoking, ingesting more than 2 alcoholic drinks daily. Exposure to radiation through chest x-ray, fluoroscopy.

22. B. Most often occurs in ductal areas of breasts C. Staging depends on size of tumor, lymph node involvement, and metastasis to distant site. D. 70% of clients with Stage I tumors survive for 10 yrs. With therapy. E. Begins as a single transformed cell and is hormone-dependent; does not develop in women who never received hormone replacement therapy.

23. Assessment: a. Clinical manifestations Lump in the upper outer quadrant of the breast, usually non tender. Dimpling of breast tissue surrounding nipple, or bleeding from the nipple. Asymmetry, with affected breast being higher. Regional lymph nodes swollen and tender.

24. b. Diagnostic and lab. Tests: mammography, UTZ, MRI, tissue biopsy

26. Fibrocystic breast disease Fibrocystic breast condition is a common, non-cancerous condition that affects more than 50% of women at some point in their lives. The most common signs of fibrocystic breasts include lumpiness, tenderness, cysts (packets of fluid), areas of thickening, fibrosis (scar-like connective tissue), and breast pain.

27. Having fibrocystic breasts, in and of itself, is not a risk factor for breast cancer. However, fibrocystic breast condition can sometimes make it more difficult to detect a hidden breast cancer with standard examination and imaging techniques.

28. Fibrocystic breast condition is most common among women between the ages of 30 and 50, although women younger than 30 may also have fibrocystic breasts. Because the condition is related to the menstrual cycle, the symptoms will usually cease after menopause unless a woman is taking hormone replacement therapy. In some cases, fibrocystic breast symptoms may continue past menopause.

29. Symptoms of fibrocystic breasts include: cysts (fluid-filled sacs) fibrosis (formation of scar-like connective tissue) lumpiness areas of thickening tenderness pain

30. The degree to which women experience these symptoms varies significantly. Some women with fibrocystic breasts only experience mild breast pain and may not be able to feel any breast lumps when performing breast self-exams.

31. Other women with fibrocystic breasts may experience more severe breast pain or tenderness and may feel multiple lumps in their breasts. Most fibrocystic breast lumps are found in the upper, outer quadrant of the breasts (near the axilla, armpit, region), although these lumps can occur anywhere in the breasts.

32. Fibrocystic breast lumps tend to be smooth, rounded, and mobile (not attached to other breast tissue), though some fibrocystic tissue may have a thickened, irregular feel. The lumps or irregularities associated with fibrocystic breasts are often tender to touch and may increase or decrease in size during the menstrual cycle.

33. What Causes Fibrocystic Breasts? Fibrocystic breasts occur from changes in the glandular and stromal (connective) tissues of the breast. These changes are related to a woman’s menstrual cycle and the hormones, estrogen and progesterone. Women with fibrocystic breasts often have bilateral cyclic breast pain or tenderness that coincides with their menstrual cycles.

34. During each menstrual cycle, normal hormonal stimulation causes the breasts’ milk glands and ducts to enlarge, and in turn, the breasts may retain water. Before or during menstruation, the breasts may feel swollen, painful, tender, or lumpy. The severity of these symptoms varies significantly from woman to woman.

35. How Are Fibrocystic Breasts Diagnosed? Fibrocystic breasts are often first noticed by the woman, and further investigated by her physician. Breast tenderness, pain, and/or lumpiness are common indicators of fibrocystic breasts, especially when they coincide with menstruation.

36. Therefore, in some cases, breast imaging exams, such as mammography or ultrasound, will need to be performed on women who show symptoms of fibrocystic breasts.

37. In some cases, additional mammography or ultrasound imaging, followed by fine needle aspiration or biopsy, will be performed on women with fibrocystic breasts to determine whether breast cancer is present. Fine needle aspiration (to drain large, painful cysts) may also be performed by a physician help relieve some of the more severe symptoms of fibrocystic breast condition

38. How Are Fibrocystic Breasts Treated? Often, physicians may recommend that the symptoms of fibrocystic breasts be treated with self-care. several measures may be recommended to relieve the symptoms of fibrocystic breasts. For instance, women may wish to wear extra support (athletic type) bras to help hold the breasts closer to the chest wall, which may provide some symptomatic relief.

39. Extra support bras are especially important for large breasted women and may provide relief when breasts are full and tense with fluid. Physicians will often recommend that a support bra be worn both during the day and at night, especially during times of the woman’s menstrual cycle when the breasts are most tender.

