Gynaecology

What are the 3 structures of the female internal reproductive system?

1. vagina
2. uterus
3. ovaries

1 of 74

The external female genitalia (the ***** and perineum) consists of what?

- mons pubis
- labia majora
- labia minora
- ********
-perineum
- Bartholin's glands

2 of 74

What do the Bartholin's glands do and where are they found?

secrete fluid into the vagina and is situated in the space between the labia minora and vagina

3 of 74

What is the major functions of the female reproductive system?

1. Ovulation
2. Hormone secretion
3. Mensuration

4 of 74

What is ovulation?

It is the stage when the mature ovum (eggs) are released from the ovaries into the Fallopian tubes

5 of 74

What are the two phases of ovulation?

1. Follicular phase = the growth and maturation of the ovarian follicles, and then the actual ovulation (egg release)

2. Luteal phase = the development of the corpus luteum from luteinzisation of the granulose close and theca interna cells

6 of 74

How long does the average ovarian cycle?

28 days, with ovulation occurring on day 14

7 of 74

Explain how female sex hormones are secreted

Inside the hypothalamus, GnRH (gonadotropin-releasing hormone) is released, which stimulates the anterior pituitary gland to releases hormones (oestrogen and progesterone)

8 of 74

What are the 2 hormones being released by the anterior pituitary gland and what do they do? (pt.1)

1. Follicle stimulating hormone (FSH) = stimulates ovarian follicle development. The follicle secretes oestrogen, when it becomes mature it is then called a grafian follicle

9 of 74

What are the 2 hormones being released by the anterior pituitary gland and what do they do? (pt.2)

2. Lutenising hormone (LH) = acts on the mature gradian follicle to induce ovulation (at LH peak).
It also stimulates the corpus lutum (derived from the ruptured grafian follicle after ovulation) to secrete progesterone

10 of 74

What is the menstrual cycle?

A repeating series of changes in the uterus lining or endometrium, in preparation of uterus receive a fertilised egg

11 of 74

What are the names of the 3 stages in the menstrual cycle?

1. Menses
2. Proliferative phase
3. Secretory phase

12 of 74

What happens in the menses stage of the menstrual cycle, and how long does it last?

Begins with shedding the uterus lining through the vagina, if pregnancy hasn't occurred. Menstration occurs
(lasts approx 5 days)

13 of 74

What happens in the proliferative phase of the menstrual cycle?

The uterus is repaired and prepares to receive another ovum.
Ovulation occurs around day 14 and egg begins its journey to the uterus (the FSH and LH play a role in this happening)

14 of 74

What happens in the secretory phase of the menstrual cycle, and how long does this last?

The second half of the menstrual cycle after ovulation
The corpus lutueum secretes progesterone to prepare the endometrium for the implantation of an embryo
Lasts from day 15-28

15 of 74

What happens if the egg is not fertilised?

The hypothalamus stops producing FSH and LH. As these hormone levels drop, the lining of the uterus sheds and the cycle starts again

16 of 74

In the 28 day cycle, on averse for a female, how many days is there between menstrual cycles?

Usually 21-35 days

17 of 74

How much is normal menstrual blood flow?

30-80 mls

18 of 74

How long does menstruation last?

2-7 days

19 of 74

What is the menopausal period?

It marks the end of a woman's reproductive capacity. No more ova mature, therefore no ovarian hormones are produced. Physical, emotional and menstrual changes may occur

20 of 74

When does menopause usually happen?

Between 45-55 years old

21 of 74

After ovulation, the Graafian follicle becomes an endocrine organ called what?

Corpus luteum

22 of 74

If after ovulation, pregnancy does not take place, what does the corpus leuteum do?

IDK

23 of 74

What are the 3 nursing aspects of a gynaecological assessment?

1. Health history
2. Physical assessment
3. Diagnostic evaluation

24 of 74

In a general health history taking, what things will you ask about?

1. menstrual history (menarche, length of cycles, duration and amount of flow, presence of cramps or pain, bleeding between periods, bleeding after intercourse, bleeding after menopause, last period date)
2. pregnancies (number and outcomes)
3. exposure t

25 of 74

In a general health history, what things will you ask about? (pt.2)

4. dysmenorrhea (pain with menses)
5. dyspareunia (pain with intercourse)
6. symptoms of vaginitis (odour, itching)
7. previous, current or recurring UTIs
8. bowel problems and bowel movements (any blood in stool, incontinence, etc.)
9. current or previou

26 of 74

In a general health history, what things will you ask about? (pt.3)

11. chronic illnesses or disabilities
12. presence or family history of any genetic disorders (ie: ovarian or breast cancer)
13. lifestyle assessment - smoking, alcohol
14. bladder assessment (haematuria, pain during urination)
15. pain assessment (what h

27 of 74

How would you conduct a sexual history taking?

