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 Compare the various types of: › Female and Male Reproductive Disorders  Definition  Clinical Manifestations  Diagnosis  Nursing Intervention.

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Presentation on theme: " Compare the various types of: › Female and Male Reproductive Disorders  Definition  Clinical Manifestations  Diagnosis  Nursing Intervention."— Presentation transcript:

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2  Compare the various types of: › Female and Male Reproductive Disorders  Definition  Clinical Manifestations  Diagnosis  Nursing Intervention

3  9trSv8I 9trSv8I

4  Prostate disorders › Benign Prostate Hyperplasia › Prostate Cancer › Prostatitis  Erectile dysfunction  Testicular & scrotal disorders  Penile disorders

5  A gland  Location: › lies just below the neck of the bladder & surrounds the urethra  Function: › Produces part of semen

6  Benign prostatic hyperplasia  Prostate cancer  Prostatitis

7  Obstruction by enlarged prostate  Symptoms  Dysuria  Hematuria  Swelling in legs  Blood in semen  Decreased force in stream of urine

8  Digital rectal exam (DRE)  Prostate specific antigen (PSA)  Post-void residual volume (PVR)  Uroflowmetry  Cystoscopy  Urodynamic pressure  Ultrasound

9  Pharmaceutical › Alpha-blockers › 5-alpha-reductase inhibitors  Surgical › Transurethral resection of the prostate (TURP) › Transurethral incision of the prostate (YUIP) › Suprapubic resection › Prostatectomy  Retropubic, perineal

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12  Assess drainage tubing  Maintain rate of flow – fluid should be light pink or colorless  Assess urinary output q1-2 hrs  Assess for bladder spasms, pain and distention  If there is a block, need to flush

13  Abdominal incision into the bladder  Remove tissue  Requires urethral & suprapubic catheter › To allow for bladder repair

14  Low abdominal incision w/o entry into bladder  Choice when prostate is very large/urethral stricture

15  Incision btw anus & scrotum  Rare  High risk of impotence  Other risks: › Rectourethral fistulas › UTIs › Epididymitis › retention

16  Most common type of cancer in men  Usually grows slowly & remains confined to the prostate gland  Other types can be aggressive & spread  Types › Locally advanced › Biochemically recurrent › Metastatic › Castrate resistant

17  Hematuria  Swelling in legs  Blood in semen  Decreased force in stream of urine  Dysuria

18  Needle biopsy › Fine needle aspiration › Core needle/prostate biopsy › Vacuum assisted biopsy › Image guided biopsy  PSA test  Intravenous pyelogram  Active surveillance

19  Chemotherapy  Radiation  Cryotherapy  Brachytherapy  Hormone therapy

20  Obtain health history to determine › Concerns, level of understanding, support systems  Provide education about diagnosis and treatment plan  Provide information › Institutional & community resources for coping  Social services  Support groups  Community agencies  Assess psychological reaction to diagnosis/prognosis › How has he coped with past stress

21  Swelling & inflammation of the prostate gland  Caused by infectious agents carried to the prostate from urethra › Bacteria, fungi, mycoplasma  E. coli is the most commonly isolated organism  Acute or Chronic

22  Perineal discomfort  Burning, urgency, frequency & pain with or after ejaculation  Acute bacterial – fever, chills, perineal, rectal or low back pain, dysuria, frequency, urgency and nocturia  Chronic bacterial – relapsing UTIs, mild symptoms and occasional urethral discharge

23  Medical history, physical exam, DRE, blood culture, urine & semen test, cystoscopy, urodynamic test  Treatment › Antibiotics › Alpha blockers › Pain relievers › Prostate massage

24  Administer prescribed antibiotics  Patient education about medication  Patient education about side effects of medication  Avoid sitting for long periods  During inflammation avoid sexual arousal & intercourse  Teaching self-care › Antibiotics, home care, encourage fluids, avoid alcohol, coffee, chosolate, cola and spices  Use of comfort measures › analgesic agents, antispasmodic medications, bladder sedatives, sitz baths, stool softeners

25  Aka Impotence  Inability to achieve/maintain erection  Psychogenic/organic causes › Anxiety, fatigue, depression, pressure to perform › Occlusive vascular disease, endocrine disease, cirrhosis, chronic renal failure, GU conditions, hematologic conditions, neurologic disorders, trauma to pelvic/gential area, alcohol, meds, drug abuse

26  Difficulty getting an erection  Difficulty keeping an erection  Reduced sexual desire  Physical exam, DRE, blood tests, urine test, ultrasound  Overnight erection test  Psychological exam

27  Medication › Viagra, Cialis, Levitra, Staxyn  Testosterone replacement  Penile uppository  Alprostadil self-injection  Penile vacuum pump  Penile implants  Blood vessel surgery  Psychological counseling

28  Education › Pamphlets, social supports › Weight loss › Exercise › Quit smoking › Treatment for alcohol/drug problems › Stress reduction

29  Essential to prevent acquired problems  Foreskin should retract easily  Begin by washing tip › Work down shaft › Then scrotum › Anal area last

30  Testicular cancer  Testicular torsion  Orchitis  Epididymitis  Hydrocele, hematocele, spermatocele  Varicocele  Undescended testicles

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32  Monthly  Best time – after bath/shower  Hold penis out of the way  Check one testicle at a time  Hold testicle btw thumb and fingers  Gently roll  Look & feel for hard lumps or smooth round bumps  Note any change in size, shape, consistency

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35  Anatomy  Diagnostic Procedures  Disorders and Treatments

36 Female Anatomy

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39  X-ray, ultrasound, MRI, PET  PET scan usually used for pre-tx staging of selective malignancies  Cytoscopy  Study of cells through microscope or other equipment  Pap smear  Speculum inserted into vagina  Sample obtained by rotating a small spatula & cervical brush at the os of the cervix  Samples saved in proper medium and sent to lab for analysis for any abnormal cell findings

40  Dilation and Curettage (D&C)  Tissue is removed from the uterine cavity  Dx or Tx of uterine conditions (bleeding, incomplete miscarriage, etc)  Cervix is dilated with an instrument, a curette is inserted to remove tissue  Anesthesia and aseptic procedure  May experience low back pain, minimal bleeding

41  Endoscopic Examinations › Laparoscopy  OR, 2cm incision below umbilicus, CO2 pumped in, laparoscope inserted  View pelvic structures, dx pain, tubal sterilization, ovarian biopsy, lysis of adhesions, myectomy (removing fibroids)  Complications are rare, procedure is safe and cost- effective › Hysteroscopy  Optical instrument with light insterted through cervical os into uterine cavity and NS or D5W infused  Useful to evaluate endometrial pathology, adjunct to D&C, stop bleeding through ablation, or manage a retained IUD  Hemorrhage, perforation and burns can occur

42 Hysterosalpingography or Uterotubography X-ray study of uterus and fallopian tubes Cannula is inserted into the cervix and contrast agent is injected, x-rays are taken Can cause n/v, cramps and syncope Peri pad worn for several hours afterwards bc the dye can stain clothing Evaluate infertility or tubal patency, or any abnormal condition of the uterine cavity Can be therapeutic because it flushes the cavity

43  Focus › PMS › PID › Endometriosis › Cancer  Brief Overview › Structural Disorders

44  PMS › combination of Sx that occur prior to menstruation and subsides with menstrual flow › Dx  Sx occur within 5 days before menstruation  Sx disappear within 4 days of onset of menstruation  Sx occur through several cycles  Premenstrual dysphoric disorder (PMDD) is Dx with severe Sx that interfere with school, work or social life  Incidence › Estimates vary, possibly 85% of menstruating women experience at least 1 PMS Sx in their monthly cycle (American College of Ostetricians and Gynecologists, 2010) › PMS syndrome (cluster of Sx resulting in dysfunctions) affects 2-5% of women › Estimated 3-8% suffer PMDD (American College of Ostetricians and Gynecologists, 2010)

45  Cause is unknown › Serotonin regulation considered to play a role › Diet, exercise, stress considered to play a role  Clinical Manifestations › Physical:  Headache  Fatigue  Low back pain  Fluid retention: bloating, breast tenderness  Abd fullness › Behavioral & emotional:  General irritability  Mood swings, binge eating, crying  Depression, anxiety

46  Medical › There is little evidence or research that non- pharmacological therapies are effective › Suggestions:  Exercise is encouraged  Avoid caffeine, high- fat foods, refined sugars  Chart Sx to anticipate and cope with them  Pharmacological  SSRI’s (Prozac, Sarafem)  GnRH agonists (stops prod’n of oestrogen, usually stops menstruation after ~2 months of Tx)  Prostaglandin inhibitors (ibuprofen, naproxen)  Antianxiety agents  Calcium supplement  Vitamins B, E, magnesium, oil of evening primrose have been used but there is no research to evaluate their effectiveness

47 Nsg Management Nsg Management – Help the client chart onset of Sx – Record a nutritional Hx to determine if the diet is low in essential nutrients – Facilitate positive coping measures: illicit family support during PMS, plan work to accommodate PMS days which may be less productive – Encourage exercise, meditation, imagery – Encourage adherence to medication regime and explain expected effects of meds – Encourage client to enroll in a PMS help group to gain an understanding of others’ experiences – Assess for suicidal, incontrollable or violent behavior – Implement reporting protocols if assessment findings indicate a safety risk to client or family

48  Primary dysmenorrhea › Painful menstruation with no identifiable pelvic pathology › Occurs at menarche or shortly after › Thought to be caused by excessive prostaglandin production which causes contraction of the uterus and arteriolar vasospasm  Secondary dysmenorrhea › As for primary, except pelvic pathology contributes to the Sx (endometriosis, tumor, etc) › Pain may occur before menses, with ovulation and with intercourse

49  Symptoms › Crampy pain just before or after menstruation starts and continues for hrs › In secondary dysmenorrhea, pain may occur before menses, with ovulation and with intercourse  Diagnosis › Pelvic exam is used to rule out endometriosis, PID, fibroid uterus, adenomyosis (thickening of uterine wall)

50  Nsg Management  Reduce anxiety by explaining the reason for the discomfort  Low heat locally applied to abd – may counteract some of the hormonal activity and vasodilate the vessels  Increase physical exercise if possible  Secondary dysmenorrhea is managed by treating the underlying pelvic pathology  Pharmacological  Provide analgesia prophylactically before onset  Prostaglandin inhibitors – q4h, aspirin, ibuprofen, naproxen, mefenamic acid – determine which one works best for the client  Low dose oral contraceptives provide Sx relief in >90% of clients

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53  What is it? Inflammation of the pelvic cavity  How does it manifest?  May begin with cervicitis and may involve inflammation of the uterus, fallopian tubes, ovaries, pelvic peritoneum or pelvic vascular system  Infection may be acute, subacute, recurrent or chronic  Infection may be local or widespread -  WBC in vaginal fluid  Causes narrowing and scarring of fallopian tubes which inc risk for ectopic pregnancy, infertility, recurrent pelvic pain due to adhesions, tubo-ovarian abscess, recurrent disease  Causes: › Usually bacterial but may be viral, fungal or parasitic  Gonorrheal or chlamydial organisms most common causes

54  Early Sx › Vaginal discharge: abnormal, mucopurulent › Dyspareunia › Lower abd/pelvic pain › Tenderness after menstruation › Pain that increases while voiding or defecating  Additional Sx › Fever › General malaise › Anorexia › N/V › Headache › Constipation › Menstrual difficulties › Intense tenderness on palpation of uterus or movement of cervix

55  Medical Management › Broad spectrum antibiotics  IV Regimen A: Cefotan or Cefotoxitin IV PLUS Doxycycline PO or IV (CDC, 2011)  IV Regimen B: Clindamycin IV PLUS Gentamicin IV  IM/PO: Ceftriaxone PLUS Doxycycline +/- Metronidazole (CDC, 2011)  IM/PO: Cefoxitin PLUS Probenecid +/- Metronidazole (CDC, 2011) › Hospitalization if infection is moderate-severe  Bed rest, IV fluids, IV antibiotics  NG suction for abd distention or ileus (intestinal obstruction)  Treat sexual partners – necessary to prevent re-infection

56  Nursing management › Bed rest, semi-Fowler’s position to facilitate dependent drainage › Monitor VS › Monitor vaginal discharge › Administer analgesics for pain › Heat to abd for pain relief › **Follow infection precautions when handling peri p ads:  Wear gloves  Dispose of pads in biohazardous waste  Meticulous hand washing  Health Promotion/Education  Condoms/safe sex  Proper peri-care (front to back)  Discourage using a douche – introduces bacteria and reduces normal flora  Annual gynecological exam

