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Chapter 12 Care of the Patient with a Reproductive Disorder Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Presentation on theme: "Chapter 12 Care of the Patient with a Reproductive Disorder Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc."— Presentation transcript:

1 Chapter 12 Care of the Patient with a Reproductive Disorder Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Slide 2 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Overview of Anatomy and Physiology Male reproductive system  Testes  Ductal system Epididymis Ductus deferens (vas deferens) Ejaculatory duct and urethra  Accessory glands Seminal vesicles Prostate gland Cowper’s glands  Urethra and penis  Sperm

3 Slide 3 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-1 Longitudinal section of the male pelvis showing the location of the male reproductive organs. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6 th ed.]. St. Louis: Mosby.)

4 Slide 4 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-2 Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell (ovum) surrounded by sperm at time of fertilization (right). (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6 th ed.]. St. Louis: Mosby.)

5 Slide 5 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Overview of Anatomy and Physiology Female reproductive system  Ovaries  Fallopian tubes  Uterus  Vagina  External genitalia  Accessory glands Skene’s glands Bartholin’s glands  Perineum  Mammary glands (breasts)

6 Slide 6 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-3 Longitudinal section of the female pelvis showing the location of the female reproductive organs. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6 th ed.]. St. Louis: Mosby.)

7 Slide 7 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-4 Sectioned view of the uterus showing relationship to the ovaries and vagina. (From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13 th ed.]. St. Louis: Mosby.)

8 Slide 8 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-6 Lateral view of the breast (sagittal section). (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6 th ed.]. St. Louis: Mosby.)

9 Slide 9 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-7 Mammalian ovary showing successive stages of ovarian (graafian) follicle and ovum development. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6 th ed.]. St. Louis: Mosby.)

10 Slide 10 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast. (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination. [5 th ed.]. St. Louis: Mosby.)

11 Slide 11 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Human Sexuality Sexual identity  The sense of being feminine or masculine Influences on sexual health  Overall wellness includes sexual health, and sexuality should be part of the health care program Illness and sexuality  Illness may cause changes in a patient’s self-concept and result in an inability to function sexually

12 Slide 12 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Laboratory and Diagnostic Examinations Diagnostic tests for the female  Colposcopy; culdoscopy; laparoscopy  Papanicolaou (Pap) smear  Biopsies: Breast, cervical, endometrial  Conization; dilation and curettage  Cultures and smears  Schiller’s iodine test  Hysterograms  Mammography; pelvic ultrasonography  Tubal insufflation (Rubin’s test)  Human chorionic gonadotropin; serum CA-125

13 Slide 13 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Laboratory and Diagnostic Examinations Diagnostic tests for the male  Testicular biopsy  Semen analysis  Prostatic smears  Cystoscopy  Rectal digital exam  Prostate specific antigen (PSA)

14 Slide 14 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Menarche  The beginning of menses  Follows breast development by 2 to 2½ years  Average age range is between 9 and 17 years  Cycle length ranges from 24 to 32 days  The average flow lasts 3 to 5 days  The average flow is 35 mL/cycle

15 Slide 15 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Amenorrhea  Etiology/pathophysiology Absent or suppressed menstrual flow  Clinical manifestations/assessment No menstrual flow for at least 3 months  Medical management/nursing interventions Based on underlying cause Hormone replacement may be necessary

16 Slide 16 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Dysmenorrhea  Etiology/pathophysiology Uterine pain with menstruation  Clinical manifestations/assessment Breast tenderness; headache Abdominal distention; nausea and vomiting Vertigo Palpitations Excessive perspiration Colicky, cyclic pain; dull pain in the lower pelvis The Reproductive Cycle

17 Slide 17 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Dysmenorrhea (continued)  Medical management/nursing interventions Exercise Nutritious foods, high in fiber Heat to pelvic area Mild analgesics Prostaglandin inhibitors

18 Slide 18 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Abnormal uterine bleeding  Menorrhagia Excessive bleeding during the regular menstrual flow Causes: Endocrine disorders; inflammatory disturbances; uterine tumors  Metrorrhagia Uterine bleeding between regular menstrual periods or after menopause May indicate cancer or benign tumors of the uterus