40. In addition, certain vitamins (particularly vitamin E, vitamin B6, or niacin) or herbal supplements such as evening primrose oil may help alleviate the symptoms of fibrocystic breasts by reducing inflammation and fluid retention. It is important that these supplements be used according to directions and that women avoid megadoses since serious side effects may occur from incorrect use.

41. Some women also find that reducing their caffeine intake by avoiding coffee, tea, chocolate, and soft drinks decreases water retention and breast discomfort. However, this is a controversial topic among healthcare professionals because studies linking breast pain and caffeine have been inconsistent.

42. Diuretics, substances that encourage the excretion of excess fluid from the body in the form of urine (which may in turn reduce tissue swelling and pain) are usually reserved for women who experience non-cyclical breast pain, but may be used to alleviate the symptoms of fibrocystic breast condition in some cases. The release of fluid in the body can help decrease breast pain and swelling.

43. Additional drug treatments for severe breast pain include: bromocriptine (Parlodel) danazol (Danocrine)

44. bromocriptine and danazol both relieve cyclical breast pain by blocking estrogen and progesterone. However, these drugs may cause serious side effects in some women. Bromocriptine is poorly tolerated by many patients; side effects include nausea, dizziness, and fertility problems.

45. Side effects of danazol may include weight gain, amenorrhea (absence of menstruation), and masculinization (such as extra facial hair) when given high doses. Other drugs, such as tamoxifen (Nolvadex) or goserelin.

46. Fibroadenoma Fibroadenomas - are tumors consisting of both fibrotic and glandular components that occur in response estrogen stimulation. The tumors may increase in size during adolescence and during pregnancy and lactation, or when a woman takes an estrogen source such as an oral contraceptive.

48. Unlike fibrocystic lesions, fibroadenomas are round and well delineated, feeling firmer and more ruberry than fluid-filled cysts. Occasionally, they calcify and feel extremely hard. They are typically painless, feel movable, and tend not to cause skin retraction.

49. Like fibrocystic lesions, the do not become malignant. Such tumors can be surgically excised so that the woman no longer has to worry about them. Bec. The incision is small, it leaves little scarring at the site.

50. Breast Hypoplasia - is also commonly called breast hypomastia. The term describes a condition in which one or both breasts never mature or develop properly. Hypomastia can be the result of several possible known causes or might be idiopathic.

51. One thing is for sure, hypomastia is sometimes an emotionally troubling condition which often necessitates treatment to restore aesthetic harmony to the body.

52. In a hypomastia patient, the breast tissue never matures into a developed adult breast. The normal process which creates a fully formed breast in a grown woman never occurs, leaving the patient’s chest with a juvenile appearance.

53. This complete lack of anatomical maturity will often affect the breast’s ability to function as a sensual organ. Hypomastia can also interfere with successful breastfeeding. However, some women with a hypoplastic condition have normal or limited mammary function, even though their breasts never fully matured

54. Causes of Breast Hypoplasia Hypoplasia can result from any number of hormonal conditions in a girl’s young body. In these instances, hormone therapy might resolve the issue and jump start normal breast development.

55. Hypomastia can be the result of a variety of diseases or systemic disorders, which need to be addressed if the breast is to stand any hope of maturing. Hypoplasia can also be the direct result of an injury or damage to the young undeveloped breast bud.

56. This structure is delicate in a girl and significant damage might prevent the bud from forming into a normal breast. Other cases of the condition are completely idiopathic, with the patient showing no particular reason why their breasts never grew normally.

57. Treatment for Breast Hypoplasia Hypomastia that is caused by a disease or systemic disorder (such as anorexia) might be reversed if the causative condition is resolved in time to resume normal growth

58. Hormone therapy is effective in some cases, but must be monitored by a specially trained expert, to minimize any unwanted side effects, especially in young patients.

59. Women who never develop are often good candidates for breast augmentation surgery. This procedure will accomplish what nature could not provide for the affected patient…a beautiful set of fully formed breasts.

60. Women who have no breastfeeding ability or undeveloped sensory response in their breasts will not regain these functions by receiving implants.

61. However, the look and feel of the breast will be normal, which is one of the most important criteria in overcoming psychological issues stemming from aesthetically immature breasts. If you are suffering with hypomastia, talk to your doctor about which treatment option might work best for your particular condition.

