This week, as you continue exploring common gynecologic conditions, you consider diagnosis, treatment, and management strategies for patients. You also explore ways to educate patients on these conditions. Gynecologic Conditions Spectrum — Sonja Thorkildsen and Brie-Anne Paterson

Learning Objectives – NURS 6551: Week 5: Gynecologic Conditions Spectrum — Sonja Thorkildsen and Brie-Anne Paterson

By the end of this week, students will:

• Assess patients with common gynecologic conditions
• Evaluate differential diagnoses for common gynecologic conditions
• Analyze treatment and management plans for patients with common gynecologic conditions
• Analyze strategies for educating patients on the treatment and management of common gynecologic conditions
• Understand and apply key terms, principles, and concepts related to common gynecologic conditions
• Evaluate common gynecologic conditions in patients
• Analyze treatment modalities for common gynecologic conditions

Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.

• • Chapter 24, “Normal and Abnormal Uterine Bleeding” (pp. 575-599)

This chapter differentiates normal uterine bleeding from abnormal and dysfunctional uterine bleeding. It also examines causes of abnormal bleeding and identifies assessment strategies for diagnosing and managing these conditions.

• • Chapter 25, “Hyperandrogenic Disorders” (pp. 603-618)

This chapter explores the etiology, clinical presentation, and impact of hyperandrogenic disorders. It also provides strategies for assessing, diagnosing, and managing patients with these conditions, including adolescents and pregnant women.

• • Chapter 26, “Benign Gynecologic Conditions” (pp. 621-652)

This chapter explains the incidence, presentation, assessment, and management of common benign gynecologic conditions. It also explores differential diagnoses for these conditions and types of treatment options.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

• • Chapter 7, “Care of the Woman with Reproductive Health Conditions”

• • • “Care of the Woman with Amenorrhea” (pp. 372-376)

This section differentiates between primary and secondary amenorrhea and describes treatment options for managing patients with this condition.

• • • “Care of the Woman with Abnormal Uterine Bleeding” (pp. 368-372)

This section explains the causes of dysfunctional uterine bleeding and recommends treatment options for managing this condition.

• • • “Care of the Woman with Endometriosis” (pp. 395-398)

This section identifies the prevalence of endometriosis in women. It also provides strategies for diagnosing, treating, and managing patients with this condition.

• • • “Care of the Woman with Fibroids” (pp. 398-401)

This section describes the classification of fibroids and their prevalence in women of childbearing age. It also presents methods for identifying, diagnosing, and treating this common benign tumor.

• • • “Care of the Woman with Polycystic Ovarian Syndrome” (pp. 433-437)

This section identifies the criteria for a polycystic ovarian syndrome diagnosis. It also presents treatment options for this disorder, including therapeutic options and alternative measures.

Optional Resources – NURS 6551: Week 5: Gynecologic Conditions Spectrum — Sonja Thorkildsen and Brie-Anne Paterson

Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/

Discussion: Diagnosing and Managing Gynecologic Conditions

Gynecologic conditions can be difficult to diagnose for a variety of reasons, including overlapping symptoms, lack of patient knowledge, or even patient fear or embarrassment about sharing information. Your role provides you the opportunity to develop a relationship of trust and understanding with these patients so that you can gather the appropriate details related to medical history and current symptoms. When caring for this patient population, it is important to make these women an integral part of the process and work collaboratively with them to diagnose and develop treatment and management plans that will meet their individual needs. For this Discussion, consider diagnosis, treatment, and management strategies for the patients in the following four case studies:

Case Study 1:

A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac.

Case Study 2:

A 42-year-old African American female is in the clinic for a routine gynecologic exam. When asked, she admits to noticing bleeding in between her menstrual periods for the past several months. She has been pregnant three times and has three children. She is sexually active with one male sex partner in a monogamous relationship. During her bimanual exam, you note an irregular intrauterine non-tender mass about 4 cm in diameter. The mass is palpable abdominally. The remainder of her gynecologic exam was normal.

Case Study 3:

A 48-year-old Caucasian female is in the clinic concerned about prolonged menstrual bleeding for three weeks now. Her prior menstrual periods have been irregular for the past eight months, lasting no more than three days each. There have been one to two months when she had no menstrual cycles at all. She reports occasional hot flushes and mood swings.

Case Study 4:

A 16-year-old Caucasian female comes to the clinic concerned because she has not had a menstrual period for three months. She’s a junior in high school and active in sports. She has lost about 10 lbs. in the past two months. She is currently 5 ft. 4 in. and weighs 100 lbs.

