REVISION QUESTIONS

GYNECOLOGICAL NURSING

UNIT I 3. Stem cell therapy

Long Essay 4. Human Sexuality and Reproductive
1. Uterine malformations/congenital Health
abnormalities of female reproductive
syatem (types, management) Difference between
Short Notes 5. Bicournuate uterus and septate uterus
2. Trends and issues in gynecological 6. Arcuate and didelphic uterus
nursing 7. Unicornuate and Bicornuate uterus

ANSWER KEY

Long Essay  Class VI:Arcuate uterus where there is

a concave dimple in the uterine fundus.
1. Uterine malformations (types,  Class VII: DES uterus-The uterine
management) cavity has a "T-shape" as a result of
fetal exposure to diethylstilbestrol.
Introduction  A rudimentary uterus is a uterine
Definition- A uterine malformation is the result remnant not connected to cervix and
of an abnormal development of the Mullerian vagina and may be found on the other
ducts) during embryogenesis. side of an unicornuate uterus.
Classification of Mullerian anomelies
1988- American fertility society ( AFS)
 Class I: Mullerian agenesis (absent
uterus).Uterus is not present, vagina
only rudimentary or absent. The
condition is also called Mayer-
Rokitansky-Kuster-Hauser syndrome.
 Class II: Unicornuate uterus (a one-
sided uterus).Only one side of the
Mullerian duct forms. The uterus has a
typical "banana shape" on imaging
systems.
 Class III: Uterus didelphic, also uterus
didelphis (double uterus).Both Clinical features
Mullerian ducts develop but fail to fuse,
thus the patient has a "double uterus” Gynecological Obstetrical
 Class IV: Bicornuate uterus (uterus  Infertility  Midtrimester miscarriage
with two horns).Only the upper part of  Dysparenuia  Rudimentary-horn pregnancy
that part of the Mullerian system that  Dysmenorrhoea  Cervical incompetence
forms the uterus fails to fuse.The uterus  Menstrual  Malpresentation
is "heart-shaped". disorders  Preterm labour,IUGR,IUD
 Class V: Septated uterus (uterine
 Prolonged labour
septum or partition).The two Müllerian
ducts have fused, but the partition  Obstructed labour
between them is still present,with a  Retained placenta
complete septum the vagina, cervix and  PPH
the uterus can be partitioned. Diagnostic studies

 History collection
  Internal examination  Cell-free DNA genetic
 Hysteroscopy screening
 Hysterography  Heated intraperitoneal
 Laparoscopy chemotherapy for treatment of
 Ultrasonography unresectable ovarian cancer
 MRI (January 2018)