Ask the following:
- any pain during sex
- any current or past STDs
- any history of bacterial vaginosis, thrush, pelvic inflammatory disease
- what she uses for menstruation (ie: tampons)
- any symptoms of thrush or BV
- how many sexual partners
- any hi

28 of 74

For women over 21 years old and sexually active, how often should they get breast and pelvic examinations?

Every 3-5 years

29 of 74

How would you conduct a visual assessment during a pelvic exam?

Assess external appearance of *****, vagina and cervix. Look for: genital mutilations, inflammation or redness, discolouration, odour, discharge, bleeding, tears, lesions, trauma, prolapse

30 of 74

What is the nurse's role during a pelvic exam?

1. gain informed consent (verbal/written) and give choice of examiner gender
2. explain procedure (the need and nature of the examination)
3. ensure a chaperone is present
4. conduct exam in private setting
5. patient should be covered at all times and on

31 of 74

What position should the patient be in during a pelvic exam?

Supine lithotomy position
(lie on back with feet in stirrups or feet together and knees dropped to sides) = provides good visibility

32 of 74

During a physical pelvic exam, how would you inspect the vagina and what are you looking for?

Use lubricant and insert 2 fingers - feel for lumps/irregularities. Press down with other hand on the lower abdomen, assess shape and size of uterus and ovaries

33 of 74

What is this technique called when pressing on abdomen whilst inserting fingers?

Bimanual palpation

34 of 74

What is a speculum used for in an examination?

Used to inspect the cervix, and the obtain Pap smears and other samples/swabs

35 of 74

What diagnostic tests can be conducted during this exam?

- cytologic test for cancer (Pap smear)
- colposcopy and cervical biopsy
- cryotherapy and laser therapy
- endometrial (aspiration) biopsy
- endoscopic examination (laparoscopy and hysteroscopy)
- transvaginal ultrasonography

36 of 74

In a gynae investigation, what bloods might be required?

- FBC (iron levels)
- U+E
- WBC
- CA125 (diagnoses endometriosis)
- thyroid
- coagulation screen

37 of 74

What is a laparoscopy?

Keyhole surgery - 3 incisions made with 1 port for camera, pumps air in, allows surgeon to see inside of abdomen

38 of 74

Name some relevant female physiological disorders?

1. Dysmenorrhea
2. abnormal uterine bleeding (AUB)

39 of 74

In simple terms, what is dysmenorrhea?

A menstrual disorder that causes excessive production of prostaglandins which leads to painful contractions = aka "period pain"

40 of 74

What is primary dysmenorrhea and what are the symptoms?

A painful mesntruation, with no identifiable pathology.
Symptoms = headache, low back pain, sore breasts, feeling of abdominal fullness, irritability, mood swings, binge eating

41 of 74

What is the treatment for primary dysmenorrhea?

reassurance, psychological support, NSAIDs

42 of 74

What is secondary dysmenorrhea?

Pain caused by a disorder in the reproductive organs. The pain tends to get worse over time, and lasts longer than normal menstrual cramps

43 of 74

What diseases can cause secondary dysmenorrhea?

- endometriosis
- tumours
- pelvic inflammatory disease

44 of 74

What is menorrhagia?

Blood flow of more than 80mls or lasts longer than 7 days

45 of 74

What is polymenorrhagia?

Bleeding cycles less than 21 days apart

46 of 74

What is amenorrhea?

Absence of periods

47 of 74

What is abnormal uterine bleeding (AUB)?

Irregular painless bleeding of endometrial origin that may be excessive, prolonged, or without pattern

48 of 74

What is acute AUB?

An episode of bleeding in a woman of reproductive age, who is not pregnant, and is of sufficient quantity to require immediate intervention the prevent further blood loss

49 of 74

What is chronic AUB?

Bleeding from the uterine corpus that is abnormal in duration, volume, and/or frequency, and has been present for the majority of the last 6 months

50 of 74

What happens in anovulatory cycle in someone with AUB?
(not ovulating)

Corpus luteum does not form.
Progesterone is not produced.
Oestrogen stimulates endometrium, and without progesterone, the endometrium continues to proliferate, eventually outgrowing blood supply. Bleeding will happen irregularly, and for a long time.