To prepare:

• Review Chapter 26 of the Schuiling and Likis text and Chapter 7 of the Tharpe et al. text.
• Review and select one of the four provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Explain how missing information from the patient history might change the diagnoses for the patients in the case studies your colleagues selected.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6551: Week 5: Gynecologic Conditions Spectrum — Sonja Thorkildsen and Brie-Anne Paterson.

MORE INFO 

Gynecologic Conditions Spectrum

Introduction

Gynecologic Conditions Spectrum is a list of the most common gynecologic conditions and symptoms. If you’ve been diagnosed with one or more of these conditions, this list will help you understand how they’re related and what treatments are available for each condition.

Abnormal Uterine Bleeding

Uterine bleeding can be a symptom of other medical conditions, such as pregnancy and endometriosis. It’s also common for women to experience abnormal uterine bleeding during their menstrual cycles if they have no underlying problem.

Abnormal uterine bleeding is not considered a specific diagnosis but rather an umbrella term for any kind of vaginal bleeding that isn’t normal in appearance or amount (or changes over time). The most common causes of abnormal uterine bleeding include:

• Uterine fibroids – These are benign tumors that grow near or inside your uterus (womb). They may cause discomfort and possibly pain during intercourse because they press against your bladder or intestine, increasing pressure on these organs while they’re in place. Uterine fibroids can be found using methods like ultrasound scans or by feeling them with your fingers after taking off some clothing around the area where they’re located—this will help doctors determine how big they are so they know whether surgery is needed at all; if surgery does happen then there’s more risk associated with having multiple surgeries done at once than just one procedure done separately instead!

Amenorrhea

Amenorrhea is the absence of menstruation. It can be caused by a number of factors, including:

• Hormonal imbalances. If you have been trying to conceive but are unable to do so, your hormone levels may be out of whack. This could result in amenorrhea if there is no ovulation or egg release (fertilization).

• Endocrine disorders such as hypothyroidism and thyroid cancer treatment can also cause amenorrhea in women; however this condition is more common among older women who have had children before or during their lifetime (especially if they’re postmenopausal).

Cervical Dysplasia

Cervical dysplasia is a precancerous condition caused by HPV. The most common sexually transmitted infection, HPV causes about 68 million new cases of cancer each year and more than 5 million deaths. It can also lead to cervical cancer if not treated early enough.

If you have signs or symptoms that may be related to cervical dysplasia (such as bleeding after sex), see your doctor for a diagnosis and treatment options.

Cancer vaccines are available now for females ages 9-26 who haven’t been vaccinated against human papillomavirus (HPV). If you’re already 26 or older and plan on getting vaccinated soon, go ahead! You should still get screened regularly because there is no way to predict who will develop cervical cancer later in life—and no test can tell if it’s precancerous right away either; it takes years before the changes become apparent on Pap smears or other tests done during regular visits with your doctor

Chronic Pelvic Pain

Chronic pelvic pain is a common gynecologic condition that can be caused by endometriosis, interstitial cystitis or other conditions. The symptoms of chronic pelvic pain include pain in the pelvic region, lower back pain and pain with intercourse.

Endometriosis

• What is endometriosis?

• Symptoms of Endometriosis:

• Swelling, pain, or tenderness in the pelvis area. This can be severe enough to interfere with daily activities and sleep.

• Pain that worsens during menstruation (menstrual cramps). The pain may be mild at first but becomes more severe over time and may include burning on urination or bowel movements. It can also come from tissue reaction (inflammation) to hormones released by the body during menstruation and pregnancy; this causes painful side effects such as chronic pelvic pain syndrome (CPPS), which is a common cause of chronic pain in women who are not pregnant yet have had children before they stopped having them due to complications like miscarriage or infertility problems caused by underlying conditions like endometriosis.* Diagnostic tests for Endometriosis:

Fibroids

Fibroids are growths that develop in the uterus. They can be benign (noncancerous) or malignant (cancerous). These tumors grow from the wall of the uterus, which is where all your eggs should be if you’re not pregnant.

Fibroids are the most common tumor of female reproductive system and also found in menopause and after menopause as well. Fibroids are often associated with other conditions such as endometriosis, uterine leiomyomata and cervical cancer.”

Hysterectomy

Hysterectomy is the surgical removal of the uterus. Hysterectomy may be performed as a treatment for cancer, fibroids, endometriosis and other conditions.

Hysterectomy may be performed through an abdominal incision or vaginally. In some cases it’s done via laparotomy (an incision in the upper abdomen). During this procedure you’ll have your ovaries removed with your uterus sectioned off from them so it won’t bleed during surgery like it would if they were left connected to each other and then removed together (the whole process is called salpingo-oophorectomy).