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58  Cells similar to those that line the uterus, grow outside the uterus and form lesions  Chronic disease  Affects 5-15% of women of reproductive age and 25-35% of infertile women  Major cause of chronic pelvic pain and infertility  Risk factors: › Having fewer children or children late in life › Familial: common where close female relatives have it › Shorter menstrual cycle, less than 27 days, flow longer than 7 days, outflow obstruction › Younger age at menarche

59  Transplantation Theory – most accepted theory: › backflow of menses (retrograde menstruation) transports endometrial tissue to ectopic sites (outside the uterus) through the fallopian tubes › During menstruation, the ectopic endometrial tissue responds to hormonal stimulation, just as it would in the uterus › The ectopic tissue bleeds but has no outlet, and causes pain and adhesions

60 Ovarian endometriomaOvarian chocolate cyst Peritoneal endometriomaAdenomyosis Ovarian endometriosis histology Endometriosis : presence of endometrial glands and stroma outside of the normal location Lung endometriosis (BMJ, 2003; Med. Inform., 2006; BMJ, 2001; Respirology, 2006)

61  Manifestations › Dysmenorrhea › Dyspareunia › Pelvic discomfort/pain › Dyschezia (pain with bowl movement) › Depression › loss of work › Relationship difficulties › Infertility due to fibrosis, adhesions, or substances produced by the implants (ex: prostaglandins)  Dx › Bimanual pelvic exam: fixed tender nodules palpated, limited uterine mobility due to adhesions › Laparoscopy confirms dx and helps stage the disease based on severity of adhesions

62  Pharmacologic Therapy › Analgesics & prostaglandin inhibitors for pain › Hormone therapy for suppressing endometriosis and menstrual pain  oral contraceptives  Cyclomen – hormone causing atrophy of the endometrium & amenorrhea  GnRH agonists – dec estrogen and cause amenorrhea  Surgical management  Laparoscopy and lasering of endometrial tissue & adhesions  Other such as: hysterectomy, oophorectomy, bilateral salpingo-oophorectomy, appendectomy

63  Nsg Management › Health Hx to determine specific Sx, time of onset, medications that are effective, etc › Alleviate anxiety by explaining the various diagnostic procedures › Address the possibility of infertility and explore options › Dispel myths › Encourage client to report dysmenorrhea or dyspareunia › Provide client contact to the Endometriosis Association for info and support for the physical pain and emotional distress

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66  Cervical  Ovarian  Uterine  Vulvar  Vaginal  Fallopian Tubes

67  Often due to HPV infection  Spreads to regional pelvic lymph nodes if not treated  S/S rare in early stages  S/S late stage: discharge, irregular bleeding, bleeding after sexual intercourse  Preventable and treatable › Pap screening can identify pre-invasive lesions and prevent cancer  Nsg management:  Preventive counselling regarding: Delay 1 st intercourse, avoid HPV infection, reproductive health, safer sex, smoking cessation, HPV immunization for females aged 9-26 yrs  Facilitate access and utilization of gynecological care

68  Tumors of the cells that produce eggs, produce hormones or of the epithelial cells on the ovary surface (most common)  Causes more deaths than any other cancer of the female reproductive system  Ovarian tumours are often difficult to detect b/c they are deep in the pelvis  No early screening mechanism exists, tumour markers are being explored (ex: CA-125 antigen testing)  Risk factors: Age, Industrialized countries, Breast cancer  **article  S/S are nonspecific: inc abd girth, pelvic pressure, bloating, back pain, constipation, abdominal pain, urinary urgency, indigestion, flatulence, leg pain, pelvic pain  Nsg management:  Support and information regarding therapies (chemo, radiation, palliation, thoracentesis)  IV therapy to manage fluid and electrolyte imbalances, parenteral nutrition, pain control, small frequent meals, decreasing fluid intake, diuretics, rest,

69  Cancer of the uterine endometrium  Risk factors: › Age over 55 › Postmenopausal bleeding › Obesity causing inc estrone levels › Estrogen therapy without progesterone  S/S: irregular bleeding  Tx: › total hysterectomy and bilat salpingo- oophorectomy › adjuvant radiation