19 Slide 19 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Premenstrual syndrome (PMS)  Etiology/pathophysiology Believed to be related to the neuroendocrine events occurring within the anterior pituitary gland  Clinical manifestations/assessment Irritability, lethargy, and fatigue Sleep disturbances; depression Headache; backache; breast tenderness Vertigo Abdominal distention Acne

20 Slide 20 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Premenstrual syndrome (PMS) (continued)  Medical management/nursing interventions Pharmacological management  Analgesics; diuretics; progesterone Dietary recommendations  High in complex carbohydrates  Moderate in protein  Low in refined sugar and sodium  Limit caffeine, chocolate, and alcohol Reduce or eliminate smoking Exercise; adequate rest, sleep, and relaxation

21 Slide 21 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Menopause  Etiology/pathophysiology The normal decline of ovarian function resulting from the aging process May be induced by irradiation of the ovaries or surgical removal of both ovaries Not considered complete until 1 year after the last menstrual period

22 Slide 22 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Menopause  Clinical manifestations/assessment Decrease in frequency, amount, and duration of the normal menstrual flow Shrinkage of vulval structures; shortening of the vagina Dryness of the vaginal wall; pelvic relaxation Loss of skin turgor and elasticity Increased subcutaneous fat; decreased breast tissue; thinning of hair Osteoporosis

23 Slide 23 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Menopause (continued)  Medical management/nursing interventions Estrogen therapy  Premarin  Provera Calcium supplements

24 Slide 24 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Male climacteric  Etiology/pathophysiology Gradual decrease of testosterone levels and seminal fluid production; 55 to 70 years of age  Clinical manifestations/assessment Decreased erections; decreased seminal fluid Enlarged prostate gland; decreased muscle tone Loss or thinning of hair  Medical management/nursing interventions Emotional support; treatment for impotence

25 Slide 25 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Erectile dysfunction  Etiology/pathophysiology Inability of an adult man to achieve penile erection Types  Functional  Anatomical  Atonic  Medical management/nursing interventions Remove cause if possible Treat diseases Viagra Mechanical devices: penile prosthesis

26 Slide 26 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle Infertility  Etiology/pathophysiology Inability to conceive after 1 year of sexual intercourse without birth control  Medical management/nursing interventions Depends on the cause Hormone therapy Repair occlusion Intrauterine insemination In vitro fertilization

27 Slide 27 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Infections of the Female Reproductive Tract Simple vaginitis  Etiology/pathophysiology Common vaginal infection Causative organisms: E. coli; staphylococcal; streptococcal; T. vaginalis; C. albicans; Gardnerella  Clinical manifestations/assessment Inflammation of the vagina Yellow, white, or grayish white, curd-like discharge Pruritus and vaginal burning

28 Slide 28 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Simple vaginitis (continued)  Medical management/nursing interventions Douching Vaginal suppositories, ointments, and creams  Organism-specific Sitz baths Abstain from sexual intercourse during treatment Treat partner if necessary Infections of the Female Reproductive Tract

29 Slide 29 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cervicitis  Etiology/pathophysiology Infection of the cervix  Clinical manifestations/assessment Backache Whitish exudate Menstrual irregularities  Medical management/nursing interventions Vaginal suppositories, ointments, and creams; organism-specific Infections of the Female Reproductive Tract

30 Slide 30 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Pelvic inflammatory disease (PID)  Etiology/pathophysiology Any acute, subacute, recurrent, or chronic infection of the cervix, uterus, fallopian tubes, and ovaries that has extended to the connective tissues Most common causative organisms  Gonorrhea; streptococcus; staphylococcus; Chlamydia; tubercle bacilli High risk: Surgical and examination procedures; sexual intercourse (especially with multiple partners); pregnancy Infections of the Female Reproductive Tract

31 Slide 31 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Pelvic inflammatory disease (PID) (continued)  Clinical manifestations/assessment Fever and chills Severe abdominal pain Malaise Nausea and vomiting Malodorous purulent vaginal exudate  Medical management/nursing interventions Antibiotics; analgesics Bed rest Infections of the Female Reproductive Tract

32 Slide 32 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Toxic shock syndrome  Etiology/pathophysiology Acute bacterial infection caused by Staphylococcus aureus Usually occurs in women who are menstruating and using tampons Infections of the Female Reproductive Tract

