2Overview of Anatomy and Physiology Male reproductive systemTestesDuctal systemEpididymisDuctus deferens (vas deferens)Ejaculatory duct and urethraAccessory glandsSeminal vesiclesProstate glandCowper’s glandsUrethra and penisSpermThe organs of the male reproductive system include the testes, the ductal system, the accessory glands, and the penis. What are the three functions of the male reproductive system?
3Figure 12-1Outline the role played by the primary structures of the male reproductive system. NOTE: Point to the structures as they are discussed. This will aid the student in visualizing the structure during the discussion of the function.(From Thibodeau, G.A., Patton, K.T. . Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)Longitudinal section of the male pelvis showing the location of the male reproductive organs.
4Figure 12-2(From Thibodeau, G.A., Patton, K.T. . Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell (ovum) surrounded by sperm at time of fertilization (right).
5Overview of Anatomy and Physiology Female reproductive systemOvariesFallopian tubesUterusVaginaExternal genitaliaAccessory glandsSkene’s glandsBartholin’s glandsPerineumMammary glands (breasts)The organs of the female reproductive system include the ovaries, uterus, fallopian tubes, and vagina.
6Figure 12-3What roles are played by the organs of the female reproductive system? NOTE: Point to the structures as they are discussed.(From Thibodeau, G.A., Patton, K.T. . Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)Longitudinal section of the female pelvis showing the location of the female reproductive organs.
7Figure 12-4The sectioned view of the uterus illustrates the relationship between the uterus, ovaries and vagina.The ovum mature in the ovaries. Once mature, they are released in response to hormonal levels. What is the term for this process? Ovulation.After leaving the ovaries, the ovum travels through the fallopian tubes toward the uterus. It is at this time sperm have the opportunity to unite with the egg cell. What is the term for this process? Fertilization.(From Thibodeau, G.A., Patton, K.T. . Structure and function of the body. [13th ed.]. St. Louis: Mosby.)Sectioned view of the uterus showing relationship to the ovaries and vagina.
8Lateral view of the breast (sagittal section). Figure 12-6This is a lateral view of the breast. Breasts function to provide nutrition to the baby.The size of the breast is determined by the quantity of adipose tissue.What hormone is responsible for the production of milk?What hormone is responsible for the release of milk?(From Thibodeau, G.A., Patton, K.T. . Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)Lateral view of the breast (sagittal section).
9Figure 12-7Note the stages of ovarian follicle development. Hormones control the process of egg maturation. What hormones play a role in this process?After the egg’s release from the ovary, if fertilized, the resulting union is the beginning of a pregnancy.If fertilization does not occur, the hormone levels are reduced. At that time, what physiological process begins?(From Thibodeau, G.A., Patton, K.T. . Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)Mammalian ovary showing successive stages of ovarian (graafian) follicle and ovum development.
10A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast. Figure 12-14(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. . Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.)A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast.
11Human Sexuality Sexual identity Influences on sexual health The sense of being feminine or masculineInfluences on sexual healthOverall wellness includes sexual health, and sexuality should be part of the health care programIllness and sexualityIllness may cause changes in a patient’s self-concept and result in an inability to function sexuallySexuality and sex differ. Sexuality refers to the sense of being a man or woman. The term “sex” refers to the biologic aspects of sexual activity.Sexual and reproductive health can impact overall emotional and physical well-being.The aging process plays a significant role in sexual health.What are some of the changes associated with aging that impact the health of the reproductive system?Biologic identity begins at conception. Influences on this identity include hormones, environment, and culture.What occurs when there is a conflict between the sexual orientation and the physiological identity?
12Laboratory and Diagnostic Examinations Diagnostic tests for the femaleColposcopy; culdoscopy; laparoscopyPapanicolaou (Pap) smearBiopsies: Breast, cervical, endometrialConization; dilation and curettageCultures and smearsSchiller’s iodine testHysterogramsMammography; pelvic ultrasonographyTubal insufflation (Rubin’s test)Human chorionic gonadotropin; serum CA-125The diagnostic tests for the female reproductive system can be divided into two groups. One group includes those tests that are recommended by physicians to be completed on a scheduled basis for screening purposes. The second group of tests is ordered when there is a specific disorder or concern within the system.Which of the examinations is ordered on a scheduled basis? The pap smear and the mammogram.What are the recommended parameters for pap smears by the American Cancer Society? What events/situations may warrant an increase in testing frequency?Mammography is a radiologic examination of the breast’s soft tissue. Baseline screening should begin for women between the ages of 35 to 39 years. After age 40, the examinations should be done annually.Provide an explanation of the remaining tests.
