NURSING MANAGEMENT OF MENOPAUSE

PRESENTED BY,Suby Annu,

First year M.Sc nursing

INTRODUCTION

During her life ,a woman undergoes alot of changes in her reproductive system which finally ends in a condition called menopause.It is a natural lifechange that can be very distressing for someone and not so for others.The word menopause originates fromthe Greek words ‘men’ meaning month and ‘pauses’ meaning cessation.

DEFINITION

1.Menopause is the permanent physiologic cessation of menstruation,associated with decreased ovarianfunction; reproductive function diminishes and ends.2.Menopause is a term used to describethe permanent cessation of the primary functions of the human ovariesi.e the ripening and release of ova andthe release of hormones that cause thecreation of the uterine lining and the subsequent shedding of the same.

3.Menopause refers to all the transition years.Also known aschange of life’’ or

‘climacteric’ or as ‘perimenopause.’Meno pause is medically declared in a woman who has had amenorrhoea for one year. Though menopause is often referred to as ‘cessation of menstruation’ it is seen that women whose uterus is removed but ovaries are preserved do not go into menopause but women whose ovaries are removed, go into immediate

menopause.

PERIMENOPAUSE

The term refers to the years when menstruation starts becoming irregular to the time when it stops.It can begin as early as 35 years of age and can last for a few years to ten years or more.During this period, the production of estrogen and progesterone by the ovaries becomes irregular.The fertility diminishes but is not zero.F.S.H levels are high.

TYPES

Natural menopause:mean age in Indian women is 44 years and that in

Westerners is 54 years. Premature menopause: it is due to

premature ovarian failure secondary to systemic diseases like autoimmune

disorders,thyroid diseases,chemo therapy,radiotherapy e.t.c.

Surgical menopause:due to surgical remo

val of ovaries or injury to the blood vessels supplying them or due to chemotherapy or radiotherapy.

HORMONAL MECHANISM IN MENSTRUATION

CHANGE IN PHYSIOLOGY

Decreased estrogen and progesterone

Increased F.S.H from pituitary

CLINICAL MANIFESTATIONS1.Vasomotor instability: Hot flashes:sudden involuntary

waves of heat beginning in the chest or neck and passing to the head and

face. - Lasts for a few seconds to one hour. - Increases with anything that increases the body temperature. Hot flushes:measurable changes in

the body temperature of the skin with a pink to red change in skin colour.

Night sweats-a hot flash with or without a hot flush.Followed by mild to severe sweating followed by chills

Increased risk of atherosclerosis. Migraine. Irregular and rapid heart beat.2. Menstrual irregularities:The amount of

flow may increase ,decrease become irregular and finally stops.The interval between periods becomes longer,maybe a few months.

3.Urogenital changes: Urogenital atrophy. Thinning of the membranes of the vulva,

vagina ,cervix and outer urinary tract. Thinning of pubic hair. Shrinking of labia. Vaginal irritation and dryness. Pruritis. Increased leucorrhoea. Urinary frequency and incontinence. Vaginal and urinary infections.

UROGENITAL CHANGES IN MENOPAUSE

4.Psychological effects: Anxiety Depression Forgetfulness Mood swings Memory loss

COMPLICATIONS

Osteoporosis and spontaneous fractures.

High levels of circulating cholestrol levels.

Cystocele,rectocele. Uterine prolapse.

MEDICAL MANAGEMENT

Hormone replacement therapy(H.R.T, H.T) Estrogen and progesterone in a

woman with a uterus. Estrogen only for women with

hysterectomy. Although beneficial in many ways H.T

increases the risk of breast cancer,stroke,heart attacks e.t.c.

GUIDELINES FOR H.T

Started in women who have recently had menopause.

Should not be used for more than five years.

Lower dose of estrogens preferred. Frequent and regular pelvic

examinations and Pap smears should be done

Medicines used: Estrogen only e.g conjugated

equine estrogen (premarin) Estrogen-progestin combination

e.g (premarin plus provera). Methods of administration: -Tablets -Dermal patches -Vaginal creams rings,

suppositories.