Treatment Legal issues

 Failure to warn or inadequate
 Self therapy consent- 3%
It is essential for the patients and their families to  Failed sterilization - 6%
attend counseling before and throughout treatment.  Failure to recognize
Conventional thearpy complications -7% Failure of
 Pharmacotherapy diagnosis or delay in diagnosis-
Anti-adhesion drugs are administered after the 17%
surgery.
 Intraoperative problems - 32%
Antibiotic therapy.
POTENTIAL AREAS OF
Hormonal therapy is used to help women with
LITIGATION IN GYNAECOLOGY
conception.
 Surgical therapy 1. Professional and personal conduct
Laparoscopic or hysteroscopic methods are used: 2. Examination of gynecological patient
 Laparoscopy 3. Valid Informed consent
 Hysteroscopy 4. Forensic gynecology
 Strassmann Hysteroplasty Operation.- 5. Effective communication
making a transverse incision on the double 6. Proper health education
uterus and the septum and repaired on the
7. Death following any procedure.
anteroposterior plane.
 Metroplasty: women with septate or 8. Standing orders in midwifery.
bicornuate uterus, uterine didelphys and 9. Defective surgery
recurrent pregnancy loss 10. Female sterilization
Complications- Abortion • Weak uterine action 11. Failed sterilization
• Adhesion of the placenta • Malpresentations • 12. Failure of contraceptives
Prolonged or obstructed labour • Uterine rupture 13. Risks related to Diagnostic
due to its poor development. • Adherent placenta laparoscopy
and PPH
14. Assisted conception
Nursing management 15. adverse outcome of multiple
pregnancy,
Nursing diagnosis 16. Financial driven private sector
Short Notes
Legal responsibilities
2. Trends and issues in gynecological  Functions in accordance with
nursing legislation and common law affecting
midwifery practice
Current trends in gynecology  Accepts accountability and
responsibility for own actions within
 Stem cell therapy in gynecology midwifery practice
 Fertility preservation  Communicates information to facilitate
 Regenerative medicine in decision making by the woman
gynecology  Promotes safe and effective midwifery
 Robotic technology in care
gynecology  Assesses, plans, provides and evaluates
safe and effective midwifery care
 Assesses, plans, provides and evaluates  Myotonia- Muscle tension,
safe and effective midwifery care for increases throughout the body
the woman and/or baby with complex during sexual stimulation and is
needs controlled by peripheral nervous
 Advocates to protect the rights of system.
women, families and communities in
relation to maternity care  Vasocongestion-
 Develops effective strategies to vasocongestion occurs in
implement and support collaborative erectile tissue ,where the blood
midwifery practice fills ,specially constructed
 Actively supports midwifery as a public places in the nipples,clitoris and
health strategy penis.
 Ensures midwifery practice is culturally Reproductive health
safe
 Bases midwifery practice on ethical
decision making
 Identifies personal beliefs and develops
these in ways that enhance midwifery
practice
 Acts to enhance the professional
development of self and others
 Uses research to inform midwifery
practice
3. Stem cell therapy
Stem cells (progenitor cells) are the
important source of regenerative health
Properties
 Totipotent stem cells
 Pluripotent stem cells  Perinatal care
 Embryonic stem cells  Newborn care
 Multipotent stem cells  Adolescent care
 Unipotent cells  Immunization
Use of embryonic stem cells in  Family planning
regenerative medicine  Prevention of sexually transmitted
 Regeneration of urogenital tract diseases
tissues Nurses responsibilities in reproductive
 Biomaterials health
 Mullerian ducts reconstruction

4. Human sexuality and reproductive

health

DEFINITION
Human sexuality is defined as the part
of life that has to do with being male
and female,it evolves and matures as an
interactional process in a biological
environment influenced by family
members, friends and church and culture
social and educational factors
Sexual response cycle
2 responses include:-
Unit II
Short Notes 2. pre and post operative management of
1. Gynecological Assessment women undergoing Gynecological
(surgical) procedures
3. Breast Self Examination

ANSWER KEY  LA or GA or SA
Short Notes  Position the patient-dorsal for
1. Gynecological Assessment abdominal operations, lithotomy for
 Breast examination vaginal operations
 Self breast examination  Bladder preparation-soft rubber catheter
 Clinical breast examination or Foleys catheter
 Abdominal examination  Draping prior to the surgery
 Inspection Intraoperative care
 Palpation  Assisting surgeon while putting incision
 Percussion and through-out the surgery.
 Auscultation  Assisting while placement of drains and
 Pelvic examination closure of site by sutures
 Inspection of external genetalia  Monitor patient condition during
 Vaginal examination surgery.
 Inspection of cervix and Post operative care
vaginal walls Immediate care
 Palpation of vagina by  Vital signs
digital examination  Recovery from anesthesia
 Bimanual examination  Fluid balance
of pelvic organs  Observation of surgical site and drain.
 Rectal examination First 24hrs:
 Rectovaginal examination  Placement in the bed
 Observation
2. Pre and post operative management of  Fluid replacement
women undergoing Gynecological  Blood transfusion if needed
(surgical) procedures  Adequate analgesia
Pre-operative preparations  Antibiotics
 Investigations  Bladder care
 Routine investigation  Mobilization
o Blood ,urine, chest X-ray and First post-op day:
ECG  General care
 Admission  Diet
 Pre-operative work-up  Sedative and analgesics
 Pre-evaluation of medical illness Second post-op day:
and pre-anesthetic fitness  Light solid diet
 Preoperative counseling and  Ambulation
informed consent  Intermittent catheter
 NPO atleast 8hrs prior Third and fourth post-operative day:
 Bowel preparation  Daily observation of vital signs
 Night sedation  Normal diet
 Local skin preparation  Suppository and enema if needed
 Morning medications like prophylactic  Surgical site dressing and removal of
antibiotics, thromboprophylactic drugs. drain
Pre-operative work-up in operating table On discharge:
 IV infusion- RL drip Advices regarding
  Rest  Follow-up
 Coitus Nursing diagnosis (peri-operative)

Unit III
Essay 5. Hormonal replacement Therapy
1. Define DUB. Explain the 6. Menstrual irregularities
pathophysiology and clinical features of Differentiate between
DUB. Describe the management of a 7. Uterine cycle and ovarian cycle
patient with DUB. 8. Ovulatory and Anovulatory bleeding
Short Notes 9. Abnormal uterine bleeding and post
2. Menstrual Dysfunction menopausal bleeding
3. Premenstrual syndromes 10. Menorrhagia and metrorrhagia
4. Menopause/climacterics 11. Menarche and menopause

ANSWER KEY and antiplatelet] and less PGF2

Essay [vasoconstriction]
1. Define DUB. Explain the
pathophysiology and clinical features Increased fibrinolytic activity
of DUB. Describe the management of a
patient with DUB. Irregular bleeding
Introduction Management of DUB
Definition- General
DUB is a state of abnormal uterine  Rest
bleeding without any clinically  Anemia
detectable organic, systemic and  Any systemic and endocrinal
iatrogenic cause abnormality
Incidence Medical
Pathophysiology  Prostaglandin synthetic
 ANOVULATORY(80%) inhibitors
Due to alteration in hypothalamic-  Fenamates (Mefenamic acid )
pituitary axis corpus luteum not formed  Antifibrinolytics
 Tranexamic acid (TA)
Failure of the cyclical secretion of  Hormones
progesterone  Norethisterone acetate
 Medroxyprogestrone acetate
Leads to continuous unopposed  Progestin releasing IUD
production of estradiol  Deydrogesterone
 Combined estrogen and
Stimulates overgrowth of the progesterone
endometrium.  19 Non-steroid derivative
 Testosterone
Endometrium grows thick ,outgrows its  GnRH analogs
blood supply necrosis and irregular  Desmopressin
bleeding Surgery
 OVULATORY (20%)  Uterine curettage
Due to defect in local endometrial  Endometrial ablation or resection
hemostasis  Hysterectomy
Nursing management
Absence of progesterone • Encourage patient to comply the
medication to reduce discomfort and
Alterations in prostaglandin production, pain • Explain importance of iron-rich
with more PGE2 PGI2 [vasodilatation foods to supplement iron.
 • Explain methods of quantifying blood perimenstrually and also at
loss and reporting to health-care other times.
provider. • Assist in and teach patient  Amenorrhea :-
pain-relieving techniques to promote Absence of menses
self-sufficiency in managing pain. Management
• Assess meaning of dysfunction for o Medical
patient to explore self- concept issues. management
• Encourage patient to express her o Surgical
feelings to increase understanding of management
individual coping style. o Nursing
Nursing Diagnosis management
 Acute Pain related to defective
endometrial stimulation 3. Premenstrual syndromes
 Fear related to abnormal health status Pre- menstrual tension is a
 Deficient fluid volume related to fluid Psychoneuro endocrine disorder of
loss unknown etiology, often noticed just
 Ineffective peripheral tissue perfusion prior to menstruation.
 Fatigue related to blood loss. Pathophysiology
 Impaired comfort
 Sexual dysfunction related to altered
body function associated with uterine
bleeding
Short Notes