13Laboratory and Diagnostic Examinations Diagnostic tests for the maleTesticular biopsySemen analysisProstatic smearsCystoscopyRectal digital examProstate specific antigen (PSA)The testicular biopsy is performed to detect abnormal cells and the presence of sperm. A small incision is initiated to perform the examination. What will the postprocedure nursing care focus be?Semen analysis is employed to evaluate the presence of or quantity of the sperm. The sperm specimen can be collected by manual stimulation or with a condom.Prostatic smears can be used to locate and identify microorganisms and cancer cells in the prostate.Cystoscopy is used to examine the prostate and bladder by using a lighted scope through the urethra to the bladder.The PSA test is performed to assess levels of the prostate-specific antigen in the bloodstream. Elevated levels are associated with cancer.
14The Reproductive Cycle MenarcheThe beginning of mensesFollows breast development by 2 to 2½ yearsAverage age range is between 9 and 17 yearsCycle length ranges from 24 to 32 daysThe average flow lasts 3 to 5 daysThe average flow is 35 mL/cycleWhat factors will impact the age of onset of menstruation?
15The Reproductive Cycle AmenorrheaEtiology/pathophysiologyAbsent or suppressed menstrual flowClinical manifestations/assessmentNo menstrual flow for at least 3 monthsMedical management/nursing interventionsBased on underlying causeHormone replacement may be necessaryAmenorrhea refers to the absence of menstrual flow. What are some potential causes of amenorrhea? How do primary and secondary amenorrhea differ?Identify two nursing diagnoses for the patient experiencing amenorrhea.
16The Reproductive Cycle DysmenorrheaEtiology/pathophysiologyUterine pain with menstruationClinical manifestations/assessmentBreast tenderness; headacheAbdominal distention; nausea and vomitingVertigoPalpitationsExcessive perspirationColicky, cyclic pain; dull pain in the lower pelvisPainful menstruation is known as dysmenorrhea. The causes of dysmenorrhea can relate to an endocrine imbalance, an increase in prostaglandin secretions, or chronic illness, fatigue, and anemia.Compare and contrast primary and secondary dysmenorrhea.
17The Reproductive Cycle Dysmenorrhea (continued)Medical management/nursing interventionsExerciseNutritious foods, high in fiberHeat to pelvic areaMild analgesicsProstaglandin inhibitorsThe treatment options available for dysmenorrhea are individualized according to the specific cause and the individual needs of the patient. Review the rationale for the treatment options listed. How do they increase the patient’s comfort?What diagnostic tests can be utilized to evaluate dysmenorrhea?
18The Reproductive Cycle Abnormal uterine bleedingMenorrhagiaExcessive bleeding during the regular menstrual flowCauses: Endocrine disorders; inflammatory disturbances; uterine tumorsMetrorrhagiaUterine bleeding between regular menstrual periods or after menopauseMay indicate cancer or benign tumors of the uterusAbnormal uterine bleeding can signal an underlying disease process. What nursing assessments are indicated when caring for the patient experiencing menorrhagia and metrorrhagia?Attributing causes of menorrhagia differ for younger and older women. What difference are these differences?
19The Reproductive Cycle Premenstrual syndrome (PMS)Etiology/pathophysiologyBelieved to be related to the neuroendocrine events occurring within the anterior pituitary glandClinical manifestations/assessmentIrritability, lethargy, and fatigueSleep disturbances; depressionHeadache; backache; breast tendernessVertigoAbdominal distentionAcneAn estimated 30% to 50% of women experience PMS.PMS is not a disease but a grouping of symptoms.What are some supported theories for the cause of PMS?The clinical manifestations of PMS can vary greatly between patients. The symptoms typically occur 7 to 10 days before the menstrual period and resolve within the first 3 days after the onset of bleeding.What are common myths and rumors associated with PMS?
20The Reproductive Cycle Premenstrual syndrome (PMS) (continued)Medical management/nursing interventionsPharmacological managementAnalgesics; diuretics; progesteroneDietary recommendationsHigh in complex carbohydratesModerate in proteinLow in refined sugar and sodiumLimit caffeine, chocolate, and alcoholReduce or eliminate smokingExercise; adequate rest, sleep, and relaxationWhen caring for the patient experiencing PMS, what should be included in the nursing interventions?What nursing diagnoses apply to the patient with PMS?
21The Reproductive Cycle MenopauseEtiology/pathophysiologyThe normal decline of ovarian function resulting from the aging processMay be induced by irradiation of the ovaries or surgical removal of both ovariesNot considered complete until 1 year after the last menstrual periodMenopause begins in most women between the ages of 35 to 60 years. It is characterized by infrequent ovulation, decreased menstrual function, and finally the cessation of menstrual flow.Discuss some of the misinformation associated with menopause.
22The Reproductive Cycle MenopauseClinical manifestations/assessmentDecrease in frequency, amount, and duration of the normal menstrual flowShrinkage of vulval structures; shortening of the vaginaDryness of the vaginal wall; pelvic relaxationLoss of skin turgor and elasticityIncreased subcutaneous fat; decreased breast tissue; thinning of hairOsteoporosisThe clinical manifestations associated with menopause occur from the loss of estrogen. Women experiencing menopause face numerous physical changes. What impact do these changes have on a woman’s life?
23The Reproductive Cycle Menopause (continued)Medical management/nursing interventionsEstrogen therapyPremarinProveraCalcium supplementsMedical management of menopause can include hormone replacement therapy. What are some of the implications and concerns associated with the administration of estrogen therapy?What nonpharmacologic remedies can be used to manage the symptoms of menopause?
24The Reproductive Cycle Male climactericEtiology/pathophysiologyGradual decrease of testosterone levels and seminal fluid production; 55 to 70 years of ageClinical manifestations/assessmentDecreased erections; decreased seminal fluidEnlarged prostate gland; decreased muscle toneLoss or thinning of hairMedical management/nursing interventionsEmotional support; treatment for impotenceThe climacteric is less evident in men than women.The experienced impact on men is often psychological in nature.Ask the class what information they may have heard about the male climacteric. How many students have heard of this phenomenon?
25The Reproductive Cycle Erectile dysfunctionEtiology/pathophysiologyInability of an adult man to achieve penile erectionTypesFunctionalAnatomicalAtonicMedical management/nursing interventionsRemove cause if possibleTreat diseasesViagraMechanical devices: penile prosthesisImpotence has several forms and is a serious concern for men.Review the differing types of impotence.What concerns can impotence cause in men?What teaching should be given to the man who is prescribed medications to manage erectile dysfunction?
26The Reproductive Cycle InfertilityEtiology/pathophysiologyInability to conceive after 1 year of sexual intercourse without birth controlMedical management/nursing interventionsDepends on the causeHormone therapyRepair occlusionIntrauterine inseminationIn vitro fertilizationInfertility is defined as inability to conceive after 1 year of sexual intercourse without birth control. Age and fertility in women are closely related. Females are most fertile between 20 and 29 years of age. Male fertility does not significantly drop with aging.Review diagnostic tests used to evaluate fertility.What are some potential causes of infertility? How can infertility impact a couple’s relationship?
27Infections of the Female Reproductive Tract Simple vaginitisEtiology/pathophysiologyCommon vaginal infectionCausative organisms: E. coli; staphylococcal; streptococcal; T. vaginalis; C. albicans; GardnerellaClinical manifestations/assessmentInflammation of the vaginaYellow, white, or grayish white, curd-like dischargePruritus and vaginal burningVaginitis is a common vaginal infection.When evaluating a patient for complaints associated with a vaginal infection, what should be included in the nursing assessment?
28Infections of the Female Reproductive Tract Simple vaginitis (continued)Medical management/nursing interventionsDouchingVaginal suppositories, ointments, and creamsOrganism-specificSitz bathsAbstain from sexual intercourse during treatmentTreat partner if necessaryIn addition to collecting the patient’s report of vaginal irritation, the physician will perform a diagnostic examination. There is typically a vaginal examination and cultures of the organisms to determine the appropriate treatment. An examination is performed to check for inflammation of the vagina and surrounding tissues.
29Infections of the Female Reproductive Tract CervicitisEtiology/pathophysiologyInfection of the cervixClinical manifestations/assessmentBackacheWhitish exudateMenstrual irregularitiesMedical management/nursing interventionsVaginal suppositories, ointments, and creams; organism-specific
30Infections of the Female Reproductive Tract Pelvic inflammatory disease (PID)Etiology/pathophysiologyAny acute, subacute, recurrent, or chronic infection of the cervix, uterus, fallopian tubes, and ovaries that has extended to the connective tissuesMost common causative organismsGonorrhea; streptococcus; staphylococcus; Chlamydia; tubercle bacilliHigh risk: Surgical and examination procedures; sexual intercourse (especially with multiple partners); pregnancy
31Infections of the Female Reproductive Tract Pelvic inflammatory disease (PID) (continued)Clinical manifestations/assessmentFever and chillsSevere abdominal painMalaiseNausea and vomitingMalodorous purulent vaginal exudateMedical management/nursing interventionsAntibiotics; analgesicsBed restPelvic inflammatory disease is an infection of the pelvic cavity and reproductive organs. PID can be mild or severe.The impact of PID could be significant. It can be associated with the development of scar tissue in the reproductive cavity and infertility.What diagnostic tests are used to evaluate the patient who presents with complaints associated with PID?Outline the patient education that should accompany a diagnosis of PID.
32Infections of the Female Reproductive Tract Toxic shock syndromeEtiology/pathophysiologyAcute bacterial infection caused by Staphylococcus aureusUsually occurs in women who are menstruating and using tamponsAlthough toxic shock syndrome can be diagnosed in men, women, and children, it is most commonly seen in women of childbearing age.
33Infections of the Female Reproductive Tract Toxic shock syndrome (continued)Clinical manifestations/assessmentUsually occurs between days 2 and 4 of the menstrual periodFlu-like symptoms; sore throat; headacheRed macular palmar or diffuse rashDecreased urinary output; BUN elevatedPulmonary edemaMedical management/nursing interventionsAntibiotics; IV fluid therapy; oxygenThe onset of clinical manifestations is sudden.There are no diagnostic tests for this disease. Diagnosis is made based upon the clinical presentation.Because the disease is often seen in menstruating women, what preventative patient teaching should be provided?
34Disorders of the Female Reproductive System EndometriosisEtiology/pathophysiologyEndometrial tissue appears outside the uterusThe tissue responds to the normal stimulation of the ovaries; bleeds each monthClinical manifestations/assessmentLower abdominal and pelvic painMay radiate to lower back, legs, and groinMedical management/nursing interventionsAntiovulatory medications; pregnancyLaparoscopy; total hysterectomyEndometriosis is the presence of endometrial tissue outside the endometrial cavity.What populations experience a higher incidence of endometriosis?What nursing care should accompany a diagnosis of endometriosis?Discuss the impact of endometriosis on a woman’s reproductive health.
35Common sites of endometriosis. Figure 12-9This figure illustrates the common locations for endometriosis. What theories support how this tissue appears outside of the uterine cavity?Common sites of endometriosis.
36Disorders of the Female Reproductive System Vaginal fistulaEtiology/pathophysiologyAbnormal opening between the vagina and another organClinical manifestations/assessmentUrine and/or feces being expelled from vaginaMedical management/nursing interventionsOral or parenteral antibioticsDiet: high protein; increase vitamin CSurgery: Repair fistula; urinary or fecal diversionA fistula is an opening between two normally separated passages. Fistulas are named for the area of the body involved.Identify potential causes of fistulas.
37Types of fistulas that may develop in the vagina and uterus. Figure 12-10(From Herbst, A.L., et al. . Comprehensive gynecology. [3rd ed.]. St. Louis: Mosby.)Types of fistulas that may develop in the vagina and uterus.
38Disorders of the Female Reproductive System Displaced uterusEtiology/pathophysiologyCongenitalChildbirthBackward displacementRetroversionRetroflexionThe uterus may be in an abnormal position due to a number of factors. The causes of this displacement can be congenital or due to muscular changes, causing a shift from the normal position. What events could precipitate muscular changes and cause a displacement of the uterus?
39Disorders of the Female Reproductive System Displaced uterus (continued)Clinical manifestations/assessmentBackacheMuscle strainLeukorrheal dischargeHeaviness in the pelvic areaMedical management/nursing interventionsPessaryUterine suspension
40Disorders of the Female Reproductive System Uterine prolapseEtiology/pathophysiologyProlapse of the uterus through the pelvic floor and vaginal openingClinical manifestations/assessmentFullness in vaginal areaBackacheBowel or bladder problemsProtrusion of cervix and vaginal walls in perineal area
41Figure 12-11 Uterine prolapse. The degree of prolapse directly influences the type and severity of symptoms experienced by the patient.What are the clinical manifestations associated with the differing degrees of uterine prolapse?(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. . Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.)Uterine prolapse.
42Disorders of the Female Reproductive System Uterine prolapse (continued)Medical management/nursing interventionsPessarySurgeryVaginal hysterectomyAnteroposterior colporrhaphyThe management of uterine prolapse can involve the use of a positioning device or surgical interventions. What factors will be used to determine which medical management options will be employed?The pessary is a device used to provide uterine support. How does the device work? What education should be provided about its use?In the event surgical intervention is selected, what procedure will be performed? How does this procedure manage the problem?
43Disorders of the Female Reproductive System Cystocele and rectoceleEtiology/pathophysiologyCystoceleDisplacement of the bladder into the vaginaRectoceleRectum moves toward posterior vaginal wallThe weakness in supporting muscle, tissues, and ligaments can cause a displacement of the bladder, vagina, or rectum.What events could be associated with the weakening of supportive structures?
44A, Cystocele. B, Rectocele. Figure 12-12(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. . Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.)A, Cystocele. B, Rectocele.
45Disorders of the Female Reproductive System Cystocele and rectocele (continued)Clinical manifestations/assessmentCystoceleUrinary urgency, frequency, and incontinence; pelvic pressureRectoceleConstipation; rectal pressure; hemorrhoidsMedical management/nursing interventionsSurgical repairAnteroposterior colporrhaphy; bladder suspensionDescribe the nursing care that accompanies the surgical repair for cystoceles and rectoceles.
46Disorders of the Female Reproductive System Leiomyomas of the uterus (fibroids, myomas)Etiology/pathophysiologyArise from the muscle tissue of the uterusStimulated by ovarian hormonesClinical manifestations/assessmentPelvic pressure; pain; backacheDysmenorrhea; menorrhagiaConstipation; urinary symptomsMedical management/nursing interventionsSurgery: Myomectomy; hysterectomyLeiomyomas are the most common benign tumor of the female reproductive tract.What populations have a higher incidence of leiomyoma development?
47Figure 12-13Note the potential locations for leiomyomas. What implications do they have regarding infertility?(Redrawn from Novak, E. R., Woodruff, J. D., eds. . Novak’s gynecologic and obstetric pathology. [6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. . Pathophysiology: the biologic basis for disease in adults and children. [4th ed.]. St. Louis: Mosby.)Leiomyomas.
48Disorders of the Female Reproductive System Ovarian cystsEtiology/pathophysiologyBenign tumors that arise from dermoid cells of the ovaryClinical manifestations/assessmentMay be no symptomsPalpable on examinationDisturbance of menstruationPelvic heaviness; painMedical management/nursing interventionsOvarian cystectomy
49Cancer of the Female Reproductive Tract Cancer of the cervixEtiology/pathophysiologySquamous cell carcinomaCarcinoma in situIf untreated, invades the vagina, pelvic wall, bladder, rectum, and regional lymph nodesHigh riskSexually active during teensMultiple sexual partnersMultiple birthsChronic cervical infectionsCancer is the second leading cause of death in women.Cervical cancer is a disease that impacts women in their childbearing years.The Pap smear is a screening tool to identify problematic cervical cell changes.What are medical recommendations concerning the screening for cervical cancer?
50Cancer of the Female Reproductive Tract Cancer of the cervix (continued)Clinical manifestations/assessmentFew symptoms in early stagesLeukorrheaIrregular vaginal bleeding; spottingAdvancedPain in the back, upper thighs, and legs
51Cancer of the Female Reproductive Tract Cancer of the cervix (continued)Medical management/nursing interventionsCarcinoma in situRemoval of the affected areaEarly carcinomaHysterectomyIntracavitary radiationAdvanced carcinomaRadical hysterectomy with pelvic lymph node dissectionWith consideration to the age and population most affected with cervical cancer, what are the implications on the woman’s reproductive health?The incidence of cervical cancer is greater among Hispanic, African American, and American Indian women than among white women. The mortality rate for minorities is more than twice that of white women. What might explain these figures?
52Cancer of the Female Reproductive Tract Cancer of the endometriumEtiology/pathophysiologyAdenocarcinoma of the uterusClinical manifestations/assessmentPostmenopausal bleeding (50% will have cancer)Abdominal pressure; pelvic fullnessMedical management/nursing interventionsSurgery: total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO)Radiation; chemotherapyCancer of the endometrium occurs more frequently in postmenopausal women. What factors could aid in explaining this phenomenon?To assist with early detection of this cancer, patient teaching is vital. What should be included in the teaching plan for women concerning prevention and early detection?
53Cancer of the Female Reproductive Tract Cancer of the ovaryEtiology/pathophysiologyFourth most common cause of cancer death in womenHigh risk: infertile; anovulatory; nulliparous; habitual aborters; high-fat diet; exposure to industrial chemicals
54Cancer of the Female Reproductive Tract Cancer of the ovary (continued)Clinical manifestations/assessmentEarlyVague abdominal discomfortFlatulence; mild gastric disturbanceAdvancedEnlarged abdominal girthFlatulence; constipationUrinary frequencyNausea and vomitingWeight lossOvarian cancer is often overlooked due to the vague symptoms reported.What diagnostic tests will be employed to identify ovarian cancer?
55Cancer of the Female Reproductive Tract Cancer of the ovary (continued)Medical management/nursing interventionsSurgeryTAH-BSO and omentectomyRadiation and/or chemotherapyConditions involving hormonal issues, disease process, and other disorders can necessitate surgical intervention. The removal of the uterus is known as a hysterectomy.There are differing types of hysterectomies. The medical terminology used to refer to the surgical procedure is based upon the type of surgical incision and the organs affected.Which of the procedures listed will induce menopause?
56Hysterectomy Total hysterectomy TAH-BSO Radical hysterectomy Removal of the uterus including the cervixTAH-BSORemoval of the uterus, fallopian tubes, and ovariesRadical hysterectomyTAH-BSO with removal of the pelvic lymph nodesVaginal hysterectomyThe uterus is removed through the vaginaAbdominal hysterectomyAbdominal incision is made to perform procedureA variety of procedures can be performed under the heading of a hysterectomy. Review how each of them differ.Explain differences in postoperative care between the procedures.Identify factors that may determine which procedure is performed on a patient.
57Disorders of the Female Breast Fibrocystic breast conditionEtiology/pathophysiologyHyperplasia and cystic formation in mammary ductsClinical manifestations/assessmentCysts are soft, well-differentiated, tender, and freely moveable; often bilateral and multipleMedical management/nursing interventionsEliminate methylxanthinesDanazol (danocrine); vitamin EFibrocystic breast disease refers to development of benign tumors of the breast. These tumors rarely ever become cancerous and are almost never seen in most menopausal women.What factors associated with menopause can explain why it does not normally occur after menopause?
58Disorders of the Female Breast Acute mastitisEtiology/pathophysiologyAcute bacterial infection of the breastClinical manifestations/assessmentBreasts are tender, inflamed, and engorgedMedical management/nursing interventionsKeep breasts cleanApplication of warm packsSupport: Well-fitting braSystemic antibiotics
59Disorders of the Female Breast Chronic mastitisEtiology/pathophysiologyFibrosis and cysts in the breastClinical manifestations/assessmentTender, painful, and palpable cystsUsually unilateralMedical management/nursing interventionsSame as for acute mastitisCompare and contrast acute and chronic mastitis.
60Disorders of the Female Breast Breast cancerEtiology/pathophysiologyUnknown cause; usually adenocarcinomaClinical manifestations/assessmentSmall, solitary, irregular-shaped, firm, non-tender, and non-mobile tumorChange in skin colorPuckering or dimpling of tissueNipple discharge; retraction of nippleAxillary tendernessBreast cancer is the most common cancer in women.Only lung cancer outranks breast cancer in the number of deaths per year.What populations are at highest risk for the development of breast cancer?Outline steps that women can take to reduce their risk for the development of breast cancer.
61Disorders of the Female Breast Breast cancer (continued)Medical management/nursing interventionsDepends on the stageRadiationChemotherapySurgeryLumpectomyMastectomy—simple, radicalOnce a diagnosis of breast cancer is made, the patient and her physician must determine the best course of treatment. What factors are used to determine the best management plan?Explain the concept of cancer staging.What are the responsibilities of the nurse when caring for a women diagnosed with breast cancer?
62Inflammatory Disorders of the Male Reproductive System ProstatitisEtiology/pathophysiologyAcute or chronic infection of the prostate glandClinical manifestations/assessmentChills and feverDysuria; urgency and frequency of urinationCloudy urinePerineal fullness; lower back painArthralgia; myalgiaTenderness, edema, and firmness of the prostateProstatitis is an infection of the prostate gland. It most commonly occurs because of a bacterial infection in the bloodstream or from an infection that has descended from the kidneys.What diagnostic tests are used to confirm prostatitis?
63Inflammatory Disorders of the Male Reproductive System Prostatitis (continued)Medical management/nursing interventionsAntibioticsDigital massage of the prostateSitz bathsMonitor I&OIdentify the role of the nurse in the care of the patient diagnosed with prostatitis.What is the prognosis for prostatitis, and what impact does it have on male reproductive health?
64Inflammatory Disorders of the Male Reproductive System EpididymitisEtiology/pathophysiologyInfection of the epididymisClinical manifestations/assessmentScrotal pain and edemaPyuria; chills and feverMedical management/nursing interventionsBed restElevate scrotum; cold compressesAntibioticsEpididymitis is a commonly occurring infection of the male reproductive tract. Common causative organisms include Escherichia coli, Streptococcus, and Neisseria gonorrhoeae.What events are associated with the development of epididymitis?
65Disorders of Male Genital Organs PhimosisEtiology/pathophysiologyPrepuce is too small to allow retraction of the foreskin over the glansUsually congenital; may be due to inflammation or diseaseClinical manifestations/assessmentInfection of foreskin and glans penisOccasionally causes obstruction of urine flowMedical management/nursing interventionsCircumcisionPhimosis results when the foreskin over the glans penis is too small and cannot be retracted.It can cause a localized infection. How does this disorder promote this manifestation?
66Disorders of the Male Genital Organs ParaphimosisEtiology and pathophysiologyAn edematous condition of the retracted uncircumcised foreskin preventing a normal return over the glansMedical management/nursing interventionsWarm compressesCircumcisionDiscuss conditions that may contribute to the development of paraphimosis.
67Disorders of Male Genital Organs HydroceleEtiology/pathophysiologyAccumulation of fluid between the membranes of the testesClinical manifestations/assessmentEnlargement of the scrotum; painMedical management/nursing interventionsAspiration of fluidSurgical removal of testicular sacBed rest; elevate scrotum; cold compressesWhat are potential causes of hydrocele?What will determine the course of treatment for the patient diagnosed with hydrocele?
68Disorders of Male Genital Organs VaricoceleEtiology/pathophysiologyDilation of scrotal veins causing obstruction and malfunction of circulationClinical manifestations/assessmentEngorgement and elongation of the scrotumPulling sensation in scrotum; dull, aching painMedical management/nursing interventionsSurgery: Removal of obstructionBed restElevate scrotum; cold compressesIdentify two nursing diagnoses for the patient with varicocele.
69Cancer of the Male Reproductive Tract Cancer of the testisEtiology/pathophysiologyCause unknownClinical manifestations/assessmentEnlarged scrotum; feeling of heavinessFirm, painless, smooth massMedical management/nursing interventionsRadical inguinal orchiectomyRadiation and/or chemotherapyTeach testicular self-examinationTesticular cancer is the most common malignancy in men ages 15 to 35 years.What populations are at highest risk for the development of testicular cancer?What are the recommendations concerning the use of self-testicular examinations?
70Cancer of the Male Reproductive Tract Cancer of the penisEtiology/pathophysiologyVery rareClinical manifestations/assessmentPainless, wart-like growth or ulceration, usually on the glans penisMedical management/nursing interventionsSurgeryRemoval of tissuePartial or total amputation of the penisMetastasis: Radical surgical proceduresCancer of the penis is not frequently seen.It is associated with a few select groups of men. Who are they?
71Sexually Transmitted Diseases Genital herpes (HSV)Etiology/pathophysiologyInfectious viral disease; usually acquired sexuallyClinical manifestations/assessmentFluid-filled vesiclesEventually rupture and develop shallow, painful ulcersFever; malaiseDysuriaLeukorrhea (female)Genital herpes is a common sexually transmitted disease.Being viral in nature, it is a disease characterized by periods of remissions and outbreaks. The frequency and severity of the outbreaks will vary between individuals.What is the relationship between herpes simplex type I and herpes simplex type II?
72Herpes simplex virus type II in a male and female patient. Figure 12-19(From Beare, P.G., Myers, J.L. . Adult health nursing. [3rd ed.]. St. Louis: Mosby.)Herpes simplex virus type II in a male and female patient.
73Sexually Transmitted Diseases Genital herpes (HSV) (continued)Medical management/nursing interventionsNo cure; treat symptomsAcyclovir (Zovirax)Sitz bathsLocal anesthetic; analgesicsKeep lesions clean and dryGOOD handwashingNo sexual contact while lesions are presentEncourage use of condomsAlthough there is no cure for herpes simplex, the disease can be managed with the use of antiviral medications such as acyclovir (Zovirax). What is the desired mode of action by the antiviral medication?Herpes simplex is a lifelong disease. What impact will the diagnosis have on the psychological well-being of the patient?
74Sexually Transmitted Diseases SyphilisEtiology/pathophysiologyTreponema pallidum organismTransmission occurs primarily with sexual contactClinical manifestations/assessmentIncubation periodNo symptomsPrimary stageChancre; headaches; enlarged lymph nodesSyphilis is the third most frequently reported communicable disease in the United States.It continues to be more common in young, heterosexual, minority groups.Why would these populations be at an increased risk for the disease?
75Sexually Transmitted Diseases Syphilis (continued)Clinical manifestations/assessmentSecondary stageRash on palms of hands and soles of feetGeneralized enlargement of lymph nodesLatent stageNo symptomsTertiary or late stageLesions may affect many different systems; may be fatalThe development of syphilis is classified by stages. Each of the stages has a unique set of clinical manifestations.
76Sexually Transmitted Diseases Syphilis (continued)Medical management/nursing interventionsPharmacological managementPenicillinTetracycline or erythromycin, if allergic to penicillinMay be treated in any stage; damage from previous stages will not be reversedTreat all sexual contactsThe goal of treatment for syphilis focuses on the complete annihilation of all traces of the disease.In the late stage of development, the damage already present cannot be reversed.Review the implications associated with the treatment of syphilis in pregnancy.
77Sexually Transmitted Diseases GonorrheaEtiology/pathophysiologyN. gonorrhoeaeTransmitted by sexual contactClinical manifestations/assessmentVaginal (female)Urinary frequency and painYellowish dischargeNausea and vomitingGonorrhea is the most commonly reported communicable disease in the United States.It is most often seen in young adults.Gonorrhea is not limited to only the genital organs. The mouth and throat can also be affected.Discuss the “Ping-Pong” effect.
78Sexually Transmitted Diseases Gonorrhea (continued)Clinical manifestations/assessment (continued)Urethra (male)Urethral discomfort; dysuriaYellowish discharge containing pusRed and swollen meatusRectal (male and female)Perineal discomfort; purulent rectal dischargePharyngitis (male and female)Sore throat and swallowing discomfortEdema of the throatWhat diagnostic tests can be used to confirm the presence of gonorrhea?
79Sexually Transmitted Diseases Gonorrhea (continued)Medical management/nursing interventionsPharmacological managementPenicillinRocephinDoxycycline or tetracyclinePatient educationTREAT ALL SEXUAL CONTACTSWhen treating a patient for gonorrhea, what follow-up care is needed?Once a diagnosis has been made, what are the responsibilities for reporting the disease to the proper authorities? Is this a requirement?
80Sexually Transmitted Diseases TrichomoniasisEtiology/pathophysiologyT. vaginalis protozoanUsually sexually transmittedClinical manifestations/assessmentMost are asymptomaticMale: Urethritis, dysuria, urinary frequency, pruritus, and purulent exudateTrichomoniasis is known as “Trich.”It is most often transmitted sexually. There are other means of transmission including dirty douche nozzles, douche containers, and washcloths. A baby can also become infected from his mother.Since many carriers are asymptomatic, what problems does this create?
81Sexually Transmitted Diseases Trichomoniasis (continued)Clinical manifestations/assessment (continued)FemaleFrothy, gray, green, or yellow malodorous dischargePruritusEdemaTenderness of vaginaDysuria and urinary frequencySpotting; menorrhagia; dysmenorrhea
82Sexually Transmitted Diseases Trichomoniasis (continued)Medical management/nursing interventionsPharmacological managementMetronidazole (Flagyl)Patient educationTREAT ALL SEXUAL CONTACTSTreatment of all sexual contacts is needed to prevent the spread of infection. What information, if any, is the patient required to provide to the health authorities?
83Sexually Transmitted Diseases CandidiasisEtiology/pathophysiologyC. albicans and C. tropicalisClinical manifestations/assessmentMouth: Edema; white patchesNails: Edematous, darkened, erythematous nail base; purulent exudateVaginal: Cheesy, tenacious white discharge; pruritus; inflammation of the vaginaPenis: Purulent exudateSystemic: Chills; fever; general malaiseCandidiasis is a fungal infection. It may be known as “yeast” or “thrush.”It is common infection.What populations are at highest risk for the development of candidiasis?
84Sexually Transmitted Diseases Candidiasis (continued)Medical management/nursing interventionsPharmacological managementNystatin (Mycostatin)Topical amphotericin BTreat underlying conditionIn addition to antifungal medications, what other nonpharmacologic interventions can be helpful in the management of candidiasis?
85Sexually Transmitted Diseases ChlamydiaEtiology/pathophysiologyChlamydia trachomatisClinical manifestations/assessmentUsually asymptomaticMaleScanty white or clear exudateBurning or pruritusUrinary frequency; mild dysuriaIt is estimated that chlamydia may be the most common sexually transmitted disease.
86Sexually Transmitted Diseases Chlamydia (continued)Clinical manifestations/assessmentFemaleVaginal pruritus or burningDull pelvic painLow-grade feverVaginal discharge; irregular bleedingMedical management/nursing interventionsPharmacological managementTetracycline; doxycycline; ZithromaxTREAT ALL SEXUAL CONTACTSChlamydia is often asymptomatic. The lack of reportable symptoms results in untreated infections and continued transmission of the disease.Chlamydia has a serious impact on the reproductive health of men and women. Discuss the implications of an untreated chlamydia infection.
87Nursing Process Nursing diagnoses Anxiety Body image, disturbed Coping, ineffectiveFearFluid volume, deficientHealth maintenance, ineffectiveInfection, risk forKnowledge, deficientPain, acute and chronicSelf-esteem, situational lowSexual dysfunctionSkin integrity, impairedTissue perfusion, ineffectiveUrinary elimination, impaired