SEXUALLY TRANSMITTED INFECTIONS (STIs)
Infection/Condition ➡ Recommended Treatment With 5 Days
Neisseria gonorrhoeae: Ceftriaxone 500 mg IM as a single dose
Chlamydia trachomatis: Azithromycin 1 g as a single dose or doxycycline 100 mg twice once a day for 7 days
Trichomoniasis: Metronidazole 2 g orally in a single dose
Human Papillomavirus (HPV) Recommended for females ages 9–26: Administer first dose of HPV vaccine series
· HUMAN IMMUNODEFICIENCY VIRUS
· PREGNANCY TESTING AND PROPHYLAXIS
Mental Health Care
SA can significantly affect the health and well-being of victims. Victims may face both short- and long-term medical and mental health disorders. These affect day-to-day function and can lead to unhealthy behaviors.
Victims who have sustained an SA have significantly higher rates of PTSD. Often, these adverse psychological outcomes are multifaceted and occur in conjunction with one another, including PTSD as well as depression, anxiety, suicidal ideation, and substance use and abuse.
Discharge Instructions
Discharge instructions are an essential component of post-assault care. Given the risk for STDs, all women should be instructed on signs and symptoms of STIs, and written instructions should be given for reinforcement. The patient should be instructed on the signs and symptoms to monitor and contact a health-care provider if they experience these signs and symptoms. They may need to return for further STD testing if symptoms develop. Support and information on advocacy services should also be provided. If a woman must return home to the person who assaulted her, it can affect her ability to seek health care or continue with prescribed medications. If the perpetrator is an acquaintance outside the patient’s home, she may be fearful of further assaults.
Mandatory Reporting
In most states, health-care providers are not required to report an SA to law enforcement. Cases were the patient is a minor, elder, or protected disabled person warrant the health-care provider to file a mandatory report. Some states may require the SANE to file a report in certain circumstances, such as if a minor was present in the home where the assault occurred. In other cases, strangulation may be classified as an attempt at homicide, which in some states falls under mandatory reporting. Nurses need to be aware of local reporting laws so they can follow specific laws and regulations regarding mandatory reporting.
PMS vs. PMDD: signs and symptoms:
PMS Premenstrual Syndrome:
Is the presence of behavioral, emotional, and physical symptoms that occur during the second half, or luteal phase, of the menstrual cycle and cease at or within a few days after the onset of menses.
S&S: Back pain, Insomnia, Increased appetite, Abdominal pain, Fatigue, Sensitive breast, Acne, Abdominal bloating, Nausea, Headache, Constipation, Diarrhea.
Occur in a cyclical pattern.
In other words, PMS syndrome are the signs and symptoms prior menses and the days afterwards.
Symptoms last from 9 to 10 days. Affects 95% of women
For most women with PMS, symptoms develop from 2 to 12 days prior to menstruation and resolve within 24 hours following the onset of menses.
PMDD Premenstrual Dysphoric Disorder:
A severe, sometimes disabling form of PMS.
Most frequently report: Abdominal bloating, anxiety, tension, Breast tenderness, crying episodes, Depression, Fatigue and lack of energy, Irritability, Difficult concentrating, Appetite changes, Thirst, and swelling of the extremities.
Populations at Highest Risk for PMS Women in their late 20s to late 40s most frequently report symptoms of premenstrual disorders. Symptoms often worsen as the woman approaches the menopausal transition. Also, women with a body mass index of 30 or above, those who have at least one child, those with a personal or family history of major depression, and those with a history of postpartum depression or an affective mood disorder are most often affected. It is important to note that premenstrual disorders:
• Occur only in ovulatory women
• Occur only during the luteal phase of the menstrual cycle
• Resolve within 4 days following the onset of menses
The occurrence of premenstrual disorders is not dependent on the presence of monthly menses. Interestingly, women who have had a hysterectomy without bilateral salpingo-oophorectomy (removal of both ovaries) can still have cyclical PMS symptoms.
Patient education PMS / PMDD Women who seek care for symptoms associated with premenstrual disorders should be given a complete physical examination and thorough clinical evaluation to rule out illness that may be the source of the symptoms. A detailed health history is the cornerstone in the accurate diagnosis of PMS/PMDD .
Nurses should inquire about risk factors such as emotional stress; poor nutritional habits;
Side effects noted when taking combined hormonal contraceptives (if indicated); increased intake of alcohol, salt, and caffeine; tobacco use (women who smoke cigarettes are more than twice as likely to have more severe symptoms); personal history of depression; pre-eclampsia or eclampsia; and family history of PMS.
Women at risk:
When evaluating a patient with PMS/PMDD symptoms, the nurse must always take any report of suicidal thoughts or other indicators of extreme mood change most seriously. The woman will need appropriate medications, close follow-up, and referral to a qualified mental health professional. In the ideal situation, mental examinations are timed to occur during both the luteal and follicular phases of the menstrual cycle. If the patient experiences significant mood symptoms (e.g., suicidal ideation) during both the luteal and follicular phases, referral to a psychiatrist is indicated.
Nursing Interventions: Once she is stable, various interventions such as lifestyle changes, dietary alterations, and conventional and complementary care approaches can be initiated that will become an important part of her long-term health promotion and maintenance.
Diseases that mimic PMS, how to rule it out
Other Conditions That Mimic PMS
When interviewing patients with premenstrual disorder symptomatology, it is essential to obtain a detailed history.
· Dysmenorrhea,
· Hypothyroidism,
· Depressive disorders,
· Pain disorders, and
· Generalized anxiety disorders are other conditions that may produce similar symptoms.
Hypothyroidism, for example, may be associated with fatigue, bloating, irritability, and depression. Breast disease (breast tenderness) or anemia (fatigue) may be responsible for other common symptoms.
