Mariadelmar GrajalesCompu-med Vocational C.docx

Mariadelmar Grajales
Compu-med Vocational Careers
Blue-Print Unit exam 2
Exam 2 Blue Print COMPLETE
Bladder Hypotonia
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
·
Medications/labs for meds
· Treatments
· Interventions
Postpartum Psychosocial (PPD/psychosis, blues)
·
Medications/contraindications/interactions,
interventions, etc
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
PMS vs. PMDD: signs and symptoms

PMD/PMDD patient education
Women at risk for PMS
Diseases that mimic PMS, how to rule it out
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-in,” (First 2 days)
“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
PostpartumPsychosocial (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
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