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295 Cards in this Set
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Infertility
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under 35 years old and unable to conceive after one year OR over 35 and unable to conceive after 6 months of trying
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Primary infertility
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Women who have never conceived or carried pregnancy to term
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Secondary infertility
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unable to achieve a second pregnancy after one or more successful pregnancies
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What is the usual cause of secondary infertility
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structural problem
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Incidence of infertility
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10-15% reproductive age couples
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Fertile time
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1-3 days around time of ovulation
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How long are sperm viable
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about 48 hours
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How long is the ovum viable for conception?
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24 hours
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What is the optimal timing for fertilization
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1-2 hours
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What percent chance of conception do you have each ovulatory period?
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20%
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What are some causes of increased prolactin levels, which can cause infertility?
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Medications, such as opiods, diazepam, methyldopa, tricyclic antidepressants
Stress/ Extreme exercise Benign pituitary adenoma (blocks A. P. gland secreation of FSH and LH) |
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What secretes FSH and LH?
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anterior pituitary gland
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What is primary anovulation?
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can be caused by pituitary disorder or congenital adrenal hyperplasia (at birth; overproduction of testosterone)
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What is secondary anovulation?
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disruption in the hypothalamus- pituitary- ovarian axis
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What are some tubal/peritoneal factors that cause infertility?
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decreased motility, alteration in structure, tubal adhesions (endometriosis)
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What may alter the structure of the fallopian tubes?
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past chlamydial infection or pelvic inflammatory disease
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What can fibroids cause?
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pregnancy problems, including early labor
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Why may an STI affect tubal structure?
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causes scarring
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How do you treat infertility from tubal factors?
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repair tubes surgically and bypass the blocked tubes
(if surgery is unsuccessful, in vitro fertilization is the only way) |
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What are some uterine factors that can cause infertility?
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bicornuate uterus (no room for growth), uterine fibroids (block site), Asherman's syndrome, Endometritis, Endometriosis
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Asherman's syndrome
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scarring of the endometrial uterus, which blocks implantation
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How do you correct Asherman's syndrome
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surgical repair
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What is used for diagnosis of uterine factors?
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hysterosalpingogram
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What is hysterosalpingogram?
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use a speculum to insert a tube and dye (while in lithotomy position)
it is painful and it helps to know if the uterus is normal or it may straighten the tube |
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What are some ways to treat uterine factors?
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treat infection, myomectomy, gestastional carrier
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What can uterine factors cause?
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miscarriage
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What can endometriosis do in relation to infertility?
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change the uterus position so that sperm cannot get in
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What is the normal vaginal fluid pH?
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4-7
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What is the cervical mucus pH at ovulation?
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7
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How does the cervical mucus change in response to ovulation?
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it is normally thick and it blocks the os so that sperm cannot penetrate, but during ovulation (for 48-72 hours), it becomes thin and slippery
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What are some factors that can change the cervical mucus?
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infections, stress, copper IUD (keeps it thick), sperm antibodies
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What do you do if you have sperm antibodies?
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have partner wear condom for 6-12 months at every intercouse, only remove at ovulation
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What are some ways to document ovulation?
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basal body temperature, character cervical mucous, character of cervix, timed endometrial biopsy, serum progesterone levels
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What should results for serum progesterone level be?
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should be at least 2.5: if not, not going on to the luteal phase
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What does a serum progesterone level of 2.5 indicate?
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ovulation has taken place
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When does FSH increase?
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follicular phase
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When does LH increase?
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luteal phase
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What are some hormone tests done for infertility?
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FSH, LH, Estradiol, progesterone, thyroid
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What test is done to look for endometriosis?
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laporoscopy
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What is care for a laparoscopy?
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NPO 8 hours before surgery, discharge 4-6 hours, referred shoulder pain for 24-72 hours, pain relief, no heavy lifting for 4-7 days
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Purpose of Hysterosalpingogram?
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view endometrial polyps, myomas and to view distortion of uterus and tubes
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How is hysterosalpingogram done?
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radiopaque contrast material is insterted through cervix
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When is hysterosalpingogram done?
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2-5 days after menstruation
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Why is hysterosalpingogram done 2-5 days after menstruation?
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decreases risk of embolism, endometrium is the thinnest, which is safest, and prevents foceing menstrual debris out into the peritoneal cavity, all vessels closed at this time
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What are some nursing considerations for hysterosalpingogram?
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referred should main, therapy
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What may cause referred shoulder pain in hysterosalpingogram?
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supraphenic irritation, teach patient to use mild analgesics or position changes
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What are some structural causes of infertility for males?
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undescended testicle, hyposadias, varioceles, blocked vas deferens, cut vas deferens, retrograde ejaculation
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What do the structual causes of infertility result in?
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low testosterone levels
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Why does undescended testicle cause inferility?
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if too high, temperature could destroy sperm potential
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What are varioceles?
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varicose veins on the testicles
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Hypospadias
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opening of urethra is not at the tip of the penis, but below: most obvious at birth
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What happens if you have a problem w/ the pituitary gland?
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decreased testosterone
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Some causes of infertility in males, besides structural
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STI, workplace hazards (radiation, high temperatures), substance abuse, smoking
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What do heroin and marijuana do to sperm?
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decrease motility and number
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What might one do to change temperature of sperm?
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change the type of underwear
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What occurs in males that smoke?
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abormal sperm and chromosome damage
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When is semen analysis done?
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after 2-5 days of abstinence
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When should semen analysis be brought to lab?
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within 2 hours of ejaculation
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What should you avoid with semen sample?
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temperature extremes
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What is normal volume of ejaculation?
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2-6 mL
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What is normal pH of ejaculation?
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7.2-8.0
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What is normal sperm count of ejaculation?
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over 40 million
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What is normal motility of sperm in ejaculation?
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50% or higher
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What is sperm morphology of ejaculation?
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30% normal
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What are some ways to test male infertility?
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postcoital test, testosterone levels
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What are somethings to do before postcoital test?
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sexual abstinence 2-4 days prior, cervical mucous sample, timed with ovulation
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Who needs tested for infertility?
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both male and female testing
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Who should be tested for infertility first?
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male first, cheaper and least invasive
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What are some psychosocial concerns for infertility?
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grief, surprise of diagnosis, denial that it is them, anger, bargaining, guilt, acceptances, financial problems, medical procedures (painful), relationship strains, blaming the other
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How much is one in vitro fertilization procedure?
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$10,000 out of pocket (usually)
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What is percentage of births from assisted reproductive therapies?
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less than 1 %
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What does Danazole do?
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stop production to let the ovaries rest
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What is important to know about Clomed for infertility?
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must have frequent Transvaginal ultrasound and estradiol levels done
Will cause cramping and make you feel exhausted |
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What are some interventions for infertility?
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changes in lifestyle, herbs
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What are some herbs to consider to help infertility?
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red clover flowers, St. John's wart, vitamin C, calcium, magnesium
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What are some herbs to avoid with infertility?
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licorice root, fennel, sage, thyme
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What is a medication for the thyroid that may help infertility?
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synthroid
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What are the action of hypoestrogenic drugs for infertility?
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conjugated estrogens, luteal defect (giving as vaginal or IM)
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What are some side effects of ovulation inducing medications?
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increased multifetal pregnancy, preterm deliveries, ovarian cyst formation, hot flashes, mood swings, depression, nausea, breast tenderness, severe headaches from the luteal defects
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What is the most common type of assisted reproductive therapy?
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in vitro fertilization
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What occurs in in virto fertilization?
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egg and sperm are fertilized in lab and the embryo is returned to the uterus
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What is in vitro used as treatment for?
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blocked or damaged tubes, male issues (difficulty transporting sperm), unexplained fertility
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What are some considerations related to in vitro fertilization?
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cryopresevation of embryos? Who gets the embryos in case of divorce? death? want no more children?
many ethical and legal problems |
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What is the process of in vitro fertilization?
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ovarian stimulation to produce eggs (medication), egg retrieval (multiple eggs), fertilization, embryo culture, embryo transfer (1-6 days post fertilization), insemination (mom or gestational carrier), cryopreservation of remaining embryos
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When are you more likely to use GIFT for infertility?
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with a sperm problem
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What occurs in GIFT?
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Gamete intra-fallopian transwer: transfer of egg and sperm to fallopian tube to fertilize; woman must have normal tubes, fertilization cannot be confirmed the same as with in vitro
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What must a woman have to use GIFT for infertility?
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normal tubes
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Why is GIFT better in some cases?
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more compatible with many religious doctrines
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What is ZIFT?
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zygote intra-fallopian transfer
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Zygote
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one cell product of sperm and ovum
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What occurs in ZIFT
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fertilized outside the body and insert zygote into tubes
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Why might a couple use ovum, sperm, or embryo donor?
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genetic diseases, poor eggs, poor quality sperm, adopted embryo
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What is the procedure for donor eggs?
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ovarian stimulation drugs, uterine lining preparation drugs, donor egg is not biologically related to baby, expensive, 40-45% success
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What occurs with donated sperm?
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screened and injected into uterine cavity
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what is surrogacy?
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pregnancy carried by egg donor, baby given to infertile couple at birth, surrogate mother is biology related to baby as the egg donor (if egg not hers, then not biology related), father may or may not be biologically related depending on sperm
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Know breast anatomy
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notes
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What do coopers ligaments do?
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supports breast and holds it up
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What are montgomery tubercles
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bumps around the nipple that lubricate
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What is the breast under influence of
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estrogen and progesterone
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What occurs with breast each cycle?
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they grow, become lumpier and more sensitive
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When is the best time to do breast self exam?
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AFTER menses because E and P lowest
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When should you do breast self exam
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monthly after age 20; can be used to identify and report breast changes
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When should you get a clinical breast exam
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at least every 3 years (ages 20-40); yearly after age 40
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When should you get mammograms
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yearly at age 40
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What decreases risk of BC
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breast feeding and early childbearing, seasonale, vegetarian diet
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What are modifiable breast cancer factors?
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obesity after menopause, sedentary lifestyle, use of HRT or hormonal contraceptives, first pregnancy after age 30, never breast fed, greater than 1 alcohol drink per day, environmental (radiation, mammogram, chemicals)
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What are most breast lumps
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benign
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Who has lower breast cancer rates
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women are pregnant and breastfeed most of childbearing years, vegetarian diets, lower body weight/ less obesity
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What are some non-modifiable breast cancer risks?
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being a woman, increasing age, benign breast lump with pathology of epithelial hyperplasia, exposure to radiation, early menarche/late menopause, previous personal or family history of breast, thyroid, ovarian cancer, or caucasian
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What is atypical ductal hyperplasia?
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cells have changed shape, incidental finding on biopsy, diligent screening
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Where does most breast cancer occur
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ducts
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What is lobular cancer in situ?
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diffuse, bilateral, incidental finding on biopsy, difficult to remove
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Why is lobular cancer in situ hard to remove?
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its patchy so its everywhere
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How can you reduce your risk of getting breast cancer?
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exercise, maintain normal body weight, avoid hormones, decrease alcohol consumption, tamoxifen/raloxifen, mastectomy, oopherectomy, MRI screening
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What are some s/e of Tamoxifen/Raloxifen?
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endometrial cancer, blood clots, weight gain, hot flashes, edema
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What can test genetic breast cancer risk
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BRCA1
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What is oophorectomy
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removing ovaries
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Why should you use mammogram over MRI?
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less false positives
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What are some screening tools for breast cancer?
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Gail Model (ask ?s to see if at risk)
BRCA tool (genetic counseling) PAT risk took (high risk; train woman to change behaviors) |
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What are BRCA1 and 2 used for?
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to detect breast cancer risk
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What increases risk of having BRCA1 or 2?
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multiple relatives, ovarian cancer, younger age of onset, Jewish decent
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What do you do if at risk for Breast Cancer?
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weight loss, get off of hormone replacement therapy, oral contraceptives (non-cyclic may reduce risk), Tamoxifen, Raloxifen, oophecomy, mastectomy, MRI
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What do you ask if patient finds a lump
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location, duration, pain, consistency, size, discharge, enlarged lymph nodes, medications taken, smoking, alcohol use
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What can marijuana cause in breast?
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galactorrhea
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Does smoking increse risk of breast cancer?
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no
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What increases risk of breast cancer
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marijuana
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What are most benign breast conditions?
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fibrocystic breasts, fibroadenoma, lipomas, nipple discharge, mammary duct ectasia, intraductal papilloma
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What are signs and symptoms of fibrocystic breast changes?
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palpable lumps in the breash, painful or tender and usually bilateral, size fluctuates with menstrual cycle, soft upon palpation, well differentiated, mobile, may worsen until menopause
lumps are slippery and moveable, oval, and menses |
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When are those with fibrocystic changes at risk for cancer?
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only if proliferative
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What is the most common benign breast condition?
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fibrocystic changes
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In what age do fibrocystic changes occur most commonly?
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20-30 year old women
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What is management for fibrocystic breast changes?
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diuretics, restriction salt, vitamin E supplement, avoidance of caffeine, supportive bra, analgesics
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What do you do for fibrocystic breast changes?
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remove fluid/aspirate and it can be used for diagnostic
if no fluid comes out, go for biopsy |
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What are signs and symptoms of fibroadenoma?
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discrete (less than 3 cm diameter), solid, encapsulated, nontender, upper outer quadrant (usually), does not increase in size with menstrual cycle
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what are the main differences between fibrocystic breast changes and fibroadenoma?
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Fibrocystic is painful and bilateral
Fibroadenoma is nontender and unilateral |
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What is treatment for fibroadenoma?
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proper diagnosis (biopsy) and lumpectomy
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What are symptoms of inflammatory breast cancer?
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breast redness, swelling, and warmth, breast may appear pitted like orange skin (peau d'orange), mammogram shows diffuse pattern
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What is treatment for inflammatory breast cancer?
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radiation, chemo
it is hard to remove because it's diffuse: poor survival rate |
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What are symptoms of galactorrhea?
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white sticky discharge; usually bilateral; spontaneous discharge from the nipple
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What are symptoms of mammary duct ecstasia?
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colorful nipple discharge, pain, burning, lump
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How do you diagnose galactorrhea?
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microscopic look at discharge
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What is treatment for galactorrhea?
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depends on results of tests
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What is etiology of galactorrhea?
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increased prolactin, pituitary tumor, stress, thyroid problems
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What is treatment of mammary duct ecstasia?
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self-limiting, infection treated with antibiotics, make incision and drain
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What is the usual chief complaint of galactorrhea?
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nipple discharge
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What are drugs associated with galactorrhea?
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estrogen, phenothiazides, methyldopa, opiates, antiemetics, marijuana
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What is the national breast and cervical cancer early detection program?
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all women (no matter their status) can have a free mammogram (after age 50), and free pap smear (with paddle after age 21)
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what is first test for breast lump?
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mammogram
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When do you use MRI for breast lump?
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those with a greater lifetime risk of breast cancer, such as strong family history or women treated for Hodgkins
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What are disadvantages of MRI for breast lump?
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too sensitive; half are false positives
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What is another way to test for breast lumps, besides mammogram or MRI?
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ultrasound
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When would you do an ultrasound to look at breast lump?
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if the patient is pregnant or if they have fibrocystic breast and its around menses
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How is fine needle aspiration/biopsy of the breast done?
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local anaesthesia given, guided placement of needle into breast lump, attempt aspiration of fluid, if entirely filled with fluid, its a cyst, aspirate fluid to analysis in lab, removal of fluid decreases cyst
if no fluid in lump or if lump remains after needle aspiration, do one of two things: removed cells sent for analysis or surgical biopsy to remove lump, band aid applied to site |
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If no fluid in the lump after aspiration, or if lump still remains, what are 2 things that can occur?
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1. removed cells sent to lab for analysis
2. surgical biopsy to remove the lump |
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What is lump entirely filled with fluid?
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cyst
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What is 90% of breast cancers?
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in the ducts
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What does prognosis of breast cancer involve?
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depends on multiple factors like:
nodal involvement (closer the lymph nodes to the shoulder worsens prognosis) tumor size estrogen and progesterone receptor assay tumor ploidy (amount of DNA in tumor cell compared with normal cell) |
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What is tumor ploidy?
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the amoutn of DNA in a turmo cell compared to normal
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What is the acronym for staging breast cancer?
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TNM
Tumor Node Metastasis |
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What is stage 1 breast cancer
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small tumor, no lymphatic involvement, no metastasis
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Stage 4 breast cancer
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large tumor, spread to lymph nodes, metastasis to other organs
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What is sentinel lymph node biopsy?
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histological status of axillary nodes
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What is the single most important predictor of outcome for breast cancer and important for choosing therapy?
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histological status of axillary nodes
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What are some problems with axillar dissection?
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altered sensation and lymphedema
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What occurs in sentinel lymph node biopsy?
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radioactive dye injected into breast skin near tumor, carried by lymph system to first node to receive lymph from tumor, hand held Geiger counter over the breast, small incision where counter is loudest, node is removed and sent to pathology, wait for results, if positive, more nodes are removed
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What is a possible side effect of removing axillary lymph nodes?
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lymphedema
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What are symptoms of lymphedema?
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swelling, tightness, pain, hard to rid
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What are some things to teach a patient after lymph node removal?
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wear gloves when doing work that can cut/damage hands, no constrictive clothing, can wear a sleeve after surgery to move lymph, no BP in that arm or no sticks, elevate arm in surgery
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What is cancer in situ?
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shows non-invasive condition
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What are types of cancer in situ?
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ductal carcinoma and lobular carcinoma
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What is lobular carcinoma
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very diffuse (cannot be removed), generally bilateral
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How are most cancer in situ discovered?
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mammogram
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What is treatment for cancer in situ?
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radiation, systemic therapy
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What is the most frequent invasive cancer?
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ductal carcinoma
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Where does ductal carcinoma originate and invade?
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originates in the lactiferous ducts and invades surrounding breast structures
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Describe ductal carcinoma
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tumor unilateral, not well delineated, solid, non-mobile, usually non-tender, irregular border, hard, fixed in location
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Where does lobular cancer originate?
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in the lobules
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Describe lobular cancer
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bilateral, non-palpable, nipple carcinoma
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Describe Paget's disease
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typically occurs with invasive ductal carcinoma, bleeding, oozing, and crusting of the nipple, areola excoriated, itchy, spreads
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What is main difference between ductal carcinoma and lobular carcinoma?
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ductal carcinoma is unilateral, solid and palpable
lobular carcinoma is bilateral and nonpalpable |
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What is local treatment for breast cancer?
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surgery, radiation
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What is goal of surgery for breast cancer
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to rid tumor
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When is radiation done?
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sometimes before surgery to shrink size, or to cure
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What is adjuvant therapy
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designed to eradicate microscopic deposits of cancer cells that may have metastasized from the primary breast cancer and to increase woman's chance of long term survival
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What are some adjuvant therapies?
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oral or IV agents, chemotherapy, hormone therapy (Tamoxifen/Raloxifen), biologic therapy (herceptin)
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What is lumpectomy
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excision of all cancerous tissue to microscopically clear margins (1-1.5 cm margin)
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What occurs in lumpectomy
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local anestheisa with conscious sedation or general anaesthesia
remove lump and surrounding tissue drains are inserted |
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What is the purpose of drains after lumpectomy?
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to avoid hematoma
|
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What are some important parts to post op management of a lumpectomy?
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pain control, incision and drain surveillance, emotional needs
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What can you not do if you have a hematoma
|
radiation
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What type of drain will you most likely have after lumpectomy
|
jackson pratt
|
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What is a modified radical mastectomy?
|
removes the entire breast and sentinel lymph node dissection
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What is a radical mastectomy?
|
removal of everything
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when is radical mastectomy done?
|
cancer has spread to chest muscles under the breast
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What is nursing care post mastectomy?
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vitals, LOC, bleeding, drains, dressing, pain, precations for lymph edema, splint chest when coughing, turn on unaffected side only, ROM, emotional support, referrals
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What are lymphedema precautions?
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keep arm elevated on pillow at the level of the heart, measure arm circumferences, no BP or needle sticks in affected arm
|
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How do you turn patient after a mastectomy?
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lie on back or unaffected side only
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What are some ROM exercises post mastectomy?
|
fingers open and closed, wrist rotation, early ambulation
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What are some referrals post mastectomy?
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reach to recovery, american cancer society Y-me, support groups
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What may the pt feel after mastectomy that is normal?
|
some numbers or tingling
|
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What can the patient expect with mastectomy?
|
anaesthesia, stay in hospital 1 or 2 nights (lumpectomy is outpatient), procedure takes about 2 to 3 hours
post op: bandage over surgery site, tubes and drains, numbness/pinching, pain |
|
What determines therapy for breast cancer?
|
type of tumor
|
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What are estrogen receptors?
|
ductal and lobular cells programmed to express genes called estrogen receptors that respond to estrogen and another that responds to progesterone
higher levels post menopause in lab, will grow if surrounded by estrogen |
|
Women who are diagnosed with breast cancer after menopause are more likey to have...?
|
estrogen receptor positive tumor
|
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What is HER-2 Positive growth receptors?
|
20% of BCs have a protein termed HER-2
aggressive tumors, high likelihood of recurrence |
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What will Tamoxifen not help?
|
HER 2 receptor positive breast cancer
|
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Those with HER 2 receptor positive growth receptors are more likely to get what treatment?
|
chemotherapy
|
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What is Oncotype DX?
|
diagnostic test performed on turmo tissue that quantifies likelihood that invasive cancer will return, helps determine need for chemo
|
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What is the objective of radiation therapy for breast cancer
|
to destroy any cancer cells remaining in the breast and chest wall and to reduce the size of a tumor prior to surgery
|
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How is radiation for breast cancer administered?
|
5 days a week over a period of about 6 or 7 weeks
started about a month after surgery each treatment is only a few minutes if used with chemo, it is given after chemo is finished |
|
If radiation and chemo are both used for breast cancer, when is radiation given?
|
after chemo is finished
|
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What is another form of radiation other than external for breast cancer?
|
interoperative radiation: 2-3 week schedule put in site and then remove
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What are side effects of localized radiation therapy for breast cancer?
|
last for 6-12 months
swelling and heaviness in the breast sunburn like changes in the treated area change in breast size and consistency |
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What is a side effect of systemic radiation?
|
fatigue
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When is chemotherapy used for breast cancer?
|
to decrease mortality, especially with very aggressive cells: beneficial in younger women; benefits are biologically determined
|
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How is chemo administed for breast cancer?
|
given in cycles every 2 weeks for 3-6 months
|
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What are the chemo drugs of choice for breast cancer?
|
adriamycin, cytoxan, taxol, taxotere
|
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What is a worry about adriamycin?
|
cardiotoxic, especially if given with Rocephin
|
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What are some side effects of chemo for breast cancer?
|
fatigue, N/V, anorexia, stomatitis, alopecia, amenorrhea, neutropenia, thrombocytopenia
|
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What are permanent side effects of chemotherapy for breast cancer?
|
premature menopause (in women over 40 years old), heart damage with adriamycin (increase in risk with Herceptin), decrease in concentration and memory, acute myeloid leukemia (1 in 1000), neuropathy
|
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What is an indication to use tamoxifen for breast cancer?
|
tumors that have estrogen receptors
|
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What does tamoxifen do?
|
disrupts the site where estrogen is supposed to bind
|
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What are advantages of using tamoxifen for breast cancer?
|
reduces chance of recurrence by as much as 50%, years after its stopped it still has benefits, prevents osteoporosis
|
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How is Tamoxifen administered?