70  Primarily squamous cell carcinoma  Little is known about the causes  S/S: long-standing pruritis & soreness, bleeding, foul- smelling discharge, pain, visible lesions, mass that becomes hard, ulcerated and cauliflower-like  Tx: excision, laser ablation, chemotherapy creams, cryosurgery  Nsg management › Education on delaying 1 st intercourse, avoiding exposure to HPV, avoiding smoking, regular pelvic and pap exams › Encourage self-exams regularly

71  Primary cancer is squamous in origin  50% caused by HPV  S/S: pt often does not have Sx, but may report slight bleeding after intercourse, spontaneous bleeding, vaginal discharge, pain, an urinary or rectal Sx  Dx: often by pap smear  Tx: excision, laser therapy, topical chemotherapy, radiation, surgery

72  Rare  Least common genital cancer  S/S: profuse watery discharge, colicky lower abd pain or abnormal vaginal bleeding, enlarged fallopian tube  Tx: surgery & radiation

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74  Hysterectomy can be a treatment option for women experiencing › Fibroids › Endometriosis › Prolapse › Cancer › Abnormal Uterine Bleeding  Surgical Approaches › Open or “traditional” procedures (abd incision) › Minimally invasive procedures (MIP) – through vagina or abd laproscopy

75 Total HysterectomyVaginal Hysterectomy Laparascopic Hysterectomies “traditional” or “open” procedure Large incision or “bikini cut” (4–6 inches)

76  Nsg pre-op management: › Shave lower abd and pubic and perineal region, clean with soap & water › Ensure NPO the night before to empty the intestinal tract › Bladder must be empty › Enema & antiseptic douche may be ordered the night before › Administer pre-op meds as prescribed for relaxation

77  Nsg post-op management : › Care for circulation to prevent thrombophlebitis, DVT, PE, hemorrhage › Infection prevention › Monitor voiding to ensure bladder problems have not occurred; Indwelling catheter may be needed › Monitor bowel function to ensure paralytic ileus has not occurred › Provide pain control › Assess emotional status regarding loss of femininity, relaitonship issues, family issues…offer support and resources to help them address their situation

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79 An abnormal opening between 2 internal hollow organs or between an internal hollow organ and the exterior of the body An abnormal opening between 2 internal hollow organs or between an internal hollow organ and the exterior of the body May be congenital May be congenital Usually due to trauma from surgery, vaginal delivery, radiation therapy, carcinoma Usually due to trauma from surgery, vaginal delivery, radiation therapy, carcinoma Goal: Tx infection and eliminate fistula Goal: Tx infection and eliminate fistula Rest, diet, antibiotics Rest, diet, antibiotics Surgery in some cases Surgery in some cases

80 Rectovaginal Sx: Continuous leakage of urine into the vagina Sx: Fecal incontinence, Flatus Discharged through vagina

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82 Cystocele EnteroceleRectocele Management: Management: Kegel exercises Kegel exercises Pessary: Doughnut or ring- shaped device positioned in the vagina to keep the organs properly aligned Pessary: Doughnut or ring- shaped device positioned in the vagina to keep the organs properly aligned surgery surgery

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85 American Cancer Society. (2012). Retrieved from ularCancer/do-i-have-testicular-cancer-self-exam Centers for Disease Control and Prevention. (2012). Sexually Transmitted Diseases: Pelvic Inflammatory Disease. Retrieved from Cesario, S. (2010). Advances in the early detection of ovarian cancer: How to hear the whispers early. Nursing for Women’s Health, 14(3), Day, R., Paul, P., Williams, B., Smeltzer, S. & Bare, B. (2010). Canadian Textbook of Medical Surgical Nursing (2nd Canadian Ed.). Philadelphia: Lippincott Williams & Wilkins. Mayo Foundation for Medical Education and Research. (2012). Erectile Dysfunction. Retrieved from Mayo Foundation for Medical Education and Research. (2012). Prostatic Hyperplasia. Retrieved from Mayo Foundation for Medical Education and Research. (2012). Prostatitis. Retrieved from Mayo Foundation for Medical Education and Research. (2012). Prostate Cancer. Retrieved from Peate, I. (2012). Breaking the silence: helping men with erectile dysfunction. British Journal Of Community Nursing, 17(7), The Official Foundation of the American Urological Association. (2012). Urology. Retrieved from The Official Foundation of the American Urological Association. (2012). Urology fact sheet.


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