Genital Urinary System Female Reproductive System

Brunner and Suddarth’s Medical Surgical Nursing Text: Ch

Behavioral Objectives: Review the anatomy and physiology of the female GU systems Describe the physical assessment of the female GU systems Discuss the application of the nursing process as it relates to patients with disorders of the female GU system Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following female GU disorders: – Vaginitis – Pelvic inflammatory disease (PID) – Endometriosis Discuss incidence, prevention & tx of the pts with CA of the GU system Discuss the nursing interventions in pre and post-operative care of patients undergoing the following surgeries – Hysterectomy – Mastectomy

Anatomy Review: Breast Female breast development – yrs Tail of Spence – Into axillary area Cooper’s ligament lobes Nipple Areola

Anatomy Review Internal Reproductive Structures Vagina – Mucus membrane – Posterior to bladder & urethra – Anterior to rectum – Anterior & posterior walls touch – Upper vagina surrounds cervix Inferior uterus

Anatomy Review Internal Reproductive Structures Uterus Pear-shaped – Muscular Size –?–? – Variable # pg

Anatomy Review Internal Reproductive Structures Location – Posterior to bladder Ligaments

Uterus Two parts of the uterus – Cervix Projects into the Vagina – Fundus Body of the uterus Endometrium: – Lining of the uterus

Anatomy Review Internal Reproductive Structures Ovaries Connected to uterus by the fallopian tubes Contains – 1000’s of birth Ova / Ovum – Egg cells (immature) – Ova – plural – Ovum - Singular

Physiology Review Ovulation Definition – Discharge of a mature ovum from the ovary Start

Physiology Review Ovulation Follicular Stage – Ovum enlarges  cyst (graafian follicle) – Reaches the surface (of the ovary) – Ovum is discharged Ovulation

Physiology Review After Ovulations Ovum  Fallopian tube  Uterus IF is meets a spermatozoon – Union & conception – Location of fertilization?

Physiology Review After ovulation Ovum cyst  – Corpus luteum – Stays in the ovary Produces progesterone Prepares the uterus for the fertilized ovum

The Menstrual Cycle 2 system control menstruation process – Reproductive – Endocrine Hormones

The Menstrual Cycle Ovaries  – Estrogen – Progesterone

The Menstrual Cycle Pituitary gland FSH – Stim. Ovaries – to secrete estrogen LH – Ovulation – Stim. Progesterone 

The Menstrual Cycle Cyclic pattern  – Changes in the endometrium and menstruation – 28 day cycle

Follicular Phase EstrogenIncreasing ProgesteroneLow FSHHigh  decreasing LHLow  increasing OvariesGrowth of follicle EndometriumProliferation of superficial layer Day(s)5 - 13

Ovulation EstrogenHigh ProgesteroneLow FSHLow LHHigh OvariesOvulation EndometriumContinued growth Day(s)14

Luteal Phase EstrogenDrops then increases ProgesteroneIncreasing FSHLow LHHigh OvariesActive corpus luteum EndometriumHighly vascular & thick Day(s)

Premenstrual Phase EstrogenDecreasing ProgesteroneDecreasing FSHIncreasing LHDecreasing OvariesDegeneration of corpus luteum EndometriumVasoconstriction, degeneration Day(s)

Menstrual Phase EstrogenLow ProgesteroneNone FSHIncreasing LHLow Ovariesfollicular development begins EndometriumDegeneration and shedding of superficial layer Day(s)1-5

Menopausal Period End of reproductive capacity Age 45 – 52 yrs Menstruation ceases – No periods for > 1 year

Menopausal Period Ovaries not active  – _?__ estrogen – –  Reproductive organs  size No ova mature

Physical assessment Health history Menstrual hx – Menarche Beginning of menstruation – Length – Amount – Cramps/pain ? Hx of pregnancies

Medication history – Hormone therapy – Hormonal contraceptives – Fertility treatment

Assessment: History & Clinical Manifestations Pain – Dysmenorrhea – Dyspareunia Hx vaginal discharge – Odor – Itching Hx urinary functions Hx B&B control

Assessment: History & Clinical Manifestations Sexual history History of sexual or physical abuse History of surgery History of chronic illness or disability History of genetic disorders

Physical Exam Breast – Frequency: Monthly

Breast Exam – Assessment Palpable masses Skin changes Pain Swelling Redness Nipple changes Self exam

Abnormal breast findings Erythema – Benign local infection or – Superficial neoplasm Prominent venous pattern –  blood supply required by tumor Edema & pitting – Neoplasm blocking the lymphatic drainage tubes

Orange-peel appearance / Peau D’orange (edema) – Advanced breast cancer Nipple inversion – If new  requires evaluation Signs of dimpling, creasing, changes in contour

Breast Cancer Mass - palpate – Single mass – One breast – Firm, hard, embedded in surrounding tissue – Non-tender

Mammography Duration – 15 minutes Recommended frequency – Annually – > age 40

Physical Assessment Pelvic – Frequency Annual – Initial > age 18 sexually active – breast – pelvic Positioning – Supine lithotomy position

Physical Assessment Inspection – Inspects external genitilia – Speculum examination Vaginal canal Cervix

Physical Assessment Pap smear – Tissue sample of cervix  – Purpose: Dx Cervical Ca – No douche before visit

Physical Assessment Bimanual palpation – Cervical palpation – Uterine palpation

Colposcopy – Portable microscope – Obtain sample