62. Hyperplasia Atypical hyperplasia is a precancerous condition that affects cells in the breast. Atypical hyperplasia describes an accumulation of abnormal cells in a breast duct (atypical ductal hyperplasia) or lobule (atypical lobular hyperplasia).

63. Atypical hyperplasia isn't cancer, but it can be a forerunner to the development of breast cancer. Over the course of your lifetime, if the atypical hyperplasia cells keep dividing and become more abnormal, your condition may be reclassified as carcinoma in situ or noninvasive breast cancer

64. Atypical hyperplasia doesn't cause any specific signs or symptoms. When to see a doctorMake an appointment with your doctor if you have any signs or symptoms that worry you.

65. Atypical hyperplasia doesn't cause signs and symptoms, but it's often discovered during a breast biopsy to investigate breast signs and symptoms or an abnormality found on a mammogram

66. It's not clear what causes atypical hyperplasia. Atypical hyperplasia forms when breast cells become abnormal in number, size, shape, appearance and growth pattern. Location of the abnormal cells within the breast tissue — the lobules or the milk ducts — determines whether the cells are atypical lobular hyperplasia or atypical ductal hyperplasia

67. The abnormal cells can continue to change in appearance and multiply, evolving into noninvasive (in situ) cancer, in which cancer cells remain confined to the area where they start growing. Left untreated, the cancer cells may eventually become invasive cancer, invading surrounding tissue, blood vessels or lymph channels.

68. Mastitis Mastitis, or breast infection, affects about 1% of women soon after childbirth, most of whom are first-time mothers who are breastfeeding. Mastitis is almost always unilateral and develop well after the flow of milk has been established.

69. The infecting organism generally is the hemolytic Staphylococcus aureus. An infected nipple fissure usually is the initial lesion, followed by ductal system involvement. Inflammatory edema and engorgement of the breast soon obstruct the flow of milk in a lobe;

71. Symptoms rarely appear before the end of the first pp wk. and are more common in the 2nd to 4th wks.

73. Bec. Mastitis rarely occurs before the pp woman is discharged, teaching should include warning signs of mastitis and counseling about prevention of cracked nipples.

74. Mgt. includes intensive antibiotic therapy (i.e., cephalosporins and vancomycin, which are particularly useful in staphylococcal infections), support of breasts, local heat or cold, adequate hydration, and analgesics. Almost all instances of acute mastitis can be avoided by using proper BF technique to prevent cracked nipples.

75. Missed feedings, waiting too long between feedings, and abrupt weaning may lead to clogged nipples and mastitis. Cleanliness practiced by all who have contact with the newborn and new mother also reduces the incidence of mastitis.

76. Predisposing factorsmay include: Inadequate emptying of the breast will lead to engorgement, plugged ducts, sudden decrease in the number of feedings, abrupt weaning, or wearing underwire bras. Sore, cracked nipples (provides portal of entry) Stress and fatigue Ill family members Breast trauma Poor maternal nutrition

77. Causative Organisms: Staphylococcus aureus, Streptococcus, and E. coli. An infected nipple fissure usually is the initial lesion, followed by ductal system involvement.

78. Analgesics/Antipyretics: Ibuprofen Complications:Breast abscess, chronic mastitis, or fungal infection of the breast. Can be prevented by early recognition and treatment.

79. Management: Lactation is maintained (if desired) by emptying the breasts every 2 to 4 hours by manual expression or a breast pump. Advise to have adequate rest Warm compresses to the breast before feeding or pumping may be useful Adequate fluid intake and balanced diet

80. Vaginal Infection Vaginal infections, or vaginitis is an inflammation of the vagina that creates discharge, odor, irritation, or itching. It is difficult to diagnose because vaginitis has many causes. Women use a variety of over-the-counter medications to treat the itching, discharge, and discomfort of these conditions.

81. Vaginitis occurs when the vaginal ecosystem has been changed by certain medications such as antibiotics, hormones, contraceptive preparations (oral and topical), douches, vaginal medication, sexual intercourse, sexually transmitted diseases, stress, and change in sexual partners.

82. Some vaginal infections are transmitted through sexual contact, but others such as yeast infections probably are not. Vaginitis means inflammation and is often caused by infections, but may be due to hormonal changes (especially when a woman is going through menopause) or due to trauma in young girls. Some infections are associated with more serious diseases.

83. Endometritis Endometritis (infection of the lining of the uterus) – is the most common pp infection. -- It usually begins as a localized infection at the placental site, but can spread to the entire endometrium.

85. -- Incidence is higher after cesarean birth. -- Signs and symptoms of endometritis include fever (usually greater than 38 ⁰C); inc. pulse, chills; anorexia; nausea; fatigue and lethargy; pelvic pain; uterine tenderness; and foul-smelling, profuse lochia.

86. Typical laboratory findings would reveal leucocytosis and increased RBC sedimentation rate. Anemia may also be present -- Blood cultures or intracervical or intrauterine bacterial cultures should reveal the offending pathogens within 36 to 48 hrs.

87. Management: IV Broad spectrum antibiotic therapy (cephalosporins, penicillins, or clindamycin and gentamycin). Supportive care: hydration, rest, and pain relief

93. Medical Management The tx. Of a large ovarian cyst is usually surgical removal. For cyst that are small and appear to be fluid-filled in a young, healthy patient however, oral contraceptives may be used to suppress ovarian activity and resolve the cyst.

94. Oral contraceptives are also usually prescribed to treat polycystic ovary syndrome. In women older than 50 yrs. Of age, only half of these cysts are benign.

95. The postoperative nursing care after surgery to remove an ovarian cyst is similar to that after abdominal surgery. Some surgeons discussed the option of a hysterectomy when a woman is undergoing bilateral ovary removal bec. Of a suspicious mass bec. It may increase life expectancy, avoid a later second surgery, and save on health care costs.

96. Premenstrual Dysphoric Disorder PDD - is a condition occurring in the luteal (latter) phase of the menstrual cycle and relieved by the onset of menses that has both behavioral and psychologic symptoms.

97. Bec. Of the variety of possible symptoms, as many as 30% of women experience some degree of PDD, a cluster of symptoms that include anxiety, fatigue, abdominal bloating, headache, appetite disturbance, irritability and depression. The cause of PDD is unproven but, contrary to previous beliefs, must be due to more than a drop in progesterone just before menses.

98. In some women, a vit. B-complex deficiency may lead to estrogen excess, causing an abnormal ratio of estrogen to progesterone; other related causes may be poor renal clearance leading to water retention or hypoglycemia leading to a surge of adrenalin and low calcium levels and interference with serotonin synthesis.

99. Symptoms of PDD vary from cycle to cycle and throughout life. Therapy is aimed at correcting specific symptoms. Adolescents who think they have PDD should keep a diary of when symptoms occur. If they are aware of recurring patterns that indicate PDD, they will be better able to recognize the cause.

100. Vaginal Fistulas A fistula is an abnormal, tortuous (twisting/bending/crooked) opening bet. Two internal hollow organs or bet. An internal hollow organ and the exterior of the body. The name of the fistula indicates the two areas that are connected abnormally: a vesicovaginal fistula- is an opening bet. The bladder and the vagina, and a rectovaginal fistula- is an opening bet. The rectum and the vagina.

101. Fistulas may be congenital in origin. In adults, however, breakdown usually occurs bec. Of tissue damage resulting from injury sustained during surgery, vaginal delivery, radiation therapy, or dse. Processes such as carcinoma.

104. In this situation care must be planned and implemented on an individual basis. Cleanliness, frequent sitz baths, and deodorizing douches are required.

105. Meticulous skin care is necessary to prevent excoriation. Applying bland creams or lightly dusting with cornstarch may be soothing. Despite the best surgical intervention, fistulas may recur. After surgery, medical follow up continues for at least 2 yrs. To monitor for a possible recurrence.

106. Uterine Prolapse Description: Downward displacement of the uterus into the vaginal canal. First-degree prolapse: less than half of the uterus extends into the vagina. Second-degree prolapse: descent of the entire uterus into the vaginal canal. Third-degree prolapse: complete prolapse of the uterus outside the body, with inversion of vaginal canal.

107. Etiology May be congenital or acquired b. Usually related to weakened pelvic musculature c. Risk factors: unrepaired lacerations from childbirth, rapid deliveries, multiple pregnancies d. Prolapse is often accompanied by cystocele or rectocele

108. Therapeutic Management Kegel exercise Vaginal hysterectomy Insertion of a vaginal pessary, a donut-shaped ring placed in the vagina to provide uterine support

109. Rectocele – is the herniation/protrusion of the rectum into the vagina. Cystocele – is the herniation of the bladder into the vagina. Involves a descent of the urinary bladder because of weakened pelvic floor muscles into the vagina.

110. ETIOLOGY: Both conditions are usually related to weakened pelvic musculature caused by stretching of supporting ligaments during pregnancy and childbirth. With cystocele, client may experience stress incontinence and difficulty emptying bladder, leading to retention and infection.

111. Risk factors: unrepaired lacerations from childbirth, rapid deliveries, multiple pregnancies, congenital weakness, loss of elasticity and muscle tone with aging, chronic coughing.

112. Assessment Clinical manifestations Bearing-down sensation in pelvic area, constipation, hemorrhoids, urinary incontinence, and fecal incontinence. With rectocele, client reports she has to press on rectocele from inside of vagina in order to defecate.

113. 3. With cystocele, signs of UTI, urinary retention, and stress incontinence. 4. Cystocele and rectocele can sometimes be seen on inspection, but usually recede when client is lying down; diagnosis is made by asking client to bear down. 5. Bulging just below urethral orifice.

114. b. Diagnostic and lab. Tests: Cystoscopy is performed to determine if there is bladder herniation Measurement of residual urine Urinalysis and culture

115. Therapeutic Management Kegel exercises Surgical correction

116. Other Reproductive Disorders in Females Imperforate Hymen. The hymen is the membranous ring tissue partly obstructing the vaginal opening. An imperforate hymen totally occludes the vagina, preventing the escape of vaginal secretions and menstrual blood.

117. Before menarche, the child with an imperforate hymen generally has no symptoms. With onset of menstruation, the menstrual flow is obstructed.

118. It builds up in the vagina, causing increased pressure in the vagina and uterus and eventual abdominal pain. Palpation of the abdomen will reveal a lower abdominal mass. On vaginal examination, an intact, bulging hymen is evident.

119. The tx. Is surgical incision or removalof the hymen tissue. The girl may have local pain after the incision, which can be relieved by a mild analgesic and warm baths.

120. Premenstrual Syndrome Group of symptoms preceding the monthly menses that regress or disappear during menstruation. ETIOLOGY: Common in women 30 to 40 years old. Affects women of all ages, races, and cultures

121. c. Believed to be related to hormonal changes such as altered estrogen-progesterone ratios (7-10 days before onset of flow). d. Decreased serotonin caused mood swings.

122. Assessment Clinical manifestations CM appear only during the luteal phase of the menstrual cycle (7-10 days before menstrual flow) b. Diagnostic and lab. Tests Organic causes ruled out first; there are no definitive diagnostic tests for PMS

123. Therapeutic Tx.: Pharmacologic mgt. Nonpharmacological mgt. includes modifications in diet, establishing an exercise plan, and stress mgt.

124. Causes: Estrogen-progesterone imbalance Interaction of estrogens, progesterone, and aldosterone Excess of prolactin, hypothyroidism or hypoglycemia Dietary factors, such as deficiency of vitamin B6, magnesium or both Lifestyle factors such as increase stress and poor diet

125. Clinical Manifestations Emotional Manifestations Somatic Problems Appear during the last few premenstrual days and are relieved suddenly with full menstrual flow. So PMS manifestations usually do not occur during the menstrual flow, so women may not associate them with the menstrual cycle.

126. Medical Management Relieve Management 1) Vitamins and Minerals 2) Medications a) Spironolactone b) Bromocriptine (Parlodel) c) Sedatives and Analgesics d) Antidepressants for severe PMS

127. Menopausal Syndrome Menopause- is the cessation of menstrual cycles The postmenopausal period- is the time of life following menopause. Perimenopausal- is a term used to denote the period during which menopausal changes are occuring.

128. Women need health teaching to learn the normal parameters of menopause so they may continue to monitor their own health during this time. Women often refer to this period as a “change of life”. It can be a time of stress because of this role change.

129. Health Teaching: > Nurses can help women appreciate that loss of uterine function may make almost no change in their life. . Many women today begin hormone replacement therapy to help reduce symptoms such as hot flashes and decrease the possibility of osteoporosis.

130. MERRY CHRISTMAS AND A HAPPY NEW YEAR TO ALL! FROM: MA’AM JENNY ASIO