51 of 74

What happens in ovulatory cycle in someone with AUB?
(ovulating)

Progesterone secretion is prolonged, irregular shedding of endometrium results because oestrogen levels are low.

52 of 74

What general investigations will take place to see if a patient is hemodynamically unstable (signs of hypovolemia)?

- gynae assessment
- physical examination
- blood tests
- pap smear
- endometrial biopsy
- ultrasound
- MRI
- CT

53 of 74

When conducting this gynae assessment, what should be considered?

- future childbearing plans
- effect of condition on lifestyle

54 of 74

What is infertility?

Failure to conceive after 12 months or more of regular, unprotected sexual intercourse

55 of 74

What are risk factors of infertility?

Reproductive system disorders, STDs, hormonal disorders, obesity, sexual violence, anxiety

56 of 74

How would you investigate a patient for infertility?

- general sexual and gynaecological assessment
- ovulation assessment (bloods: serum progesterone level, LH testing)
- pelvic exam
- laparoscopy
- ultrasound
- hysterosalpingography (HSG)

57 of 74

What are some male factors to investigate in infertility?

- analysis of semen density and quality
- testing testosterone
- varicoceles (varicose veins around the testicles)

58 of 74

How would you manage a patient with expected infertility?

- educate on lifestyle changes = smoking, healthy BMI
- treat any ovulatory dysfunctions (ie: PCOS)
- treat underlying issues

59 of 74

How would you manage a patient with unexpected infertility?

- intrauterine insemination (IUI)
- controlled ovarian hyperstimulation (COH) with IUI
- invitro fertilisation (IVF)

60 of 74

What are the nursing management considerations for a couple with infertility?

- assist in reducing stress
- encourage cooperation
- protect privacy
- make appropriate referrals
- patient education
- CBT

61 of 74

What is a pelvic organ prolapse?

weakening of vaginal walls allowing the pelvic organs to descend and protrude into the vaginal canal

62 of 74

What is cystocele?

Prolapsed bladder (into vagina)

63 of 74

What is rectocele?

Posterior vaginal prolapse (rectum bulge into vagina)

64 of 74

What is uterine prolapse?

Prolapse of uterus into the vaginal canal

65 of 74

What are the signs and symptoms of pelvic organ prolapse?

- sensation of pulling in pelvis
- feeling of something coming down
- tissue protruding from vagina
- urinary incontinence or retention
- dyspareunia (painful intercourse)
- backache
- trouble having bowel movement
- sexual concerns: feeling of looseness

66 of 74

What is endometriosis?

A gynaecological condition involving the presence of endometrial tissue (endometrium = glands and stoma) found in the pelvic cavity outside the uterine mucosa (uterus)

67 of 74

What are the genetic factors of endometriosis?

- Daughters or sisters of women with endometriosis are at a higher risk of developing it
- Low progesterone may be genetic and may contribute to hormone imbalances

68 of 74

What are some factor associated with endometriosis (aetiology)?

- environmental toxins
- nulliparity (not having given birth)
- prolonged exposure to estrogen, ie: in late menopause or early menarche (first period)
- obstruction of menstrual outflow, ie: due to mullein anomalies (obstructive anomaly)

69 of 74

What type of aetiology does endometriosis have?

It is idiopathic (unknown cause)

70 of 74

What is the most assumed pathophysiological explanation for endometriosis? (pt.1)

Menstrual blood flow that contains endometrial cells flows BACK (retrograde flow) through the Fallopian tubes, and into the pelvic cavity instead of being expelled from the body

71 of 74

What is the most assumed pathophysiological explanation for endometriosis? (pt.2)

These endometrial cells adhere to the pelvic walls and the pelvic surfaces of the pelvic organs, where they develop and continue to thicken and bleed throughout menstrual cycle

72 of 74

What happens in endometriosis when blood cannot exit the body?

The blood becomes trapped and forms cysts which cause scare tissues and adhesions, and can eventually cause infertility.

It also irritates surrounding tissue which causes pain

73 of 74

What are the signs and symptoms of endometriosis?

- chronic pelvic pain
- heavy menstrual flow
- dysmenorrhea
- dyspareunia
- dysuria (urinary urgency, frequency, painful voiding)
- dyschezia (painful bowel movements)
- infertility

74 of 74

Get Revising

Gynaecology

Other cards in this set

Card 2

Front

Back

Card 3

Front

Back

Card 4

Front

Back

Card 5

Front

Back

Comments

Similar Nursing resources: