1. Health care for Women
Disease of women’s reproductive
organs

2. contents
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Health assessment for women
Infectious disease of genitalia
Sexual transmitted disease
Endometrial problems
Tumor of reproductive organs
Menstrual disorders

3. Health assessment for women
Papanicolaur test(Pap smear)
Breast self examination(BSE)

4. Papanicolau test(Pap smear)
• Regular pelvic examination and Pap smear
are the best way to assess and detect
condition in the reproductive system early
• The Pap smear is a safe and in expensive
tool for early detection of cervical cancer
• Early diagnosis, the cure rate is almost 100%
• Ps; Papanicolau test; DevelopedGreek Physician Dr.
George Papanicolau in the 1940s

5. Screening schedule and guideline
• 1st Pap smear; age 18/or first intercourse
• 18-64yr; Yearly or every 3 yrs after
consecutive yearly normal results
• Age 65; Yearly, or 3yrs after two
consecutive yearly normal results
• Age 70: stop Pap test
• Ps; U.S. preventive service task force guidelines

6. Classification of Pap smear
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Dysplasia
CIN
SIL
mild
grade 1 low grade
moderate
grade 2
severe
grade 3 high grade
Carcinoma in situ
CIN= cervical Intra epithelial neoplasia
SIL= Squamous Intraepithelial lesion

7. Risk factors for cervical cancer
• Exact etiology is Unknown
• Sexual behavior and history; multiple partner,
rape, early age sexual intercourse
• HPV(Human papillomavirus) infection;
HPV 16, 18, 45, 58
HPV 16 squamous cancer
HPV 18 adenocarcinoma
• Lower socioeconomic status
• Cigarette smoking

8. Performing a pelvic exam and Pap
smear
• Purpose; to evaluate the condition of the internal
female reproductive structure and to obtain specimen
for cytologic screening
• Equipment;
- Examination glove,
- Sheet or bath blanket for draping,
- Specimen collection devices-cyto-brush and plastic
spatula,
- Label specimen container or slide and splay
fixative
- Complete lab request
- Adequate light source

9. Implementation
1. Explain the procedure
2. Empty bladder to minimize
discomfort and easy
palpation internal organs
3. Wash hand
4. Have client position herself
on the exam table-buttocks
are just past the bottom
edge of the table
5. Place sheet over the client
for privacy
6. Ask relaxation technique

10. Implementation
7. Put on gloves
8. Warm the speculum with
warm water to avoid
chilling the clint
9. Using gloved hand,
spread the labia,
inspecting and palpating
the area to check for
abnomalities;
throughout encourage
the women take deep
breaths to aid in
relaxation

11. Implementation
10. Insert the warmed
speculum in to the
vagina and slowly
open the blades to
allow clear
visualization of cervix;
once in place, lock
the blades

12. Implementation
11. Obtain samples for
pap smear; use the
cytoblush or sterile
cotton tipped applicator
and swab the
endocervix, using one
full circular motion
12. Use the plastic curved
spatula to gently and
firmly scrape the cervix
os

13. Implementation
13. Immediately after collecting each
specimen in the appropriately
labeled container or slide and
spray with a fixative
14. Unlock the blades of the
speculum and remove it gently to
reduce the risk for trauma too the
client
15. Remove the glove from the
nondominant hand and place on
low abdomen; insert a lubricated
gloved finger of the dominant
hand in to vagina to perform the
bimanual examination
16. Assist the client to sitting position
and allow her to get dress

14. Result
• If infection is suspected cause abnormal
result treat the infection, repeat test
• If infection is not reason  colposcopy,
biopsy
• Pap smear is most valuable, simple, easy
and cost effective screening test for early
detect of cancer
• Barriers to gynecologic checkups and pap
smear; fear, lack of information, cultural belief,
social status, embarrassment, absence of
symptom, lack of time and cost

15. Breast Heath
• Purpose: preventing breast cancer
• Key: risk factor screening, diagnostic
testing
• Risk factors: being a women, age, family
history of breast cancer
• Gene theory: Breast cance1(BRCA1)
Breast cancer2(BRCA2)
Ps; In 1994 discovered and found correlate with
increase for breast, ovarian and other cancer

16. Breast Heath
• Breast cancer is most common cancer in
women.
• Treatable cancers if detected early
• 5 yr survival rate as
- 99% no invasion
- 90% for local invasion
- 68% regional spread
* Early detection is most important

17. Breast Cancer Screening
Recommendation
• Breast Self Examination: monthly at 20yr
• Clinical Breast Examination: every 3 yrs
from 20-40 yrs, yearly after 35 yrs if at risk,
yearly after 40yrs
• Mammography: 35 yrs if at risk
every 1-2yrs from 40-50yrs,
every year after 50

18. Breast Self Examination(BSL)
1. Observation in a mirror for any change in
appearance of breast
2. To check their own breast by methodically
palpating the breast tissue for change and
lumps
3. The best time to examine the breast is few
days after the menstrual period
4. BSE is most comfortable after the menstrual
period because the breast are least tender

19. Breast Self Examination(BSL)
• The following signs and symptoms require
follow-up
- Lump
- Pain(breast cancer or may not painful)
- Discharge
- Skin change
- Lymphadenopathy, with or without other
symptoms
- Any change the women finds as personal
unusal

20. Breast Self Examination(BSL)
• BSE early detection of potential
malignancies continues to be single most
important factor in successful treatment of
breast cancer.
• Nurse should encourage and educate
women on performing BSE regardless of
field of nursing.

21. Step in the Breast Self
Examination(BSL)

22. Step in the Breast Self
Examination(BSL)

23. Clinical Breast Examination
• Clinical Breast
Examination:
- Experienced
professionals may
find changes that the
women has missed.
- To demonstrate and
explain a through
breast examination
• Mammography

24. Steps in the clinical breast
examination

25. Steps in the clinical breast
examination