chapter 3 assessment and health promotion all elsevier items and derived items © 2014, 2010, 2006,...
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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
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Internal structures Vagina Uterus Cervix Fallopian tubes Ovaries
Female Reproductive System (Cont.)
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Bony pelvis Protection of pelvic structures Accommodation of growing fetus during pregnancy Anchorage of pelvic support structures
Female Reproductive System (Cont.)
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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
Female Reproductive System (Cont.)
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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
Female Reproductive System (Cont.)
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Menarche and puberty Menstrual cycle
Endometrial cycle Hypothalamic-pituitary cycle Ovarian cycle Other cyclic changes
Menstruation
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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.)
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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
Menstruation (Cont.)
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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
Menstruation (Cont.)
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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
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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.)
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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.)
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Financial issues Racial and socioeconomic disparity
Cultural issues Constantly changing demographics
Gender issues Sexual orientation
Barriers to Entering the Health Care System
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Disease prevention Adolescents
• Teenage pregnancies Young and middle adulthood
• Contraception• Pelvic and breast screenings
Late reproductive age
Caring for Women across the Lifespan
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Preconception counseling and care Pregnancy Fertility control Infertility Menstrual problems Perimenopause
Care at Specific Stages of a Woman’s Life
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Social, cultural, genetic Substance use and abuse
Prescription drug use Illicit drug use Alcohol consumption Cigarette smoking Caffeine
Identification of Risk Factors
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Nutritional problems Nutritional deficiencies Obesity Eating disorders
• Anorexia• Bulimia nervosa
Lack of exercise
Identification of Risk Factors (Cont.)
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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.)
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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
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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.)
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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.)
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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
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Interview Ways to encourage sharing information
• Facilitation• Reflection• Clarification• Empathic responses• Confrontation• Interpretation
Assessment of the Woman
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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.)
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Physical examination General appearance Vital signs Objective data is recorded by body systems Findings are described in detail
Assessment of the Woman (Cont.)
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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
Assessment of the Woman (Cont.)
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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
Assessment of the Woman (Cont.)
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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
Assessment of the Woman (Cont.)
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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
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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)
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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 (Cont.)
48All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
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 (Cont.)
49All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
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 (Cont.)
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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
Health Screening for Women Across the Life Span (Cont.)
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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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