10.health care for women 1

Health care for Women

Disease of women’s reproduc-tive organs

contents

• Health assessment for women• Infectious disease of genitalia• Sexual transmitted disease• Endometrial problems• Tumor of reproductive organs• Menstrual disorders

Health assessment for women

Papanicolaur test(Pap smear)

Breast self examination(BSE)

Papanicolau test(Pap smear)

• Regular pelvic examination and Pap smear are the best way to assess and detect condition in the reproductive system early

• The Pap smear is a safe and in expensive tool for early detection of cervical cancer

• Early diagnosis, the cure rate is almost 100%

• Ps; Papanicolau test; DevelopedGreek Physician Dr. George Papanicolau in the 1940s

Screening schedule and guideline

• 1st Pap smear; age 18/or first inter-course

• 18-64yr; Yearly or every 3 yrs after consecutive yearly normal results

• Age 65; Yearly, or 3yrs after two con-secutive yearly normal results

• Age 70: stop Pap test

• Ps; U.S. preventive service task force guidelines

Classification of Pap smear

• Dysplasia CIN SIL• mild grade 1 low grade• moderate grade 2 • severe grade 3 high grade• Carcinoma in situ• CIN= cervical Intra epithelial neopla-

sia • SIL= Squamous Intraepithelial lesion

Risk factors for cervical cancer

• Exact etiology is Unknown• Sexual behavior and history; multiple

partner, rape, early age sexual intercourse• HPV(Human papillomavirus) infection; HPV 16, 18, 45, 58

HPV 16 squamous cancer HPV 18 adenocarcinoma

• Lower socioeconomic status• Cigarette smoking

Performing a pelvic exam and Pap smear

• Purpose; to evaluate the condition of the internal female reproductive structure and to obtain speci-men for cytologic screening

• Equipment; - Examination glove, - Sheet or bath blanket for draping, - Specimen collection devices-cyto-brush and

plastic spatula, - Label specimen container or slide and splay fix-

ative - Complete lab request - Adequate light source

Implementation

1. Explain the procedure2. Empty bladder to mini-

mize discomfort and easy palpation internal organs

3. Wash hand4. Have client position her-

self on the exam table-buttocks are just past the bottom edge of the table

5. Place sheet over the client for privacy

6. Ask relaxation technique

Implementation

7. Put on gloves8. Warm the speculum

with warm water to avoid chilling the clint

9. Using gloved hand, spread the labia, in-specting and palpating the area to check for abnomalities; through-out encourage the women take deep breaths to aid in relax-ation

Implementation

10. Insert the warmed speculum in to the vagina and slowly open the blades to allow clear visualization of cervix; once in place, lock the blades

Implementation

11. Obtain samples for pap smear; use the cytoblush or sterile cotton tipped applica-tor and swab the en-docervix, using one full circular motion

12. Use the plastic curved spatula to gently and firmly scrape the cervix os

Implementation13. Immediately after collecting

each specimen in the appropri-ately labeled container or slide and spray with a fixative

14. Unlock the blades of the speculum and remove it gently to reduce the risk for trauma too the client

15. Remove the glove from the nondominant hand and place on low abdomen; insert a lubri-cated gloved finger of the dom-inant hand in to vagina to per-form the bimanual examination

16. Assist the client to sitting posi-tion and allow her to get dress

Result

• If infection is suspected cause abnormal re-sult treat the infection, repeat test

• If infection is not reason colposcopy, biopsy• Pap smear is most valuable, simple, easy and

cost effective screening test for early detect of cancer

• Barriers to gynecologic checkups and pap smear; fear, lack of information, cultural be-lief, social status, embarrassment, absence of symptom, lack of time and cost

Breast Heath

• Purpose: preventing breast cancer• Key: risk factor screening, diagnostic

testing• Risk factors: being a women, age, fam-

ily history of breast cancer• Gene theory: Breast cance1(BRCA1) Breast cancer2(BRCA2) Ps; In 1994 discovered and found correlate with

increase for breast, ovarian and other cancer

Breast Heath

• Breast cancer is most common can-cer in women.

• Treatable cancers if detected early• 5 yr survival rate as - 99% no invasion - 90% for local invasion - 68% regional spread* Early detection is most important

Breast Cancer Screening Recom-mendation

• Breast Self Examination: monthly at 20yr

• Clinical Breast Examination: every 3 yrs from 20-40 yrs, yearly after 35 yrs if at risk, yearly after 40yrs

• Mammography: 35 yrs if at risk every 1-2yrs from 40-50yrs,

every year after 50

Breast Self Examination(BSL)

1. Observation in a mirror for any change in appearance of breast

2. To check their own breast by methodi-cally palpating the breast tissue for change and lumps

3. The best time to examine the breast is few days after the menstrual period

4. BSE is most comfortable after the men-strual period because the breast are least tender

Breast Self Examination(BSL)

• The following signs and symptoms require follow-up

- Lump - Pain(breast cancer or may not painful) - Discharge - Skin change - Lymphadenopathy, with or without other

symptoms - Any change the women finds as personal

unusal

Breast Self Examination(BSL)

• BSE early detection of potential ma-lignancies continues to be single most important factor in successful treatment of breast cancer.

• Nurse should encourage and educate women on performing BSE regardless of field of nursing.

Step in the Breast Self Examina-tion(BSL)

Step in the Breast Self Examina-tion(BSL)

Clinical Breast Examination

• Clinical Breast Ex-amination:

- Experienced pro-fessionals may find changes that the women has missed.

- To demonstrate and explain a through breast examination

• Mammography

Steps in the clinical breast exami-nation

Steps in the clinical breast exami-nation