33 Slide 33 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Toxic shock syndrome (continued)  Clinical manifestations/assessment Usually occurs between days 2 and 4 of the menstrual period Flu-like symptoms; sore throat; headache Red macular palmar or diffuse rash Decreased urinary output; BUN elevated Pulmonary edema  Medical management/nursing interventions Antibiotics; IV fluid therapy; oxygen Infections of the Female Reproductive Tract

34 Slide 34 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Reproductive System Endometriosis  Etiology/pathophysiology Endometrial tissue appears outside the uterus The tissue responds to the normal stimulation of the ovaries; bleeds each month  Clinical manifestations/assessment Lower abdominal and pelvic pain May radiate to lower back, legs, and groin  Medical management/nursing interventions Antiovulatory medications; pregnancy Laparoscopy; total hysterectomy

35 Slide 35 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-9 Common sites of endometriosis.

36 Slide 36 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Vaginal fistula  Etiology/pathophysiology Abnormal opening between the vagina and another organ  Clinical manifestations/assessment Urine and/or feces being expelled from vagina  Medical management/nursing interventions Oral or parenteral antibiotics Diet: high protein; increase vitamin C Surgery: Repair fistula; urinary or fecal diversion Disorders of the Female Reproductive System

37 Slide 37 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Types of fistulas that may develop in the vagina and uterus. (From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3 rd ed.]. St. Louis: Mosby.)

38 Slide 38 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Displaced uterus  Etiology/pathophysiology Congenital Childbirth Backward displacement  Retroversion  Retroflexion Disorders of the Female Reproductive System

39 Slide 39 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Displaced uterus (continued)  Clinical manifestations/assessment Backache Muscle strain Leukorrheal discharge Heaviness in the pelvic area  Medical management/nursing interventions Pessary Uterine suspension Disorders of the Female Reproductive System

40 Slide 40 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Uterine prolapse  Etiology/pathophysiology Prolapse of the uterus through the pelvic floor and vaginal opening  Clinical manifestations/assessment Fullness in vaginal area Backache Bowel or bladder problems Protrusion of cervix and vaginal walls in perineal area Disorders of the Female Reproductive System

41 Slide 41 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Uterine prolapse. (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination. [5 th ed.]. St. Louis: Mosby.)

42 Slide 42 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Uterine prolapse (continued)  Medical management/nursing interventions Pessary Surgery  Vaginal hysterectomy  Anteroposterior colporrhaphy Disorders of the Female Reproductive System

43 Slide 43 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cystocele and rectocele  Etiology/pathophysiology Cystocele  Displacement of the bladder into the vagina Rectocele  Rectum moves toward posterior vaginal wall Disorders of the Female Reproductive System

44 Slide 44 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure A, Cystocele. B, Rectocele. (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7 th ed.]. St. Louis: Mosby.)

45 Slide 45 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cystocele and rectocele (continued)  Clinical manifestations/assessment Cystocele  Urinary urgency, frequency, and incontinence; pelvic pressure Rectocele  Constipation; rectal pressure; hemorrhoids  Medical management/nursing interventions Surgical repair  Anteroposterior colporrhaphy; bladder suspension Disorders of the Female Reproductive System

46 Slide 46 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Leiomyomas of the uterus (fibroids, myomas)  Etiology/pathophysiology Arise from the muscle tissue of the uterus Stimulated by ovarian hormones  Clinical manifestations/assessment Pelvic pressure; pain; backache Dysmenorrhea; menorrhagia Constipation; urinary symptoms  Medical management/nursing interventions Surgery: Myomectomy; hysterectomy Disorders of the Female Reproductive System

47 Slide 47 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Leiomyomas. (Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak’s gynecologic and obstetric pathology. [6 th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the biologic basis for disease in adults and children. [4 th ed.]. St. Louis: Mosby.)

48 Slide 48 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Ovarian cysts  Etiology/pathophysiology Benign tumors that arise from dermoid cells of the ovary  Clinical manifestations/assessment May be no symptoms Palpable on examination Disturbance of menstruation Pelvic heaviness; pain  Medical management/nursing interventions Ovarian cystectomy Disorders of the Female Reproductive System

49 Slide 49 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the Female Reproductive Tract Cancer of the cervix  Etiology/pathophysiology Squamous cell carcinoma Carcinoma in situ If untreated, invades the vagina, pelvic wall, bladder, rectum, and regional lymph nodes High risk  Sexually active during teens  Multiple sexual partners  Multiple births  Chronic cervical infections

50 Slide 50 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the cervix (continued)  Clinical manifestations/assessment Few symptoms in early stages Leukorrhea Irregular vaginal bleeding; spotting Advanced  Pain in the back, upper thighs, and legs Cancer of the Female Reproductive Tract

51 Slide 51 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the cervix (continued)  Medical management/nursing interventions Carcinoma in situ  Removal of the affected area Early carcinoma  Hysterectomy  Intracavitary radiation Advanced carcinoma  Radical hysterectomy with pelvic lymph node dissection Cancer of the Female Reproductive Tract

52 Slide 52 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the endometrium  Etiology/pathophysiology Adenocarcinoma of the uterus  Clinical manifestations/assessment Postmenopausal bleeding (50% will have cancer) Abdominal pressure; pelvic fullness  Medical management/nursing interventions Surgery: total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) Radiation; chemotherapy Cancer of the Female Reproductive Tract

53 Slide 53 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the ovary  Etiology/pathophysiology Fourth most common cause of cancer death in women High risk: infertile; anovulatory; nulliparous; habitual aborters; high-fat diet; exposure to industrial chemicals Cancer of the Female Reproductive Tract

54 Slide 54 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the ovary (continued)  Clinical manifestations/assessment Early  Vague abdominal discomfort  Flatulence; mild gastric disturbance Advanced  Enlarged abdominal girth  Flatulence; constipation  Urinary frequency  Nausea and vomiting  Weight loss Cancer of the Female Reproductive Tract

55 Slide 55 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the ovary (continued)  Medical management/nursing interventions Surgery  TAH-BSO and omentectomy Radiation and/or chemotherapy Cancer of the Female Reproductive Tract

56 Slide 56 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Hysterectomy Total hysterectomy  Removal of the uterus including the cervix TAH-BSO  Removal of the uterus, fallopian tubes, and ovaries Radical hysterectomy  TAH-BSO with removal of the pelvic lymph nodes Vaginal hysterectomy  The uterus is removed through the vagina Abdominal hysterectomy  Abdominal incision is made to perform procedure

57 Slide 57 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast Fibrocystic breast condition  Etiology/pathophysiology Hyperplasia and cystic formation in mammary ducts  Clinical manifestations/assessment Cysts are soft, well-differentiated, tender, and freely moveable; often bilateral and multiple  Medical management/nursing interventions Eliminate methylxanthines Danazol (danocrine); vitamin E

58 Slide 58 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast Acute mastitis  Etiology/pathophysiology Acute bacterial infection of the breast  Clinical manifestations/assessment Breasts are tender, inflamed, and engorged  Medical management/nursing interventions Keep breasts clean Application of warm packs Support: Well-fitting bra Systemic antibiotics

59 Slide 59 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast Chronic mastitis  Etiology/pathophysiology Fibrosis and cysts in the breast  Clinical manifestations/assessment Tender, painful, and palpable cysts Usually unilateral  Medical management/nursing interventions Same as for acute mastitis

60 Slide 60 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast Breast cancer  Etiology/pathophysiology Unknown cause; usually adenocarcinoma  Clinical manifestations/assessment Small, solitary, irregular-shaped, firm, non-tender, and non-mobile tumor Change in skin color Puckering or dimpling of tissue Nipple discharge; retraction of nipple Axillary tenderness

61 Slide 61 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast Breast cancer (continued)  Medical management/nursing interventions Depends on the stage  Radiation  Chemotherapy  Surgery o Lumpectomy o Mastectomy—simple, radical

62 Slide 62 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Inflammatory Disorders of the Male Reproductive System Prostatitis  Etiology/pathophysiology Acute or chronic infection of the prostate gland  Clinical manifestations/assessment Chills and fever Dysuria; urgency and frequency of urination Cloudy urine Perineal fullness; lower back pain Arthralgia; myalgia Tenderness, edema, and firmness of the prostate

63 Slide 63 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Prostatitis (continued)  Medical management/nursing interventions Antibiotics Digital massage of the prostate Sitz baths Monitor I&O Inflammatory Disorders of the Male Reproductive System

64 Slide 64 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Epididymitis  Etiology/pathophysiology Infection of the epididymis  Clinical manifestations/assessment Scrotal pain and edema Pyuria; chills and fever  Medical management/nursing interventions Bed rest Elevate scrotum; cold compresses Antibiotics Inflammatory Disorders of the Male Reproductive System

65 Slide 65 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of Male Genital Organs Phimosis  Etiology/pathophysiology Prepuce is too small to allow retraction of the foreskin over the glans Usually congenital; may be due to inflammation or disease  Clinical manifestations/assessment Infection of foreskin and glans penis Occasionally causes obstruction of urine flow  Medical management/nursing interventions Circumcision

66 Slide 66 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Male Genital Organs Paraphimosis  Etiology and pathophysiology An edematous condition of the retracted uncircumcised foreskin preventing a normal return over the glans  Medical management/nursing interventions Warm compresses Circumcision

67 Slide 67 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of Male Genital Organs Hydrocele  Etiology/pathophysiology Accumulation of fluid between the membranes of the testes  Clinical manifestations/assessment Enlargement of the scrotum; pain  Medical management/nursing interventions Aspiration of fluid Surgical removal of testicular sac Bed rest; elevate scrotum; cold compresses

68 Slide 68 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of Male Genital Organs Varicocele  Etiology/pathophysiology Dilation of scrotal veins causing obstruction and malfunction of circulation  Clinical manifestations/assessment Engorgement and elongation of the scrotum Pulling sensation in scrotum; dull, aching pain  Medical management/nursing interventions Surgery: Removal of obstruction Bed rest Elevate scrotum; cold compresses

69 Slide 69 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the Male Reproductive Tract Cancer of the testis  Etiology/pathophysiology Cause unknown  Clinical manifestations/assessment Enlarged scrotum; feeling of heaviness Firm, painless, smooth mass  Medical management/nursing interventions Radical inguinal orchiectomy Radiation and/or chemotherapy Teach testicular self-examination

70 Slide 70 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the Male Reproductive Tract Cancer of the penis  Etiology/pathophysiology Very rare  Clinical manifestations/assessment Painless, wart-like growth or ulceration, usually on the glans penis  Medical management/nursing interventions Surgery  Removal of tissue  Partial or total amputation of the penis  Metastasis: Radical surgical procedures

71 Slide 71 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Genital herpes (HSV)  Etiology/pathophysiology Infectious viral disease; usually acquired sexually  Clinical manifestations/assessment Fluid-filled vesicles Eventually rupture and develop shallow, painful ulcers Fever; malaise Dysuria Leukorrhea (female)

72 Slide 72 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure Herpes simplex virus type II in a male and female patient. (From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3 rd ed.]. St. Louis: Mosby.)

73 Slide 73 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Genital herpes (HSV) (continued)  Medical management/nursing interventions No cure; treat symptoms Acyclovir (Zovirax) Sitz baths Local anesthetic; analgesics Keep lesions clean and dry GOOD handwashing No sexual contact while lesions are present Encourage use of condoms

74 Slide 74 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Syphilis  Etiology/pathophysiology Treponema pallidum organism Transmission occurs primarily with sexual contact  Clinical manifestations/assessment Incubation period  No symptoms Primary stage  Chancre; headaches; enlarged lymph nodes

75 Slide 75 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Syphilis (continued)  Clinical manifestations/assessment Secondary stage  Rash on palms of hands and soles of feet  Generalized enlargement of lymph nodes Latent stage  No symptoms Tertiary or late stage  Lesions may affect many different systems; may be fatal

76 Slide 76 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Syphilis (continued)  Medical management/nursing interventions Pharmacological management  Penicillin  Tetracycline or erythromycin, if allergic to penicillin May be treated in any stage; damage from previous stages will not be reversed Treat all sexual contacts

77 Slide 77 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Gonorrhea  Etiology/pathophysiology N. gonorrhoeae Transmitted by sexual contact  Clinical manifestations/assessment Vaginal (female)  Urinary frequency and pain  Yellowish discharge  Nausea and vomiting

78 Slide 78 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Gonorrhea (continued)  Clinical manifestations/assessment (continued) Urethra (male)  Urethral discomfort; dysuria  Yellowish discharge containing pus  Red and swollen meatus Rectal (male and female)  Perineal discomfort; purulent rectal discharge Pharyngitis (male and female)  Sore throat and swallowing discomfort  Edema of the throat

