chapter 3 assessment and health promotion all elsevier items and derived items © 2014, 2010, 2006,...

Chapter 3

Assessment and Health Promotion

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

External structures Mons pubis Labia majora and labia minora Clitoris Vestibular glands Vaginal vestibule Vaginal orifice Urethral opening

Female Reproductive System

2All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Internal structures Vagina Uterus Cervix Fallopian tubes Ovaries

Female Reproductive System (Cont.)


Bony pelvis Protection of pelvic structures Accommodation of growing fetus during pregnancy Anchorage of pelvic support structures



Breasts – Structure Mammary gland composed of

a number of lobes, divided into lobules• Lobules are clusters of acini• Acinus is a saclike terminal part of a compound gland

emptying through a narrow lumen or duct• Acini are lined with epithelial cells that secrete colostrum and

milk



Breasts - Function Lactation Organs for sexual arousal Physiologic alterations in breast size reach minimal

level about 5 to 7 days after menstruation stops• Breast self-examination best carried out during this phase of

menstrual cycle



Menarche and puberty Menstrual cycle

Endometrial cycle Hypothalamic-pituitary cycle Ovarian cycle Other cyclic changes

Menstruation


Prostaglandins Oxygenated fatty acids classified as hormones Effects on:

• Ovulation• Fertility• Changes in cervix and cervical mucus• Tubal and uterine motility• Sloughing of endometrium (menstruation)• Onset of abortion (spontaneous and induced)• Onset of labor (term and preterm)

Menstruation (Cont.)


Climacteric and menopause Climacteric

• Transitional phase during which ovarian function and hormone production decline

• Spans the years from onset of premenopausal ovarian decline to postmenopausal time, when symptoms stop



Climacteric and menopause Menopause

• Refers to the last menstrual period• Dated with certainty 1 year after menstruation ceases• Average age 51.4 years old• Range of ages 35 to 60 years old



Females and males achieve physical maturity at approximately age 17 years old

First outward appearance of puberty may appear at a much earlier age

Individual development varies greatly Women and men are more alike than different in

physiologic response to sexual excitement and orgasm

Sexual Response


Sexual stimulation results in an increase in circulation to circumvaginal blood vessels

Venous congestion is localized primarily in the genitals and to a lesser degree in breasts and other parts of the body

Arousal is characterized by myotonia, resulting in voluntary and involuntary rhythmic contractions

Sexual Response (Cont.)


Sexual response cycle is divided into four phases: Excitement Plateau Orgasmic Resolution

Time, intensity, and duration for cyclic completion vary for individuals and situations

Sexual Response (Cont.)


Financial issues Racial and socioeconomic disparity

Cultural issues Constantly changing demographics

Gender issues Sexual orientation

Barriers to Entering the Health Care System


Disease prevention Adolescents

• Teenage pregnancies Young and middle adulthood

• Contraception• Pelvic and breast screenings

Late reproductive age

Caring for Women across the Lifespan


Preconception counseling and care Pregnancy Fertility control Infertility Menstrual problems Perimenopause

Care at Specific Stages of a Woman’s Life


Social, cultural, genetic Substance use and abuse

Prescription drug use Illicit drug use Alcohol consumption Cigarette smoking Caffeine

Identification of Risk Factors


Nutritional problems Nutritional deficiencies Obesity Eating disorders

• Anorexia• Bulimia nervosa

Lack of exercise

Identification of Risk Factors (Cont.)


Stress Mental health conditions Sleep disorders Environmental and work place hazards Risky sexual practices Risk for certain medical or gynecologic

conditions Female genital mutilation

Identification of Risk Factors (Cont.)


Intimate partner violence (IPV) Physical or emotional abuse Sexual assault Isolation Controlling all aspects of the woman’s life

• Money• Shelter• Time• Food

Violence Against Women


Cycle of violence Phase 1: Tension building

• That her experiences increased tension, victim minimizes problems

• Tension becomes intolerable Phase 2: Abusive incident

• Batterer highly abusive, incident occurs Phase 3: Honeymoon period

• Loving, apologetic, promises change

Violence Against Women (Cont.)


Battering during pregnancy Rates range from 4% to 8% and may be as high as

20% in some populations Incidence of intimate partner violence may escalate May happen for the first time during pregnancy Risk to the fetus includes increased rate of

miscarriage, preterm birth, and stillbirth

Violence Against Women (Cont.)


Helpful in maintaining wellness and coping with illness

Refers to the efforts of our being and humanity Holistic approach to women’s wellness Spiritual assessment

Spiritual Approaches to Women’s Health


Interview Ways to encourage sharing information

• Facilitation• Reflection• Clarification• Empathic responses• Confrontation• Interpretation

Assessment of the Woman


History Biographic data Reason for seeking care Present health or history of present illness Past health Family history Screen for abuse Review of systems Functional assessment

Assessment of the Woman (Cont.)


Physical examination General appearance Vital signs Objective data is recorded by body systems Findings are described in detail



Cultural considerations and communication variations Trust that woman is expert on her life, culture, and

experiences If asked with respect and genuine desire to learn,

woman will tell nurse how to care for her May be considered inappropriate for woman to

disrobe completely for physical examination In many cultures a female examiner is preferred



Women with special needs Women with disabilities

• Emotional or physical disorders• Vision or hearing impaired• Adapt to each woman’s needs

Adolescents (ages 13 to 19 years old)• Risky sexual behaviors• Eating disorders• Safety



Pelvic examination External inspection and palpation Vulvar self-examination Collection of specimens Papanicolaou test Vaginal wall examination Bimanual palpation Rectovaginal palpation Pelvic examination during pregnancy Pelvic examination after hysterectomy



Laboratory and diagnostic procedures The following laboratory and diagnostic procedures

are ordered at discretion of clinician: see next slide Results of these tests may be reported in person, by

phone call, or by letter

Health Screening for Women Across the Life Span


Health Screening for Women Across the Life Span (Cont.)

Hemoglobin Fasting blood glucose Total blood cholesterol Lipid profile Urinalysis Syphilis serology (VDRL

or RPR) and other screening tests for sexually transmitted infections

Mammogram

Tuberculosis skin testing Hearing Visual acuity Electrocardiogram Chest x-ray Pulmonary function Fecal occult blood Flexible sigmoidoscopy Bone mineral density

(DEXA scan)

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 47

Laboratory and diagnostic procedures Tests for human immunodeficiency virus and hepatitis

B and drug screening may be offered with informed consent in high risk populations



The nurse suspects that a client who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman was very emotional and hesitant in responding to the questions, verbally she denied abuse as being a problem. While waiting for the results of the pregnancy test, the nurse decides to teach the client about partner abuse anyway. The rationale for the nurse’s decision is that all women should be informed about:

a. The nurse’s ethical responsibility to protect clients.b. The cycle of violence, which continues and escalates over time once it

begins.c. Women’s legal right not to be controlled by men.d. The masochistic nature of women who stay in abusive relationships.

Question


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