Chapter 4

Assessment and Health

Promotion

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 Learning Objectives
 Identify the structures and functions of the
female reproductive system.
 Describe the menstrual cycle in relation to
hormonal, ovarian, and endometrial
response.
 Identify the phases of the sexual response
cycle.
 Describe common reasons that women enter
the health care system.
 Analyze barriers that may affect a woman’s
decision to seek health care.
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 Learning Objectives (Cont.)
 Describe risk factors for women’s health in
the childbearing years.
 Describe the components of the history and
physical examination.
 Describe how to adapt the history and
physical examination for women with special
needs.
 Describe how to screen for/identify signs of
abuse, including referral to community
agencies.

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 Learning Objectives (Cont.)
 Identify the steps for assisting with and
collecting specimens for Papanicolaou (Pap)
testing.
 Outline the health-screening and
immunization recommendations for women
across the life span.
 Describe anticipatory guidance that prevents
disease and promotes health and self-
management.

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 Female Reproductive System
 External structures
 Mons pubis
 Labia majora and labia minora
 Prepuce
 Frenulum
 Fourchette
 Clitoris
 Vaginal vestibule
 Perineum

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Female Reproductive System (Cont.)
 Internal structures
 Vagina
 Uterus
• Corpus—upper triangular portion
• Fundus—dome-shaped top of uterus
• Cervix—lower cylindrical portion
• Isthmus—lower uterine segment that separates the
corpus from the cervix
 Uterine tubes
• Fallopian tubes
 Ovaries

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Female Reproductive System (Cont.)
 Internal structures
 Uterine wall
• Endometrium
• Myometrium
• Peritoneum (partial)
 Uterine tubes (fallopian tubes)
• Attach to uterine fundus
• Divided into 4 sections
 Ovaries
• Ovulation
• Hormone production

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Female Reproductive System (Cont.)
 Bony pelvis: primary
purposes
 Protects the pelvic
structures
 Accommodates the
growing fetus during
pregnancy
 Anchors the pelvic
support structures
 Bony pelvis: two parts
 False pelvis
 True pelvis

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Female Reproductive System (Cont.)
 Breasts
 Located between second and sixth ribs
 Upper 2/3 overlies pectoralis muscle
 Lower 1/3 overlies serratus anterior muscle
 Estrogen
• Stimulates growth of breasts
• Increases vascularity
 Progesterone
• Causes mammary gland maturation

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Female Reproductive System (Cont.)
 Breasts (Cont.)
 Each mammary gland is made up of a number of
lobes divided into lobules
 Lobules are clusters of acini
• Acinus is a saclike terminal part of a compound gland
emptying through a narrow lumen or duct.
• Acini are lined with epithelial cells that secrete colostrum
and milk.

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Female Reproductive System (Cont.)
 Breasts (Cont.)
 Change in size and nodularity in response to
cyclic ovarian changes
 Physiologic alterations in breast size reach
minimal level 5 to 7 days after menstruation stops
• Breast self-examination (BSE) best carried out during
this phase of menstrual cycle
 Function
• Lactation
• Sexual arousal in mature adult

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 Menstruation and Menopause

 Menarche and
puberty
 Menstrual cycle
 Hypothalamic-
pituitary cycle
 Ovarian cycle
 Endometrial cycle
 Other cyclic changes

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Menstruation and Menopause (Cont.)
 Prostaglandins (PGs)
 Oxygenated fatty acids classified as hormones
 Affect smooth muscle contractility and modulation
of hormonal activity
 Play a key role in ovulation
 Increase the motility of uterine musculature
 Tubal and uterine motility
 Sloughing of endometrium: menstruation
 Initiation and maintenance of labor

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Menstruation and Menopause (Cont.)
 Climacteric and menopause
 Climacteric
• Transitional phase during which ovarian function and
hormone production decline
• Spans the years from onset of premenopausal ovarian
decline to postmenopausal time when symptoms stop

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Menstruation and Menopause (Cont.)
 Climacteric and menopause (Cont.)
 Menopause
• Last menstrual period
• Dated with certainty only 1 year after menstruation
ceases
 Perimenopause
• A period preceding menopause that lasts about 4 years

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 Sexual Response
 Females and males achieve physical maturity
at approximately age 17 years.
 Individual development varies greatly.

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 Sexual Response (Cont.)
 Women and men are more alike than
different in their physiologic responses to
sexual excitement and orgasm.
 Glans clitoris and glans penis are embryonic
homologs.
 Little difference exists between female and male
sexual responses.