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20 mg/day for 5 years (no benefit after 5 years)
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What are risks of taking Tamoxifen?
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increased risk for endometrial cancer, unusual vaginal bleeding, blood clots, pulmonary embolism, CVA, hot flashes, teratogenic, cataract formation
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What can tamoxifen do to unborn baby?
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birth defects
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What are benefits of using Raloxifen over Tamoxifen for breast cancer?
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raloxifen has fewer blood clots and fewer endometrial cancers
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What are good effects of tamoxifen?
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reduces breast cancer risk, lowers LDL cholesterol, strengthens bones
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What are bad effects of tamoxifen?
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increase blood clot risk, increase uterine cancer risk
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What are good effects of taking raloxifen?
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strengthens bones, lowers LDL cholesterol, reduces risk for invasive breast cancer, fewer uterine cancers than tamoxifen, fewer blood clots than tamoxifen
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What are bad effects of taking raloxifen for breast cancer?
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no relief of hot flashes, no reducation in LCIS or DCIS (in situ?)
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What do aromatase inhibitors do?
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decrease post menopausal estrogen production and reduces the risk of recurrence in estrogen positive tumors
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What are the indications for using aromatase inhibitors for breast cancer?
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woman must be post menopausal, tumors must be hormone positive
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What are the preparations of aromatase inhibitors?
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letrozole (femara), exemestane (aromasin), anastrozole (arimidex)
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What are side effects of aromatase inhibitors?
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N/V, depression, lightheadedness, hypertension, peripheral edema, hot flashes, joint pain, no bone protection (induced menopause)
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What are the advantages of aromatase inhibitors over tamoxifen?
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dont cause stroke or endometrial cancer; just as effective
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What are indications of using herceptin for breast cancer?
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decrease recurrence in HEr-2 positive breast cancer, used in conjuction with chemotherapy, use with caution with Adriamycin
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What is dosage of Herceptin?
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440 mg Reconstitute power with dilutent provided for IV administration, administer initial colorless dose over 90 minutes, then weekly administration and watch cardiac status
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What are side effects of Herceptin?
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***fever and chills, weakness***, increased susceptibility to infections, N/V, cough, diarrhea, headache, cardiovascular changes, report SOB, limitations with physical activities
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What is the role of biphosphonates in breast cancer?
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slow the progression of bone metastases and reduce skeletal complications in women with metastatic breast cancer; may prevent development of bone metastases in newly diagnosed patients with no evidence of metastasis
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What are 2 biphosphonates?
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fosamax, actonel
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What treatment for breast cancer do you give to premenopausal women that are HER-2 + and ER+?
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Chemo, herceptin, and hormone therapy
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What treatment for breast cancer do you give to older menopausal women that are HER 2+ and ER +?
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herceptin and hormone therapy
(chemo not as good after menopause) |
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What treatment for breast cancer do you give for women of any age that is ER+ and HER 2-?
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low risk hormone therapy
OR high risk chemo + hormone therapy |
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What are the goals of breast reconstruction?
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achieve symmetry, preserve body image, need to feel complete again, avoid use of external prosthesis, decrease self consciousness, enhance femininity
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When may breast reconstruction be doen?
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immediately or later
timing doesn't change survival rates or interfere with disease treatment |
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What is autologous flap reconstruction for breast?
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using the womans own tissue to create a breast that creates a more natural shape
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What are the 2 types of autologous flap breast reconstruction?
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latissimus dorsi flap and abdominis transverse rectus myocutaneous
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What is TRAM?
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transverse rectus abdominus muscle
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What are some other breast reconstruction options?
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Saline filled tissue expander (silicone), nipple reconstruction (tattoo areola)
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What is nursing care after breast reconstruction?
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ongoing support, pain management, education about surgical risks, watch for leaking fluids
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What are some surgical risks of breast reconstruction?
