SAS 22

• There are three parts to a woman’s reproductive history: menstrual history, obstetric history, and sexual history.
• All responses must be given importance to social distancing, hygienic practices, and wearing of mask at all times.
• Respond to students’ answers during the next class meeting or as soon as possible.
• It is usually more comfortable for the patient if the nurse begins with the menstrual and obstetric history and saves the sexual history questions for last.
• If the woman comes to you relating to the issue, the nurse should start with the sexual history.
• The five phases of a woman’s reproductive health are: prepuberty (premenstruation), puberty (menarche), childbearing (menstruation), perimenopausal, and menopausal.
• The nurse must incorporate the needs of each phase into the assessment process as appropriate for the individual.
• When a woman reports a problem in the reproductive system, the “OLD CART” mnemonic may be used to elicit a full history of the problem.
• If no problem is reported, obtain a baseline reproductive history starting with the menstrual history.
• Menarche, Menstruation, Menopause.
• Oligomenorrhea is not a term used to describe an interval between menses.
• Estrogen replacement can increase the risk of thrombosis, varicosities, hypertension, and heart failure.
• Salpingitis is a type of pelvic infection.
• Lack of progesterone, luteinizing hormone, estrogen, and lactogen can cause sexual dysfunction such as inadequate vaginal lubrication and inability to achieve orgasm.
• Vaginismus is a condition characterized by involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during intercourse painful or impossible.
• Human immunodeficiency virus, Neisseria gonorrheae, Treponema pallidum, and Herpes zoster cannot cause a sexually transmitted disease.
• Endometrial polyps are a type of pelvic infection.
• Endometriosis is a type of pelvic infection.
• Depression is not a sign of premenstrual syndrome.
• Pelvic inflammatory disease is a type of pelvic infection.
• Hot flashes, flushing, sleep disturbances, and all of the above are signs and symptoms of perimenopause.
• Primary dysmenorrhea results from prostaglandin production during which phase of the menstrual cycle?
• The setting of sexual dysfunction is an important but complicated topic, involving the patient’s general health; medications and drugs, including use of alcohol; her4 of 6 partner’s and her own knowledge of sexual practices and techniques; her attitudes, values, and fears; the relationship and communication between partners; and the setting in which sexual activity takes place.
• In addition to ascertaining the nature of a sexual problem, ask about its onset, severity (persistent or sporadic), setting, and factors, if any, that make it better or worse.
• A reassuring manner will help them express concerns about their sexual health and activity.
• Direct questions about sexual orientation may be difficult to answer.
• Ask also about dyspareunia (pain or discomfort during intercourse).
• A woman may lack desire, she may fail to become aroused and attain adequate vaginal lubrication, or, despite adequate arousal, she may be unable to reach orgasm.
• What does the patient think is the cause of the problem, what has she tried to do about it, and what does she hope for?
• Are they painful or not?
• If they are living (or have lived) with someone, ask what their relationship is to that person, then follow up using the patient’s language.
• Because patients vary in their understanding of anatomic terms, be prepared to try alternative phrasing such as “Any itch ing (or other symptoms) near your vagina?
• Ask about any local sores or lumps in the vulvar area.
• The cause of vaginismus may be physical or psychological.
• Also ask about oral and anal sex and, if indicated, about symptoms involving the mouth, throat, anus, and rectum.
• Local symptoms or findings on physical examination may raise the possibility of sexually transmitted diseases (STDs).
• Superficial pain suggests local inflammation, atrophic vaginitis, or inadequate lubrication; deeper pain may be from pelvic disorders or pressure on a normal ovary.
• After establishing the usual attributes of any symptoms, identify sexual preference (male, female, or both).
• Inquire about sexual contacts and establish the number of sexual partners in the prior month.
• Ask if the patient has concerns about HIV infection, has been tested for HIV previously, desires HIV testing, or has current or past partners at risk.