Incontinence

Incontinence is a condition that causes you to lose control of your bladder or bowel. It can affect your life in many ways and make it difficult for you to perform daily tasks.

There are two types of incontinence:

• Urge incontinence—when the muscles around your bladder contract, causing it to empty. This happens when you feel like going but can’t hold it any longer because the urge is strong enough that its urgency overrides any other signals from your brain telling you not to go yet (or at least until after dinner).

• Stress incontinence—when there’s no physical cause for an episode; instead, stress has been shown to trigger this type of leakage either by making people more likely than not to lose control over their bladders during times when they’re under pressure (like during an exam) or simply just being stressed out about something else entirely.* Causes include childbirth and menopause among others.* Treatment options include wearing diapers while sleeping at night — they help absorb some of the urine so that it doesn’t leak onto bedding — using timed alarms on computer desktops so that users aren’t tempted by nearby temptations like snacks lying around nearby desks where food could damage sensitive electronics if accidentally ingested without realizing what happened first hand.”

Infertility

Infertility is a problem of the reproductive system that can be due to many factors. The inability to conceive after one year of unprotected intercourse is considered infertility. Infertility is most common in women, with about 75% of cases being diagnosed as female-factor related (male factor accounts for approximately 20%). Most cases are caused by problems with egg quality, sperm count and motility, or cervical mucus.

The most common cause for infertility in women is blocked fallopian tubes—this can occur because scar tissue has formed inside the uterus during childbirth (a condition called an adhesion), or it may be due to pelvic inflammatory disease (PID). In addition to PID being an important cause of female factor infertility, it also causes tubal damage that makes conception difficult later on if left untreated long enough

Menopause and Perimenopause

Menopause is the time in a woman’s life when her ovaries stop producing eggs and she stops menstruating, or has very light periods. A woman can go through menopause at any age from 45 to 55 years old and perimenopause occurs when there are symptoms of the transition from childbearing to non-childbearing years. This can include hot flashes, night sweats, irregular periods and vaginal dryness.

Menstrual Cramps, Dysmenorrhea and Premenstrual Syndrome (PMS)

Menstrual cramps, dysmenorrhea and PMS are all conditions that can affect women during their period. Some of the most common symptoms include:

• Cramping in the lower abdomen and/or back, accompanied by pain in the pelvic area

• Feeling of pressure or heaviness in the pelvis (back or belly)

• Heavy menstrual flow (menses)

Ovarian Cysts and Polycystic Ovary Syndrome (PCOS)

Ovarian cysts are fluid-filled sacs that can develop on the ovaries. They’re common in women of childbearing age and, if left untreated, can lead to more serious health conditions like endometriosis.

You may have heard about PCOS (polycystic ovarian syndrome), which is characterized by irregular periods and excess hair growth on your face and body. Some women with PCOS also have painful periods or may experience a lack of ovulation—it’s important to know how these symptoms will manifest so you can find a doctor who understands them well!

Pelvic Organ Prolapse

Pelvic organ prolapse is the downward and forward slipping of one or more pelvic organs (usually the bladder, uterus, or rectum) into or beyond the vagina. It occurs when pelvic muscles, ligaments and connective tissue weaken.

Pelvic organ prolapse is most common in women over 50 years old but can be seen in younger women as well. The most common types include:

• Uterine prolapse – a condition in which a woman’s uterus slips out of place through her vagina; this may cause fluid to collect between tissues making it painful for you to walk; also called “uterine” or “vaginal” prolapse

• Rectal prolapse – when your rectum drops down inside your body near where it attaches to your anus; this can cause bleeding due to rubbing against something sharp like toilet paper during bowel movements which could lead to infection

Pelvic Pain (Non-Endometriosis Related)

Pelvic pain is a common reason for women to seek medical care. It can be acute or chronic and may be caused by a variety of conditions, including endometriosis, pelvic inflammatory disease (PID), ovarian cysts and cancer.

One in three women will experience pelvic pain at some point in their lives. In fact, approximately 80 percent of women with chronic vulvar pain have no identifiable cause other than the condition itself!

Gynecologic Conditions Spectrum

The following is a list of gynecologic conditions:

• Endometriosis

• Polycystic ovary syndrome (PCOS)

• Vulvar vestibulitis vestibulitis and vaginismus are considered separate conditions, but they often overlap in the symptoms they cause and their treatment options.

Conclusion

The gynecologic conditions spectrum is a very broad umbrella that encompasses many common gynecological conditions. It’s important to remember that there is no one-size-fits-all approach when it comes to treating these issues, so it’s important for your doctor to understand what kind of treatment works best for you and your body type. Each person should always be treated as an individual with unique needs, not just numbers on paper or test results from other patients who have had similar issues in the past.