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hematoma, infection, delayed wound healing, capsular contractions form, leakage of the implant
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What happens in the saline filled breast is ripped?
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must be replaced
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What is follow up after breast cancer?
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15% of recurrence, Tamoxifen lowers this risk by 40-50%, Mammogram and clinical breast exam every 6-12 months, breast cancer centers
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How do you treat metastatic disease?
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patient directed; one drug at a time
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What amount of calcium should a woman take after menopause?
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1200 mg
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When do you give hormone replacement therapy?
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vasomotor symptoms
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What are 3 STDs caused by bacteria?
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gonorrhea, syphilis, chlamydia
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What type of organism is Trichomonas?
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protozoa
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What is an herbal remedy for vasomotor symptoms?
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dong quai
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What would you teach your patients about ACOG?
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augments anticoagulants and antihypertensives
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What do you need to remember in a patient with internal radiation of the cervix?
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lead box, gloves, forceps, shield
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What are reportable symptoms with an IUD?
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PAINS
late Period Abodominal pain Infection Not feeling well Spring is missing |
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What do you teach a patient who had cryosurgery?
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watery discharge 2-3 weeks and what to report
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What is primary amennorrhea?
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don't have period by age 16 or sex characteristics by 14
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What is secondary amennorrhea?
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you have your period for at least 3 months and then it stops
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What is the most likely cause of amennorrhea?
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pregnancy
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What is primary dysmennorrhea?
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young girls before they're pregnant due to increased prostaglandins
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What is secondary dysmennorrhea?
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due to pathology
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How do you determine endometriosis?
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laparoscopy
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What is metorrhagia?
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bleeding between periods
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What can cause metorrhagia?
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oral contraceptives
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What is treatment for PCOS?
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Meformin, oral contraceptives, lifestyle changes, Danazol and Luprol
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What is treatment for E receptor positive breast cancer in a post menopausal woman?
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aromatase inhibitors/ Tamoxifen
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What are some modifiable breast cancer risks?
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obesity, alcohol over one drink per day, late childbearing
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What are 2 benign conditions of the breast?
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fibrocystic and fibroadenoma
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What is fibroadenoma?
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unilateral nontender
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What is fibrocystic breast?
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tender bilateral
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what are types of pelvic floor dysfunction?
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uterine prolapse, cystocele, rectocele
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What are the causes of pelvic floor dysfunction?
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pregnancy, pelvic surgery, chronic constipation, chronic coughing, heavy lifting, genetics
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What is uterine prolapse?
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uterus goes down into the vagina
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What is cystocele?
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bladder goes into vagina
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What is rectocele?
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rectum goes into vagina
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What are symptoms of pelvic floor dysfunction?
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urinary incontinence (cystocele)
recurrent cystitis constipation (rectocele) back pain pelvic pressure dyspareunia (uterine prolapse) |
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What is grade 0 of pelvic relaxation?
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normal position
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What is grade 1 of pelvic relaxation?
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descent halfway to the hymen
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What is grade 2 of pelvic relaxation?
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descent to the hymen; see uterus in mirror
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What is grade 3 of pelvic relaxation?
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descent halfway past hymen; bulging outward
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What is grade 4 of pelvic relaxation?
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maximum possible descent for each site
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What is treatment for pelvic floor dysfunction?
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dependent upon symptoms and grade
can use a pessary to hold the uterus in place, surgery, bowel/bladder training, knee chest position |
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What is a pessary?
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a fitted piece that is inserted to hold the uterus in place but it can cause necrosis.
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What must you do w/ a pessary?
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take it out at night, clean it, and reinsert it in the morning
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What is the point of bowel/bladder training for pelvic flood dysfunction?
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can help rectocele and cystocele;
defecate at the same time every day to prevent constipation |
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What are Kegel exercises?
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to strengthen pelvic muscles
hold for 3 seconds 3 times and then 5 seconds for 3 times but do not hold your breath |
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What may it be if your pessary is foul smelling?
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infection
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