Other medicines: -Selective estrogen receptor

modulators. Act as agonists on bones and as antagonists on breasts and uterus.eg.Raloxifene,Tamoxifene.

-Antidepressants. -Antihypertensives. -Gabapentin. -Vitamins B6 andvit:E.

BONE AND HEART HEALTH

Weight bearing exercises. Avoid alcohol and smoking. Diet rich in calcium,low in saturated fat .

SCREENING

Regular gynaecologic examinations. Mammograms. Colonoscopy Fecal occult blood testing Bone mineral density.

NUTRITION

Low fat ,low caloric diet. Calcium-1200-1500 mg, vit.D-800 IU Adequate intake of whole grains,

fibre, fruits and vegetables.

ALTERNATE MEDICINE

Herbal preparations like soya products to be taken under medical supervision.

Accupuncture. Meditation.

NURSING MANAGEMENT

Provide education,support and assistance to cope with the phase.

Accurate information is given to increase adjustability.

Educate about risks and benefits of H.R.T. Advise use of topical estrogen preparations

to relieve vaginal discomfort. Stress on importance of weight bearing

exercises,cessation of smoking and alcohol. Good perineal hygiene and increased fluid

intake helps prevent UTIs. Kegel’s exercises.

CONCLUSION

Though menopause is a difficult phase in a woman’s life, proper nursing management and client participation in health care planning can help improve the life quality in menopausal women.

NURSING MANAGEMENT OF A VICTIM OF SEXUAL

ASSAULT

INTRODUCTION

Sexual assault has become very common and the victims need sensitive and proper management.Nurses in the emergency department are required to have skill in handling such cases.

MEANING Sexual assault or ‘RAPE’ is forced sexual acts especially when it involves vaginal

or anal penetration.

ASSESSMENT AND DIAGNOSIS Crisis intervention starts when the client

enters the emergency department. Specially trained nurses called sexual

assault nurse examiners(SANE) manage these cases.

They are trained with special skills:forensic evidence collection,history taking,documenting and ways of approaching the patient.

She also needs skills in photography,videography,colposcopy and

microscopy.

RAPE TRAUMA SYNDROME Characterised by: An acute disorganisation phase-

shock,disbelief,fear,guilt,humiliation which are expressed or hidden.

A phase of denial-unwilling to talk,anxiety,flashbacks,sleep disturbances, hyperalertness and psychosomatic disorders.

Phase of reorganization-recovers or develops chronic stress disorders and phobias.

MANAGEMENT

The goals of management are: To give sympathetic support and

counselling. To reduce the patient’s emotional

trauma. To gather available evidence for

legal proceedings. Encourage patient to gain control

over her life.

PHYSICAL EXAMINATION

Written and informed consent for physical examination,photography and revealing findings to the police.

History taking if it was not taken by police or counsellor.

Record history in the patient’s own words.

Ask if the patient has bathed brushed,changed clothes or passed urine or faeces.

Document the time of admission,date and time of alleged rape,patient’s condition ,evidence of trauma.

Head to toe examination for injuries especially to the head ,neck,breasts ,thighs,buttocks etc.

Look for: -evidence of trauma -dried semen stains -broken finger nails,body tissues

and foreign materials Oral examination

Pelvic and rectal examination SPECIMEN COLLECTION Vaginal discharge for presence of sperms Swab specimens of vaginal secretions Oral,anal and vaginal smears Culture for gonorrhoea Blood serum for syphilis and HIV Pregnancy tests Any foreign material Pubic hair samples

TREATING POTENTIAL PROBLEMS Prophylactic antibiotics Antipregnancy measures FOLLOW UP CARE Counselling services Refferal to the help organizations Follow up for surveillance of

pregnancy,STDs and HIVtesting Rehabilitation

NURSES RESPONSIBILITY Physical examination and collection

of evidence Provide support and counselling Never leave the client alone Encourage talking Show empathy and honest listening Be available Promote physical comfort and sense

of security Explain every procedure

Tell her what to expect immediately and afterwards

Maintain eye contact. CONCLUSIONRecovery of a client from sexual

assault is along term process that can be facilitated by constant support from care givers,family and friends.

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