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Chapter 12 Care of the Patient with a Reproductive Disorder

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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 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 The 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?

3 Figure 12-1 Outline 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. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.) Longitudinal section of the male pelvis showing the location of the male reproductive organs.

4 Figure 12-2 (From Thibodeau, G.A., Patton, K.T. [2007]. 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).

5 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) The organs of the female reproductive system include the ovaries, uterus, fallopian tubes, and vagina.

6 Figure 12-3 What 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. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.) Longitudinal section of the female pelvis showing the location of the female reproductive organs.

7 Figure 12-4 The 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. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.) Sectioned view of the uterus showing relationship to the ovaries and vagina.

8 Lateral view of the breast (sagittal section).
Figure 12-6 This 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. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.) Lateral view of the breast (sagittal section).

9 Figure 12-7 Note 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. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.) Mammalian ovary showing successive stages of ovarian (graafian) follicle and ovum development.

10 A, 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. [2003]. Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.) A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast.

11 Human Sexuality Sexual identity Influences on sexual health
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 Sexuality 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?

12 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 The 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.

13 Laboratory and Diagnostic Examinations
Diagnostic tests for the male Testicular biopsy Semen analysis Prostatic smears Cystoscopy Rectal digital exam Prostate 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.

14 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 What factors will impact the age of onset of menstruation?

15 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 Amenorrhea 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.

16 The Reproductive Cycle
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 Painful 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.

17 The Reproductive Cycle
Dysmenorrhea (continued) Medical management/nursing interventions Exercise Nutritious foods, high in fiber Heat to pelvic area Mild analgesics Prostaglandin inhibitors The 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?

18 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 Abnormal 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?

19 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 An 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?

20 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 When caring for the patient experiencing PMS, what should be included in the nursing interventions? What nursing diagnoses apply to the patient with PMS?

21 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 Menopause 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.

22 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 The 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?

23 The Reproductive Cycle
Menopause (continued) Medical management/nursing interventions Estrogen therapy Premarin Provera Calcium supplements Medical 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?

24 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 The 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?

25 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 Impotence 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?

26 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 Infertility 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?

27 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 Vaginitis is a common vaginal infection. When evaluating a patient for complaints associated with a vaginal infection, what should be included in the nursing assessment?

28 Infections of the Female Reproductive Tract
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 In 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.

29 Infections of the Female Reproductive Tract
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

30 Infections of the Female Reproductive Tract
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

31 Infections of the Female Reproductive Tract
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 Pelvic 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.

32 Infections of the Female Reproductive Tract
Toxic shock syndrome Etiology/pathophysiology Acute bacterial infection caused by Staphylococcus aureus Usually occurs in women who are menstruating and using tampons Although toxic shock syndrome can be diagnosed in men, women, and children, it is most commonly seen in women of childbearing age.

33 Infections of the Female Reproductive Tract
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 The 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?

34 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 Endometriosis 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.

35 Common sites of endometriosis.
Figure 12-9 This figure illustrates the common locations for endometriosis. What theories support how this tissue appears outside of the uterine cavity? Common sites of endometriosis.

36 Disorders of the Female Reproductive System
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 A fistula is an opening between two normally separated passages. Fistulas are named for the area of the body involved. Identify potential causes of fistulas.

37 Types of fistulas that may develop in the vagina and uterus.
Figure 12-10 (From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3rd ed.]. St. Louis: Mosby.) Types of fistulas that may develop in the vagina and uterus.

38 Disorders of the Female Reproductive System
Displaced uterus Etiology/pathophysiology Congenital Childbirth Backward displacement Retroversion Retroflexion The 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?

39 Disorders of the Female Reproductive System
Displaced uterus (continued) Clinical manifestations/assessment Backache Muscle strain Leukorrheal discharge Heaviness in the pelvic area Medical management/nursing interventions Pessary Uterine suspension

40 Disorders of the Female Reproductive System
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

41 Figure 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. [2003]. Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.) Uterine prolapse.

42 Disorders of the Female Reproductive System
Uterine prolapse (continued) Medical management/nursing interventions Pessary Surgery Vaginal hysterectomy Anteroposterior colporrhaphy The 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?

43 Disorders of the Female Reproductive System
Cystocele and rectocele Etiology/pathophysiology Cystocele Displacement of the bladder into the vagina Rectocele Rectum moves toward posterior vaginal wall The 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?

44 A, Cystocele. B, Rectocele.
Figure 12-12 (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.) A, Cystocele. B, Rectocele.

45 Disorders of the Female Reproductive System
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 Describe the nursing care that accompanies the surgical repair for cystoceles and rectoceles.

46 Disorders of the Female Reproductive System
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 Leiomyomas are the most common benign tumor of the female reproductive tract. What populations have a higher incidence of leiomyoma development?

47 Figure 12-13 Note the potential locations for leiomyomas. What implications do they have regarding infertility? (Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak’s gynecologic and obstetric pathology. [6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the biologic basis for disease in adults and children. [4th ed.]. St. Louis: Mosby.) Leiomyomas.

48 Disorders of the Female Reproductive System
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

49 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 Cancer 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?

50 Cancer of the Female Reproductive Tract
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

51 Cancer of the Female Reproductive Tract
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 With 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?

52 Cancer of the Female Reproductive Tract
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 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?