79 Slide 79 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Gonorrhea (continued)  Medical management/nursing interventions Pharmacological management  Penicillin  Rocephin  Doxycycline or tetracycline Patient education TREAT ALL SEXUAL CONTACTS

80 Slide 80 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Trichomoniasis  Etiology/pathophysiology T. vaginalis protozoan Usually sexually transmitted  Clinical manifestations/assessment Most are asymptomatic Male: Urethritis, dysuria, urinary frequency, pruritus, and purulent exudate

81 Slide 81 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Trichomoniasis (continued)  Clinical manifestations/assessment (continued) Female  Frothy, gray, green, or yellow malodorous discharge  Pruritus  Edema  Tenderness of vagina  Dysuria and urinary frequency  Spotting; menorrhagia; dysmenorrhea

82 Slide 82 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Trichomoniasis (continued)  Medical management/nursing interventions Pharmacological management  Metronidazole (Flagyl) Patient education TREAT ALL SEXUAL CONTACTS

83 Slide 83 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Candidiasis  Etiology/pathophysiology C. albicans and C. tropicalis  Clinical manifestations/assessment Mouth: Edema; white patches Nails: Edematous, darkened, erythematous nail base; purulent exudate Vaginal: Cheesy, tenacious white discharge; pruritus; inflammation of the vagina Penis: Purulent exudate Systemic: Chills; fever; general malaise

84 Slide 84 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Candidiasis (continued)  Medical management/nursing interventions Pharmacological management  Nystatin (Mycostatin)  Topical amphotericin B Treat underlying condition

85 Slide 85 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Chlamydia  Etiology/pathophysiology Chlamydia trachomatis  Clinical manifestations/assessment Usually asymptomatic Male  Scanty white or clear exudate  Burning or pruritus  Urinary frequency; mild dysuria

86 Slide 86 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases Chlamydia (continued)  Clinical manifestations/assessment Female  Vaginal pruritus or burning  Dull pelvic pain  Low-grade fever  Vaginal discharge; irregular bleeding  Medical management/nursing interventions Pharmacological management  Tetracycline; doxycycline; Zithromax TREAT ALL SEXUAL CONTACTS

87 Slide 87 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process Nursing diagnoses  Anxiety  Body image, disturbed  Coping, ineffective  Fear  Fluid volume, deficient  Health maintenance, ineffective  Infection, risk for  Knowledge, deficient  Pain, acute and chronic  Self-esteem, situational low  Sexual dysfunction  Skin integrity, impaired  Tissue perfusion, ineffective  Urinary elimination, impaired

88 Sex Hormones  Production influenced by the anterior pituitary  Male: testosterone; androgens  Female: estrogen; progesterone 88 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

89 Androgens Actions  Development of secondary sex characteristics; tissue building Uses  Hypogonadism, hypopituitarism, dwarfism, eunuchism, cryptorchidism, oligospermia, and male androgen deficiency Adverse Reactions  Edema due to sodium retention, acne, hirsutism, male pattern baldness, cholestatic hepatitis with jaundice, buccal irritation, nausea and vomiting, diarrhea 89 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

90 Androgens (cont.) Drug Interactions  Increased effects – anticoagulants, antidiabetic agents, and other drugs  Decreased effects – barbiturates  Concurrent use with corticosteroids increase edema Nursing Implications  Assessment, diagnosis, planning, implementation, and evaluation Drug Table Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

91 Androgens (cont.) Patient and Family Teaching  Administration  Response time  Diet  Symptoms to report  Administration considerations 91 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

92 Female Sex Hormones  Estrogens  Progestins  Table Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

93 Estrogens Action and Uses  Used for hormone replacement therapy in menopause and other conditions (ovarian failure); infertility work- ups; palliative breast cancer treatment Adverse Reactions Drug Interactions 93 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

94 Progestins Action Uses  Contraception, control excessive uterine bleeding, treatment of secondary amenorrhea, dysmenorrhea, premenstrual tension, and control of pain in endometriosis Drug Interactions Nursing Implications and Patient Teaching 94 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

95 Oral Contraceptives Combination Drugs: Estrogen and Progestin  Table Action  Prevent ovulation Use  Contraception Adverse Reactions  Estrogen excess, progestin excess, androgen excess, estrogen deficiency, progestin deficiency Contraindications for Oral Contraceptives 95 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.


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