Blueprint

Abdominal diastasis

After pains

Vaginal recovery:

· normal/abnormal findings

Cesarean recovery

· Risks, interventions, medications, education

Early maternal assessment (ALL body changes)

· Vital signs

· Body systems and adaptations/physiological changes

· BUBBLE-HE(B)

· Assessment of Lochia Flow

Phases associated with the Mothering Role

Deep Vein Thrombosis/thrombosis

· Treatments

· Interventions

Postpartum Psychosocial (PPD/psychosis, blues)

Postpartum hemorrhage

· Labs

· Medications to treat PPH

· Education

Hematomas

· signs & symptoms/ interventions, patient education,

Storing breastmilk/ breast pumping

Uterine Involution and how to document

REEDA Acronym: scoring

IPV: Economic, Isolation, emotional, threats

IPV: priority interventions for each type of abuse

Phases of IPV (honeymoon, tension, etc.)

Documenting IPV

Sexual assault treatments/ therapeutic communication

PMD/PMDD patient education

Women at risk for PMS

Menopause: effects/body changes/ treatment of symptoms

Fibrocystic changes

Benign breast tumor

Breast drainage

Breast self-examination

Breast screenings

Fine needle biopsy vs. core needle biopsy.

Breast cancer: cancer stage prognosis/ cancer survivorship plans/ diagnostics

REVIEW UNIT 2 EXAM

Bladder Hypotonia:

Occurs when your bladder muscles lose their ability to hold your urine.

You are not longer able to sense when your bladder is full or empty it completely, so it over fills and urine leaks out.

Is also called flaccid or hypotonic bladder.

Urinary retention can also result from bladder hypotonia after childbirth because the weight of the gravid uterus no longer limits bladder capacity.

Assess the maternal bladder (extremely important)

N.I: Kegel exercises.

Abdominal Diastasis:

Diastasis recti abdominal (abdominal separation) the separation between the two rectus abdominis muscles that can occur from pregnancy.

N.I: Nurses should teach them to maintain correct posture when performing activities such as lifting, carrying, and bathing the baby for at least 12 weeks after birth.

Performing modified sit-ups during this time is beneficial in helping to strengthen the abdominal muscles.

Afterpains:

Afterpains are intermittent
uterine contractions that occur during the process of involution. Patients often describe the sensation as discomfort
similar to menstrual cramps.

Also defined as
belly cramps that a postpartum mother feels as her uterus shrinks back to its regular size after pregnancy.

Multiparas and patients with uterine overdistention (e.g., large baby, multifetal gestation, or hydramnios) are more likely to experience afterpains because of the continuous pattern of uterine relaxation and vigorous contractions.

Afterbirth pain is often severe for 2 to 3 days after childbirth

N.I: N.I for discomfort include assisting the patient into a prone position with a small pillow placed under her abdomen, initiating sitz baths (for warmth), encouraging ambulation, and administrating mild analgesics. Breastfeeding the NB.

Breastfeeding women should take pain medication approximately 30 minutes before nursing the baby to achieve maximum pain relief.

Vaginal Recovery:

· Normal/Abnormal findings

REEDA

Redness,
Edema,
Ecchymosis,
Discharge,
Approximation

Cesarean Recovery:

· Risks, Interventions, Medications, Education

Additional challenges faced by patients during recovery from a cesarean birth include recovery from the anesthesia, a need to cope with incisional and gas pain, and slow ambulation. Mother-infant bonding may be delayed, and patients are at an increased risk for hemorrhage, surgical wound infection, urinary tract infections (UTIs), and DVT.

Care of the patient after cesarean birth:

The nurse must complete the
Breasts,
Uterus,
Bladder,
Bowel,
Lochia, and
Episiotomy (
BUBBLE-HEB)
Homan sign,
Emotions,
Bonding assessment.

· Recovery from anesthesia

· Abdominal Distension

· Urinary (retention/distension)

· Care of the cesarean Incision/Episiotomy

N.I: Perineal care. Clean, Front to back, Washing, Padding, Sitting, Change pad (3 to 4 hrs.) Ice Packs first 24 hrs. postpartum. Tucks, if Hemorrhoids. Sitz Baths relief pain and discomfort (24 to 48 hrs. postpartum)
If bleeding occurs, notify the physician *PRIORYTY

Early Maternal Assessment:

Monitor for Infection/Hemorrhage

·
Vital Signs: 1st 24hrs.

Temperature: 98.6 ~ 100.4 F

Pulse: 60~100 bpm Bradycardia is common

Blood Pressure: Consistent 120/80mmHg If High: Anxiety, HTN, Preeclampsia.

Respirations: 12~20 per minute

Pain: “The Fifth Vital Sign”

Medications:

Stool softener, Laxative, Hemorrhoid Cream, NSAID.

Body system adaptations/physiological changes:

·
Hematological and Metabolic System

500mL Blood Loss if Vaginal Childbirth 1gr / 1000mL Blood Loss if C/S 2gr

It is important for the nurse to remember that, as the body’s excess fluid is excreted, the hematocrit may rise because of hemoconcentration.

Maternal plasma volume decreases even further as a result of diuresis.

Circulating levels of estrogen and progesterone decrease dramatically after delivery of the placenta; human placental lactogen, cortisol, growth hormone, and insulinase, also fall.

maternal fatigue.

Patients who received epidural or spinal anesthesia may experience headaches, especially when they assume an upright position. After spinal or epidural anesthesia, headaches may result from the leakage of cerebrospinal fluid into the extradural space.

·
Neurological

Fatigue, Discomfort, OXYTOCIN causes sleepiness.

·
Renal System, Fluids and Electrolytes

Urinary output 3000mL in 24 hrs. Diuresis occurs after birth.

·
Respiratory System

Resp system goes back to normal non-pregnancy state. Progesterone levels drop.

The immediate decrease in intra-abdominal pressure associated with the birth of the baby allows for increased expansion of the diaphragm and relief from the dyspnea usually associated with pregnancy.

·
Integumentary System

Changes related to major alterations in hormones, alterations in pigmentation, connective and cutaneous tissue, hair, nails, secretory glands, and pruritus. Most pregnancy-related skin changes disappear completely during the postpartum period, although some, such as striae gravidarum (stretch marks), fade but may remain permanently.

·
Cardiovascular System

Maternal cardiac output is significantly elevated above pre-labor levels for 1 to 2 hours postpartum and remains high for 48 hours postpartum. Returns to normal within 2~4 weeks after childbirth.

·
Immune System

WBC slightly increased (25.000 count) during labor and birth and remains elevated during the early postpartum period, gradually returning to normal values within 4 to 7 days after childbirth.
Rubella shot (MMR if titters are not immune)
RhoGAM If Mom (-) and child (+)

·
Ovulation

Menstruation usually resumes within
6 to 8 weeks after childbirth in women who are not breastfeeding.

Exclusively breastfeeding moms may not ovulate or menstruate for 3 or more months.

breastfeeding is not a reliable method of contraception.

·
Gastrointestinal System

Bowels more active right after birth, mom may become hungry and thirsty
. Constipation, a common nursing diagnosis for the postpartum patient, is associated with abdominal discomfort and decreased hunger.

·
Musculoskeletal System

Diastasis recti abdominal: separation of the abdominal muscles.
N.I Maintain correct posture when lifting, carrying and bathing the baby for at least 12 weeks after birth. Perform modified sit-ups to strength abdominal muscles.

BUBBLE HEB

BREAST: Engorgement

UTERUS: Fundal Heigh- Uterine Placement/ Consistency (Boggy/ Firm)

BOWEL: Gas passing, Constipation, Air can engage in arm (Early Ambulation)

BLADDER: Assess Catheter/Remove Urine color and amount

LOCHIA:
COCA Color,
Odor,
Consistency,
Amount.

EPISISOTOMY: Perineum, Hemorrhoids

REEDA Redness,
Edema,
Ecchymosis,
Discharge, Approximation.

Homans Sign: Calf + Pushing test

Emotions: Affect, family interactions, Baby Blues

Bonding: Gazing, Enfolding, Interaction with the Newborn.

Assessment of Lochia Flow:

Scant: 1 inch 2.5cm

Light: 4inch 10cm

Moderate: 6inch 15cm

Heavy: Per Pad Saturated within 1hr.

Lochia Rubra: 3-4 days postpartum Dark bright red/ Menstrual odor/ Decreasing

Lochia Serosa: Up to 14th day postpartum
pink, old blood, decrease amount

Lochia Alba: Up to 6 weeks postpartum White yellow creamy/light

Phases associated with the Mothering Role:

Rubin (1975) described three distinct phases that are associated with the woman’s assuming the mothering role. She labeled these phases:

“Taking-hold,” (2nd and 3rd day)
and

“Letting-go” (2-6 weeks postpartum)

“Taking-in,” her birth experience in the first day or two after birth.

“Taking -hold,” Mom assumes care for herself and her infant. signs of bonding

“Letting-go,” Starts to focus on issues directly with herself and her newborn

DVT Deep Vein Thrombosis

Common during pregnancy

S & S: Depend on size

Unilateral Leg Pain

Positive Homan’s Sign

Calf Tenderness / Warm / Inflamed

Swelling / Maybe asymptomatic 50%

Pedal Pulse at +2

Developmental of Collateral Circulation

Degree of Vessel Occlusion

• Medications/labs for meds

ENOXAPARIN

LABS:

– D-dimer

– Basic Chemistry test

– PT and PTT

Thrombophlebitis = Thrombus + Inflammation

Describe inflammation

Typically occurs in CALFS

Risk during postpartum

Thrombosis

Superficial Venous Thrombosis

Deep Venous Thrombosis

Pulmonary Embolism
Med: Warfarin/Heparin

Maintain antidotes on bedside (e.g., protamine sulfate for Heparin, Vitamin K for warfarin) to promptly treat drug overdose.

• Treatments

Collaborative management

Specific diagnostic procedures (e.g., venography and real-time and color Doppler ultrasound)

Avoid massage when DVT is suspected

When you sit, elevate your legs and do not cross them.

Drink plenty of fluids (10–12 8-ounce glasses) to prevent dehydration.

Avoid sitting in one position or standing for a prolonged period of time.

• Interventions

Avoid sitting in one position or standing for a prolonged period of time

Early ambulation is important; If ambulation is not possible, perform active and passive leg exercises. do not place pillows under your knees

Postpartum
Psychosocial (PPD/Psychosis, Blues)

• Medications/contraindications/interactions, interventions, etc.

Postpartum Depression PPD

10% to 20% of postpartum women progress beyond the baby blues into postpartum depression (PPD), Occurs within 6 months postpartum.

S & S: Symptoms of PPD

include

· depressed mood or decreased interest/pleasure in previously enjoyable activities,

· insomnia or hypersomnia,

· lack of appetite or weight loss,

· restlessness, anxiety,

– inability to cope, and feelings of hopelessness

N.I

Risk factors should begin with the first prenatal visit.

Cognitive behavioral therapy (CBT) and
interpersonal psychotherapy (IPT) have been shown to be beneficial in treating perinatal depression. CBT is an action-oriented approach that treats maladaptive thinking as the cause of pathological behavior and “negative” emotions.

Exercise has been shown to increase levels of neurotransmitters (Dopamine) that communicate with brain cells to increase feelings of euphoria.

Medication for PPD:

SSRIs
“lopran” suffix Anxiety/Depression

SNRIs “faxine” suffix Anxiety/Depression

TCAs/heterocyclics “pramine” “ptyline” suffix Anxiety/Depression

Mood stabilizer Lithium Bipolar/Postpartum psychosis

Postpartum Psychosocial (PPD/Psychosis/ Blues)

• Medications/contraindications/interactions, interventions, etc.

· Rare but severe form of mental illness.

· Affects not only the new mother but the entire family

· Greatest risk in those with pre-existing psychosis

· Behavioral cues that signal postpartum psychosis

· Collaborative management. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT)

*IMPORTANT: Postpartum Psychosis may present with PPD symptoms; However, the distinguishing signs of Psychosis are
Hallucinations, delusions, agitation, confusion, disorientation, sleep disturbances, suicidal and homicidal thoughts, and, loss of touch reality.

This condition may also resemble a sudden maniac attack. Mothers who are in a maniac state, require constant supervision when caring for the infant; they are frequently too preoccupied to tend to their infant’s needs.

N.I: Examples of bonding-oriented nursing care include rooming-in, decreasing sensory stimuli so that the family can focus on one another, and limiting visitors (if the patient desires).

Postpartum Blues:

· Common emotional response of periods of happiness followed by periods of tearfulness

· Self-limiting and resolve by 10 days postpartum.

· Signs & Symptoms:

· – Tearfulness, Mood swings, anxiety, fatigue, sadness, insomnia, forgetfulness and con fusion.

· Alleviating factors

Postpartum Hemorrhage:

Is a blood loss greater than
500 mL after a vaginal birth
1gr and, 1,000
mL
(2gr) or more after a cesarean birth.

Is a serious condition.

Early Postpartum Hemorrhage: An early (primary) PPH occurs within the first 24 hours after childbirth.

Late Postpartum Hemorrhage: A late (secondary) PPH occurs from 24 hours to 12 weeks after childbirth.

When bleeding is associated with uterine atony or retained placental fragments, the blood is
dark red with clots and the uterus is soft and boggy.

When the bleeding is associated with lacerations from the perineum, cervix or vagina, the
blood is bright red, often without clots, and the uterus is firmly contracted.

MEDICATION:

Methylergonovine (Methergine) Contraindicated for HTN

oxytocin (Pitocin)

Carboprost tromethamine (Hemabate) Contraindicated in Asthma, Cardiac, hepatic, renal pts

Misoprostol (Cytotec)

Dinoprostone (Prostin E2)

Labs for PPH: Include, CBC. PT & PTT Electrolytes, BUN

N.I: Patients who are experiencing
PPH hemorrhage from genital tract lacerations need one or two large-bore IV sites, frequent recording of vital signs, accurate measurements of intake and output from all sources (including blood), laboratory work, an indwelling urinary catheter, oxygen, and pain medication.

Help the patient assume a lithotomy position, obtain bright lighting and examination instruments, and prepare suction equipment.

Hematomas:

A hematoma is a localized collection of blood in connective or soft tissue under the skin that follows injury of or laceration to a blood vessel without injury to the overlying tissue.

Sign & Symptom of a hematoma is

·
unremitting pain and pressure, the pain and pressure worsen if active bleeding continues.

· sensation of “heaviness” in the vagina and/or rectal pressure

· Tachycardia and hypotension

Storing breastmilk/ breast pumping

Store breast milk if prematurity of baby or illness.

Freshly pumped breast milk can be safely stored at room temperature 77°F (25°C) for 4 hours or refrigerated at 40°F (4°C) for 4 days after collection. Milk kept in a deep freezer at 0°F (–18°C) can be stored for 6 to 12 months

REEDA

R redness

E edema

E ecchymosis

D discharge

A approximattion

IPV: Economic, Isolation, emotional, threats

Categories of IPV

·
Physical abuse: The intentional use of physical force with the potential for causing death, disability, injury,

or harm. Direct acts include slapping, punching, kicking, biting, strangulation, burns, attacking with weapons, throwing objects, and depriving the partner of sleep. Indirect acts include abuse in which physical effects can result such as subjecting the person to reckless driving or withholding medical attention.

·
Sexual coercion: Includes the use of physical force to compel a person to engage in a sexual act against their will, whether or not the act is completed; attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act (e.g., owing to illness, disability, or the influence of alcohol or other drugs or because of intimidation or pressure); and abusive sexual contact. Other acts include forcing the person to engage in sexual activities with others, pregnancy coercion, and subjecting the person to sexually transmitted infections.

·
Threats: A type of abuse in which words, gestures, or weapons are used to communicate the intent to cause death, disability, injury, or physical harm. These can include threats to harm the partner, partner’s family, friends, pets, property, and/or children (or threat to take the children away), as well as indirect acts and threats to kill themselves.

·
Emotional abuse: Emotional abuse constitutes a range of various tactics, name calling, threats of acts, coercive tactics, publicly humiliating partners, convincing the partner they have mental health problems, and gaslighting. Stalking, which refers to harassing or threatening behavior that an individual engages in repeatedly (e.g., following a person, appearing at a person’s home or place of business, making harassing phone calls, vandalizing a person’s property) is frequently included among the types of IPV.

·
Isolation: Isolation includes cutting partner off from friends and family; denying privacy; preventing them from leaving the house; denial of communication from other people; preventing the person from learning the language spoken in the country where they live; and controlling social media, phone calls, and e-mails.

·
Economic abuse: Occurs when the perpetrator controls all money, prevents the partner from working, or forces the partner to work excessively and takes the earnings. Related types of abuse include interfering with the partner’s job or ruining credit ratings so that the person is financially distressed. increase

IPV: priority interventions for each type of abuse

Phases of IPV (honeymoon, tension, etc.)

1. Tension-building phase

· Period of increasing tension

2. Acute violence/explosion

· Abuser discharges pent-up tension

· May be triggered by an internal response in the abuser or by an external crisis

3. Honeymoon period

· Tranquil, loving period of calm and remorse

Documenting IPV

· Description of the person who abused the patient

· Date and time of incident or abusive situation

· Patient’s account of what happened, all detail should be included

· Specific details about the abuse, using quotations to indicate when the statements represent exactly what the patient said

· Injuries should be documented with detailed descriptions and measurements and pictures should be taken if possible

· Note patient’s coping and responses to the abuse

· Type of injuries sustained or official reports

· Note safety measures taken and safety assessment

· Note referrals made for follow-up

· Mandatory reporting and corresponding safety planning

Sexual assault treatments/ therapeutic communication

Medical Treatment

Medical treatment of SA patients always begins with treating life-threatening conditions such as strangulation.

Depending on the injury, treatment may include a complete trauma panel with x-rays and CT scans. Many victims of SA may not be fully aware of the complete acts that were committed against them.

Prophylactic Treatments

· 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:

Risk factors for breast cancer may be related to demographics, personal health history, lifestyle choices, and defects in certain genes
.

Alcohol use increases breast cancer risk, especially for women who drink more than one alcoholic beverage per day.

DUCTAL CARCINOMA IN SITU: DCIS is considered a stage 0 breast cancer and is considered a noninvasive or preinvasive cancer.

LOBULAR CARCINOMA: LCIS is not considered a true cancer, although this neoplasm is sometimes classified as a type of noninvasive breast cancer.

INVASIVE (INFILTRATING) LOBULAR CARCINOMA: Invasive (infiltrating) lobular carcinoma (ILC) originates in the lobules (milk-producing glands) and spreads to surrounding breast tissue.

Can metastasize to other parts of the body.

INFLAMATORY BREAST CANCER: IBC Inflammatory breast cancer (IBC) is a rare neoplasm that occurs more often in younger women and women of color and
tends to grow more quickly and aggressively than the more common types of breast cancers.

Tips for Reducing Breast Cancer Risk

Nurses can teach families about simple at-home strategies that may reduce breast cancer risk:

Diet and exercise: Reducing calories and engaging in regular exercise may slow tumor growth and lower the amount of circulating leptin, a fat-released protein that has been linked to breast cancer.

Extra-virgin olive oil: This oil contains polyphenol compounds that suppress a breast cancer-promoting gene.

Apples: Phenols found in apples may combat malignant tumors.

Vitamin D: This vitamin prevents the division of cancer cells and activates a tumor-suppressing protein.

Folate: Consuming foods that contain the B-vitamin folate (e.g., leafy green vegetables, beans, and fortified cereals) may help to mitigate the increased breast cancer risk associated with drinking alcohol.

Soy supplements: Soy contains isoflavones, substances that act like estrogen and may stimulate the growth of certain types of breast cancers. Supplements that contain concentrated amounts of isoflavones should be avoided. However, healthy soy foods such as edamame, soy milk, and tofu are not considered harmful.

AXILARY NODES:

Lymphedema (an accumulation of fluid and protein in the extravascular space from trauma to the lymphatic system or supporting structures; results in swelling of the arm).

CANCER STAGING SYSTEM:

The stage of cancer is based on the size of the tumor, the number of lymph nodes involved, and whether the cancer has spread.

The TNM staging system classifies cancers based on their T, N, and M stages:

T = Tumor: size and spread within the breast and to nearby organs

N = Nodes: spread to the lymph nodes

M = Metastasis: spread to distant organs

Stage 0: Ductal carcinoma in situ (DCIS)

Stage I: The tumor measures 2.0 cm in diameter or less and there is no involvement of the lymph nodes and no distant metastasis.

Stage II: The tumor measures 2.0 cm in diameter to 5.0 cm. Depending on the specific findings, the cancer may have spread to the axillary or internal mammary lymph nodes but has not spread to distant sites.

Stage IIIA: 1) The tumor is not more than 5.0 cm

2) The tumor is larger than 5.0 cm

Stage IIIB: The tumor has grown into the chest wall or skin.

Stage IIIC: The tumor is any size, and it has spread.

Stage IV: The cancer can be any size (any “T”), may or may not have spread to nearby lymph nodes (any “N”). It has metastasized (“M”) to distant organs or to distant lymph nodes.

EDUCATION:

■ New lump in the breast or underarm (armpit)

■ Thickening or swelling of part of the breast

■ Irritation or dimpling of breast skin

■ Redness or flaky skin in the nipple area or the breast

■ Pulling in of the nipple or pain in the nipple area

■ Nipple discharge other than breast milk, including blood

■ Any change in the size or the shape of the breast

■ Pain in any area of the breast

Breast Symptoms:

Nipple discharge

Skin changes

Breast Pain (Mastalgia)

Breast Cancer Screening:

BSE

CBE

Mammography

MRI

Breast Tomosynthesis