53 Cancer of the Female Reproductive Tract
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

54 Cancer of the Female Reproductive Tract
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 Ovarian cancer is often overlooked due to the vague symptoms reported. What diagnostic tests will be employed to identify ovarian cancer?

55 Cancer of the Female Reproductive Tract
Cancer of the ovary (continued) Medical management/nursing interventions Surgery TAH-BSO and omentectomy Radiation and/or chemotherapy Conditions 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?

56 Hysterectomy Total hysterectomy TAH-BSO Radical 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 A 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.

57 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 Fibrocystic 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?

58 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 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 Compare and contrast acute and chronic mastitis.

60 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 Breast 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.

61 Disorders of the Female Breast
Breast cancer (continued) Medical management/nursing interventions Depends on the stage Radiation Chemotherapy Surgery Lumpectomy Mastectomy—simple, radical Once 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?

62 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 Prostatitis 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?

63 Inflammatory Disorders of the Male Reproductive System
Prostatitis (continued) Medical management/nursing interventions Antibiotics Digital massage of the prostate Sitz baths Monitor I&O Identify 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?

64 Inflammatory Disorders of the Male Reproductive System
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 Epididymitis 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?

65 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 Phimosis 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?

66 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 Discuss conditions that may contribute to the development of paraphimosis.

67 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 What are potential causes of hydrocele? What will determine the course of treatment for the patient diagnosed with hydrocele?

68 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 Identify two nursing diagnoses for the patient with varicocele.

69 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 Testicular 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?

70 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 Cancer of the penis is not frequently seen. It is associated with a few select groups of men. Who are they?

71 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) 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?

72 Herpes simplex virus type II in a male and female patient.
Figure 12-19 (From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.) Herpes simplex virus type II in a male and female patient.

73 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 Although 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?

74 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 Syphilis 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?

75 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 The development of syphilis is classified by stages. Each of the stages has a unique set of clinical manifestations.

76 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 The 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.

77 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 Gonorrhea 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.

78 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 What diagnostic tests can be used to confirm the presence of gonorrhea?

79 Sexually Transmitted Diseases
Gonorrhea (continued) Medical management/nursing interventions Pharmacological management Penicillin Rocephin Doxycycline or tetracycline Patient education TREAT ALL SEXUAL CONTACTS When 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?

80 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 Trichomoniasis 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?

81 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 Sexually Transmitted Diseases
Trichomoniasis (continued) Medical management/nursing interventions Pharmacological management Metronidazole (Flagyl) Patient education TREAT ALL SEXUAL CONTACTS Treatment 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?

83 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 Candidiasis 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?

84 Sexually Transmitted Diseases
Candidiasis (continued) Medical management/nursing interventions Pharmacological management Nystatin (Mycostatin) Topical amphotericin B Treat underlying condition In addition to antifungal medications, what other nonpharmacologic interventions can be helpful in the management of candidiasis?

85 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 It is estimated that chlamydia may be the most common sexually transmitted disease.

86 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 Chlamydia 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.

87 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 What are some of the male secondary sex characteristics that develop during puberty? How do anabolic steroids work in the body? Where is progesterone produced? Synthetic estrogen and progesterone are often combined and used as treatment for what condition? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

89 Androgens Actions Uses Adverse Reactions
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 Why would a patient who is suffering from muscle wasting be treated with androgens? How would the use of androgens be used in the treatment of cancer? What does the term erythropoiesis mean? Where is the misuse of androgens commonly seen? What type of adverse reactions may be seen when androgens are used by females? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

90 Androgens (cont.) Drug Interactions Nursing Implications
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 21-9 When the patient is taking androgens, the nurse should encourage what type of diet? What routes are used for administration of the drug? 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 How long does it take for the drug to be effective? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

92 Female Sex Hormones Estrogens Progestins Table 21-10
Exogenous estrogens aid in the development of both primary and secondary sex characteristics, including growth and development of the uterus, increased cervical mucus, and decreased vaginal pH How do estrogens maintain bone strength? What are some of the risks associated with estrogen use? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

93 Estrogens Action and Uses Adverse Reactions Drug Interactions
Used for hormone replacement therapy in menopause and other conditions (ovarian failure); infertility work-ups; palliative breast cancer treatment Adverse Reactions Drug Interactions Estrogen-progestin combinations provide a decreased incidence of uterine cancer. What are the medical risks associated with estrogen use? What are some of the adverse reactions seen with estrogen use? Which drugs interact with estrogen? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

94 Progestins Action Uses Drug Interactions
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 How do progestins work? What other conditions are treated with progestins? How do the adverse effects of progestin compare to those of estrogen? What patient education should the LPN/LVN provide to the patient who has been prescribed progestin? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

95 Oral Contraceptives Combination Drugs: Estrogen and Progestin Action
Table 21-11 Action Prevent ovulation Use Contraception Adverse Reactions Estrogen excess, progestin excess, androgen excess, estrogen deficiency, progestin deficiency Contraindications for Oral Contraceptives What is unique about the “mini-pill”? What are the administration considerations when emergency contraception is used? What drugs interact with oral contraceptives and consequently decrease their effectiveness? How do absolute contraindications to use of oral contraceptives compare to relative contraindications? What is the relationship between oral contraceptives and smoking? When preparing a patient education plan for oral contraceptive use, what should be included? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.


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