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 Sexual Response (Cont.)
 Sexual stimulation results in increase in
circulation to circumvaginal blood vessels.
 Venous congestion is localized primarily in
the genitals.
 Lesser degree in breasts and other parts of the
body

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 Sexual Response (Cont.)
 4 phases of sexual response cycle
 Excitement phase
 Plateau phase
 Orgasmic phase
 Resolution phase
 Time, intensity, and duration for cyclic
completion vary for individuals and situations

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Reasons for Entering the
Health Care System
 Preconception
counseling and care
 Pregnancy
 Well-woman care
 Fertility control and
infertility
 Menstrual problems
 Perimenopause

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 Barriers to Seeking Health Care
 Financial issues
 Cultural issues
 Gender issues
 Gender of health care provider
 Sexual orientation may also be a barrier
 Providers need to develop an approach that does
not assume that all clients are heterosexual

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 Health Risks to Women (Cont.)
 Age
 Adolescence
• Teenage pregnancy
 Young and middle adulthood
• Parenthood after age 35
 Late reproductive age

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 Health Risks to Women (Cont.)
 Social, cultural, economic, and genetic factors
 Substance use and abuse
 Smoking
 Alcohol consumption
 Caffeine
 Prescription drug use
 Illicit drugs

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 Health Risks to Women (Cont.)
 Nutritional deficiencies
 Obesity
 Eating disorders
● Subclinical eating disorders
● Anorexia nervosa
● Bulimia nervosa
● Binge eating disorder
 Lack of exercise
 Stress
 Depression, anxiety, and other mental
health conditions
 Sleep disorders
 Environmental and workplace hazards

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 Health Risks to Women (Cont.)
 Sexual practices
 Undesired pregnancy
 STIs
 Medical conditions
 Gynecologic conditions
 Female genital mutilation
 Practiced in more than 45 countries, the majority
of which are in Africa
 Violence against women; IPV

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 Health Assessment
 Interview
 Open-ended questions
 Cultural considerations
• Using the 4 C’s of Cultural Competence
 Women with special needs
 Women with disabilities
 Abused women
 Adolescents (ages 13 to 19 years)
 Midlife and older women (ages 50 years and older)
 Healthy aging

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 Health Assessment (Cont.)
 Review health history
 Physical examination
 General appearance
 Lungs
 Vital signs
 Abdomen
 Skin
 Extremities
 Head
 Genitourinary
 Eyes and ears
 Rectal
 Nose, mouth, and throat
 Musculoskeletal
 Neck, lymphatic
 Neurologic
 Breasts
 Heart
 Peripheral vascular
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 Health Assessment (Cont.)
 Pelvic examination
 External inspection and palpation
• Teaching vulvar self-examination
(VSE)
 Internal examination
• Collection of specimens
• Papanicolaou test (“Pap smear”)
• Vaginal wall examination
 Bimanual palpation
 Rectovaginal palpation
 Pelvic examination during
pregnancy
 Pelvic examination after
hysterectomy
 Laboratory and diagnostic
procedures
 STI testing
 Other serum lab tests
 Other screening tests: TB, hearing,
vision, mammogram

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Anticipatory Guidance for Health Promotion
and Illness Prevention

 Health promotion
 The motivation to increase well-being and
actualize health potential
 Illness prevention
 The desire to avoid illness, detect it early, or
maintain optimal functioning when illness is
present

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Anticipatory Guidance for Health Promotion and
Illness Prevention (Cont.)

 Nutrition
 Exercise
 Kegel exercises
 Stress management
 Substance use
cessation
 Sexual practices
that reduce risk

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Anticipatory Guidance for Health Promotion and
Illness Prevention (Cont.)
 Health screening
schedule
 Health risk
prevention
 Health protection
 Nurses can make a
difference in
stopping violence
against women and
preventing further
injury

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 Key Points (Cont.)
 Normal feedback regulation of the menstrual
cycle depends on an intact hypothalamic-
pituitary-gonadal mechanism.
 The female’s reproductive tract structures
and breasts respond predictably to changing
levels of sex steroids across her life span.
 The myometrium of the uterus is uniquely
designed to expel the fetus and promote
hemostasis after birth.

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 Key Points (Cont.)
 The changing status and roles of women affect their
health, needs, and ability to cope with problems.
 Anticipatory guidance is enhanced in a private, safe
environment in which the interaction is culturally
competent, nonjudgmental, and confidential.
 Culture, religion, socioeconomic status, personal
circumstances, the uniqueness of the individual, and
the stage of development influence a person’s
recognition of the need for care and the response to
the health care system and therapy.

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 Key Points (Cont.)
 Preconception counseling allows
identification and possible remediation of
potentially harmful personal and social
conditions, medical and psychologic
conditions, environmental conditions, and
barriers to care before pregnancy occurs.
 Conditions that increase a woman’s health
risks also increase risks for her offspring.
 Effective educational programs about sex and
family life are imperative to control the rate of
teen pregnancy and STIs.

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 Key Points (Cont.)
 Health promotion and prevention of illness assist
women to actualize health potential by increasing
motivation, providing information, and suggesting
how to access specific resources.
 IPV against women is a major social and health care
problem in the United States and includes physical,
sexual, emotional, psychologic, and economic abuse.
 Periodic health screening, including history, physical
examination, and diagnostic and laboratory tests,
provides the basis for overall health promotion,
prevention of illness, early diagnosis of problems,
and referral for management.
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 Question
1. When obtaining a reproductive health history from a
woman, the nurse should:
1. Limit the time spent on exploration of intimate topics
2. Avoid asking questions that may embarrass the woman
3. Use only accepted medical terminology when referring
to body parts and functions
4. Explain the purpose for the questions asked and how
the information will be used

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