Various gynecological disorders such as:
Polycystic ovary syndrome PCOS or
Endometriosis may also cause symptoms that can be confused with PMS.
2 0r 3 months with the symptoms
MENOPAUSE
Menopause refers to the last menstrual period and can be dated with certainty when there has been at least 1 whole year without menstruation .
Drastic changes in the body occur to prepare for and enter menopause, resulting in a range of physical and emotional symptoms. Many women have just a few mild symptoms, but others have severe symptoms that interfere with activities of daily living.
Premenopause is the time up to the beginning of perimenopause, but the term is also used to define the time up to the last menstrual period.
Perimenopause is the time preceding menopause, usually starting between 2 and 8 years before menopause and lasting an average of 4 years
Postmenopause begins when ovarian estrogen terminates, ovulation ceases, and menstrual p Irregular menses
PREMENOPAUSE
Hot flushes
Vaginal dryness
Dyspareunia
Mood changes
MENOPAUSE
Hot flushes
Night Sweats
Vaginal dryness
Discomfort during sex
Difficulty sleeping
Low mood or anxiety
Reduced sex drive (libido)
Problems with memory and concentration
Body Changes during MENOPAUSE
· Menopause commence with a decrease in the production of hormones.
· Periods become progressively more irregular.
· “Vasomotor symptoms,” “hot flash,” and “hot flush” are often used to describe the same phenomenon.
· The mucous membranes, previously supported by estrogen stimulation, become thin, dry, and fragile. The vagina loses its rough texture and dark pink coloration and becomes smooth and pale. The vagina also shortens and narrows
· Alteration in the normal vaginal flora results in a decrease in the normal protective mechanisms of the vagina. Declining estrogen secretion is accompanied by a corresponding reduction in the lactobacilli needed to maintain a healthy acidic vaginal environment. With these changes in pH, normally harmless pathogens may colonize the more alkaline vagina, potentially leading to infection. When the vaginal mucosa becomes inflamed, the condition is termed “atrophic vaginitis,” a condition characterized by burning, leukorrhea, and malodorous yellow discharge.
· The breasts may lose their fullness, flatten, and drop. The nipples may become smaller and flatter.
· Rapid bone loss begins within 3 years of cessation of menstruation.
Treatment of Menopause Symptoms:
Hormonal Therapies:
Estrogen is the only pharmacological therapy that is government approved in the United States and Canada for treating menopause-related symptoms.
two categories: estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT).
Alternative Medical Systems, Mind-Body Medicine, Manipulative and Body-Based Methods, and Energy Medicine.
TRADITIONAL CHINESE MEDICINE (TCM)
AYURVEDA
HOMEOPATHIC MEDICINE
Herbal therapies intended for ingestion may be administered in a variety of ways, such as:
■ Tea infusions (soft, aromatic parts of the plant are steeped, not boiled, in water)
■ Tea decoctions (barks and roots, boiled in water)
■ Essential oils (highly concentrated)
■ Tinctures and fluid extracts (herbs macerated into water-alcohol mixtures)
■ Dried standardized extract (these typically contain part of a plant but can contain the whole plant; extracts are standardized to one ingredient only)
■ Homeopathic preparations (extremely diluted) (NAMS, 2021)
Fibrocystic Changes:
BENIGN BREAST MASSES
Also termed: Fluid-filled cysts, palpable thickening in the breasts often associated with pain and tenderness that fluctuates with the menstrual cycle.
Nurses can reassure them that fibrocystic changes are common and benign and tend to appear during the second and third decades of life and suggest strategies for coping with Mastalgia: use of a well-fitting supportive bra, analgesics, NSAIDs, and consumption of dietary flaxseed (25 g/day).
Fibroadenomas: are solid cysts composed of stromal (connective) and glandular tissue. the most common benign breast tumor, occurring in 25% of women and usually located in the upper outer quadrant of the breast.
Lipomas are mobile, nontender fat tumors that are soft with discrete borders. Lipomas may develop anywhere in the body, including the breasts.
Intraductal papilloma are small, wartlike growths in the lining of the milk ducts near the nipple.
Mammary duct ectasia is an inflammation of the ducts located behind the nipple.
SCREENING:
Annual CBEs performed by a trained health-care professional are an important tool in the early detection of breast cancer, often before a woman has any signs or symptoms.
Screening methods include clinical breast examinations (CBE), mammography, and ultrasonography.
Breast self-awareness, and breast self-examination (BSE), can also assist in early detection and early treatment.
BSE: BSE is 7 to 9 days after menses, when the breasts are least likely to be swollen or tender due to hormonal changes. BSE can be perform in front of a mirror so that the women can see clearly, in the shower so the hand can easily slide along the wet skin, or when lying down on a comfortable surface.
Fine Needle Aspiration (FNA): use of a fine needle that is carefully guided into the suspicious area while the practitioner palpates the lump.
ultrasound or a stereotactic biopsy can be used to help locate and ensure an adequate sampling of the suspicious tissue.
Core Needle Biopsy: Is a technique where a large-bore needle is used to remove a small cylinder of tissue. is often guided as with the FNA procedure.
BREAST DRAINAGE:
Nipple Discharge:
Galactorrhea (the continuation of milk secretion after breastfeeding has ceased) is characterized by a spontaneous bilateral, milky, sticky discharge.
False discharge refers to fluid that appears on the nipple or areola but is not secreted by breast tissue. False discharge may be bloody, clear, colored, purulent, serous, or viscous. Various conditions such as eczema, dermatitis, nipple trauma, and Paget’s disease may be associated with false nipple discharge.
Mondor disease of the breast is a rare, self-limiting condition characterized by thrombophlebitis of the superficial veins.
BREAST CANCER:
