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Elisa WeberJan 2017WEEK 13: NORMAL BIRTH II ASSIGNMENT 2: VARNEY’S MIDWIFERY Read p.381 – p.426 in Varney’s Midwifery– Normal Labor and Birth found in the lending library. Please do not leave the classroom with this book.Ectopic pregnancy is usually accompanied by light cramp-like abdominal or pelvic pain. Appendicitis is accompanied with right lower quadrant pain accompanied by a fever and an elevated white blood count. Ovarian torsion can cause acute pelvis pain is an uncommon cause. Women with pyelonephritis may also have back or flank pain and tenderness at the costovertebral angle. Spicy foods, alcohol, stress, or sexual activity can increase IC symptoms. Fear of pain, as well as pain during sexual activity, can produce a distressing cycle of sexual frustration and tension in relationships. Examination of the vulva includes evaluation of skin changes, vaginal secretions, presence of lesions, and changes in the vulvar architecture. Among women with pelvic pain, 40%-50% have been found to have endometriosis. The goals of surgical treatment for endometriosis may include the attempt to restore normal reproductive function in addition to the reduction of pain by removing the lesions. Fibroids are described based on their location. Fibroids are the most common diagnosis associated with hysterectomy. Unlike fibroids, which are made up of uterine smooth muscle, adenomyosis results from the growth of endometrial tissue in the myometrium layer of the uterus, typically causing uterine enlargement. Ovarian cysts may or may not be palpable, depending on their size and location. If the cyst increases in size, further evaluation must be made to rule out an ovarian neoplasm or other mass. Ovarian enlargement can be a sign of polycystic ovary syndrome.In the embryo, the two mullerian ducts differentiate to form the uterus, cervix, superior portion of the vaginal, and fallopian tubes. The two most common findings related to pelvic floor changes are pelvic organ prolapse and urinary incontinence. Asking the woman to perform a Valsalva maneuver or cough allows the midwife to visually assess the level of vaginal wall support. UI condition is often associated with significant diminishment of a woman’s quality of life. Reassurance that having to void once or twice during the night is not necessarily indicative of urinary dysfunction.Type of involuntary caused by effort or exertion is a sign of stress urinary incontinence. Estrogen use for urinary incontinence was once thought to be promising therapy, especially for postmenopausal women. The activity level of adolescents, especially young athletes, might also contribute to a musculoskeletal injury presenting as pelvic pain, this may be an issue that an OBGYN may see when dealing with teen girls. Feelings of depression, sadness, or worry about gynecologic function may contribute to or manifest as physical pain. It must be the primary goal of the midwife providing her care to address her health needs in a manner that does not add to her physical or emotional distress, when dealing with victims of abuse. Helping women understand the importance of breast self-awareness, cervical cancer screening via Pap tests, or other regular cancer screening modalities without raising excessive fears requires skilled communication. Significant changes in screening techniques for cervical cancer have occurred over the last two decades. Candida found on a pap test most likely does not require treatment. If any lesions of the cervix are found during the magnified inspection of the colposcopic procedure, sampling of the region is required. Some oncologists recognize a third type of endometrial cancer, which is known to be hereditary in nature and is less commonly found that type I or II. Clinically, the most significant sign of endometrial cancer is bleeding. An accurate cost-effective screening method for endometrial cancer remains elusive. The most common symptoms/sign of this form of cancer is abnormal uterine bleeding regarding uterine sarcomas. With ovarian cancer and most cancers, the risk of contracting the disease rises with age. Reminders for women about the signs and symptoms of ovarian cancer may potentially aid in detecting this carcinoma. Additional symptoms of ovarian cancer such as abdominal or pelvic pain, fatigue, urinary problems including urgency or frequency, irregular vaginal bleeding – tend to appear later in the course of the disease. As with all midwifery care, the essential element of practice in each of these situations is to listen to the woman and what she has to say about her condition and the effect it has on her life. Tanner’s classification of sexual maturity is a scale used to evaluate breast and pubic hair growth as a way of assessing normal growth development. The amount of fat present determines the size of the breast. In the past women were encouraged to perform monthly breast self-examination.A standard screening mammogram involves four images that are evaluated for changes that are suspicious of cancer, micro calcifications, distortions of the normal architecture of the breast, and any non-palpable lesions. Women who are at high risk for breast cancer most likely are more fearful of a delayed diagnosis of breast cancer than of a false-positive result. The clinical examination should include examination of the neck, breasts, chest wall and axillae. The most common benign breast disorders are fibrocystic changes, breast cysts, and fibroadenomas. More frequent screening for breast cancer and strategies to reduce breast cancer risk may be recommended as well. Nipple discharge is common in reproductive age women and generally benign, although 10% to 15% of women with nipple discharge do have breast cancer. According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results survey, African American women have a lower incidence of breast cancer but have a higher risk of breast cancer recurrence. Breast cancer treatment usually involves surgery that may be followed with radiation therapy, chemotherapy, hormonal therapy, or immunotherapy. Breast reconstruction should be an option for all women. ................
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