2. Menstrual Dysfunction
 Dysmenorrhea:-Painful
menstruation of sufficient
magnitude so as to incapacitate
day to day activities.
 Primary-no identifiable pelvic
pathology
 Secondary-associated with
pelvic pathology Clinical features
 Pelvic congestion syndrome:- Treatment
congestive pelvic discomfort Non-pharmacological
due to disturbance in autonomic  Life style modification
nervous system, which may lead  Dietetic advice and exercise
to gross vascular congestion Non-hormonal
with pelvic varicosities.  Pyridoxin 100mg daily
 Pre-menstrual syndrome:–  Anxiolytic -Alpraxolam 0.25mg
Psychoneuro- endocrine BD
disorder of unknown Selective serotonin reuptake inhibitors( SSRI)
etiology ,often noticed just prior  Fluoxetine 20mg per day
to menstruation.  Sertaline 50mg per day
 Mittelschmers’s syndrome :-
Ovular pain in midmenstrual 4. Menopause/climacterics
period situated in hypogastrium Menopause means permanent
or in either side of iliac fossa. cessation of menstruation at the end of
 Menstrual migraine:-attack of reproductive life due to loss of ovarian
migraine that occurs either follicular activity.
perimenstrually or both
  Parathyroid hormone
Complementary and alternative medicine
 Acupuncture –decreases hot flushes
Nursing management
 Thorough physical examination and
history collection
 Proper counseling.
 Lifestyle modification
Clinical features  Dietary modification-high-
5. Vasomotor symptoms calcium,protein, vitamin rich,low fat
6. Urogenital atrophy diet
7. Osteoporosis and fracture  Encouraging physical activity.
8. Cardiovascular disease
 Family counseling
9. Cerebrovascular diseases
 Prevention of fracture
10. Psychological changes
11. Skin and hair  Regular follow-up for ruling out
12. Sexual dysfunction cardiovascular diseases.
13. Dementia and cognitive decline Nursing diagnosis
Diagnosis of menopause
 Cessation of menstruation for 12 5. Hormonal replacement Therapy
consecutive months during climacteric. Introduction
 Average age of menopause: 50yrs Indications for hormone therapy
 Appearance of menopausal symptoms  Relief of post menopausal
“hot flushes” and night sweats. symptoms
 Vaginal cytology.  Relief of vasomotor symptoms
 Low serum estradiol less than <  Prevention of osteoporosis
20pg/ml.  To maintain quality of life
 Serum FSH and LH > 40mIU/ml. Benefits of hormone therapy
Conservative management Drug regimen
 Proper counseling Hormonal treatment
 Reassurance  Oral estrogen regime
Treatment  Estrogen and cyclic progestin therapy
Non-hormonal treatment  Transdermal administration of estrogen
 Lifestyle modification  Subdermal implants
 Nutritious diet  Percutaneous estrogen gel
 Supplementary calcium  Vaginal gel
 Exercise  Progestins
 Vitamin D  Levonogestrel intrauterine system
 Cessation of smoking and alcohol  Tibolone
 Administration of biophosphonates,  Testosterone
calcitonin, clonidine (hot  Parathyroid hormone
flushes),paroxetine ,vitamin E etc Contraindications of hormone therapy
Hormonal treatment  Breast cancer
 Oral estrogen regime  Genital tract bleeding
 Estrogen and cyclic progestin therapy  Neoplasm in body
 Transdermal administration of estrogen  DVT
 Subdermal implants  Active liver disease
 Percutaneous estrogen gel  Jaundice
 Vaginal gel  Gallbladder disease
 Progestins  Endometriosis
 Levonogestrel intrauterine system Complications of hormone therapy
 Tibolone  Endometrial cancer
 Testosterone  Breast cancer
  DVT
 CHD
 Altered lipid metabolism
 Dementia
 Alzheimer disease
Pre –evaluation prior hormone therapy
Nurses responsiblity