1. Nursing Management: Female Reproductive Problems Chapter 54 Overview Chapter 54 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Infertility Etiology and Pathophysiology Diagnostic Studies Ovulatory studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

3. Infertility Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Fig. 54-1. Basal body temperature chart. A, Typical biphasic temperature curve indicative of ovulation and normal progesterone effect. B, Irregular monophasic curve characteristic of anovulatory cycles. C, ­Ovulatory curve with sustained temperature elevation following conception and the first missed period.

4. Infertility Diagnostic Studies, continued Tubal patency studies Postcoital studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4

5. Nursing and Collaborative Management: Infertility Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5

6. Abortion Spontaneous Abortion Induced Abortion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6

7. Problems Related to Menstruation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7

8. Premenstrual Syndrome Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies and Collaborative Care Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8

9. Dysmenorrhea Etiology and Pathophysiology Clinical Manifestations Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9

10. Nursing Management: Dysmenorrhea Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10

11. Abnormal Vaginal Bleeding Types of Irregular Bleeding Oligomenorrhea and secondary amenorrhea Menorrhagia Metrorrhagia Diagnostic Studies and Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11

12. Abnormal Vaginal Bleeding Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Fig. 54-2. Balloon thermotherapy for treatment of menorrhagia. A, Balloon-tipped catheter is inserted into the uterus through the vagina and cervix. B, The balloon is inflated with a sterile fluid that expands to fit the size and shape of the uterus. The fluid is heated to 188° F (87° C) and maintained for 8 minutes while the uterine lining is treated. C, Fluid is withdrawn from the balloon and the catheter is removed.

13. Abnormal Vaginal Bleeding Diagnostic Studies and Collaborative Care, continued Surgical therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13

14. Nursing Management: Abnormal Vaginal Bleeding Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14

15. Ectopic Pregnancy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Fig. 54-3. Ectopic pregnancy occurring in the fallopian tube.

16. Ectopic Pregnancy Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16

17. Nursing and Collaborative Management: Ectopic Pregnancy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Fig. 54-4. Laparoscopic treatment of ectopic pregnancy in the right fallopian tube.

18. Perimenopause and Postmenopause Clinical Manifestations Collaborative Care Drug therapy Nonhormonal therapy Nutritional therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18

19. Culturally Competent Care: Menopause Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19

20. Nursing Management: Perimenopause and Postmenopause Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20

21. Conditions of Vulva, Vagina, and Cervix Etiology and Pathophysiology Clinical Manifestations Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

22. Nursing Management: Conditions of Vulva, Vagina, and Cervix Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22

23. Pelvic Inflammatory Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Fig. 54-5. Pelvic inflammatory disease. Acute infection of the fallopian tubes and ovaries. The tubes and ovaries have become an inflamed mass attached to the uterus. A tubo-ovarian abscess is also present.

24. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

25. Pelvic Inflammatory Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25

26. Pelvic Inflammatory Disease Etiology and Pathophysiology Clinical Manifestations Complications Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 26

27. Nursing Management: Pelvic Inflammatory Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 27

28. Endometriosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Fig. 54-6. Common sites of endometriosis.

29. Endometriosis Etiology and Pathophysiology Clinical Manifestations Collaborative Care Drug therapy Surgical therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29

30. Nursing Management: Endometriosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30

31. Benign Tumors of Female Reproductive System Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31

32. Leiomyomas Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32

33. Leiomyomas Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Fig. 54-7. Leiomyomas. Uterine section showing whorl-like appearance and locations of leiomyomas.

34. Leiomyomas Clinical Manifestations Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34

35. Cervical Polyps Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 35

36. Benign Ovarian Tumors Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Fig. 54-8. Large ovarian cyst.

37. Benign Ovarian Tumors Polycystic Ovary Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 37

38. Benign Ovarian Tumors Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Fig. 54-9. Polycystic ovary syndrome. Multiple fluid-filled cysts in the ovary.

39. Cancer of Female Reproductive System Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 39

40. Cervical Cancer Etiology and Pathophysiology Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 40

41. Cervical Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Fig. 54-10. Cervical cancer. View through a speculum inserted into the vagina.

42. Cervical Cancer Diagnostic Studies Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 42

43. Endometrial Cancer Etiology and Pathophysiology Clinical Manifestations Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 43

44. Ovarian Cancer Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 44

45. Vaginal Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 45

46. Vulvar Cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 46

47. Surgical Procedures: Female Reproductive System Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Fig. 54-11. A, Cross section of subtotal hysterectomy. Note that cervical stump, fallopian tubes, and ovaries remain. B, Cross section of total hysterectomy. Note that fallopian tubes and ovaries remain. C, Cross section of vaginal hysterectomy. Note that fallopian tubes and ovaries remain. D, Total hysterectomy, salpingectomy, and oophorectomy. Note that uterus, fallopian tubes, and ovaries are completely removed.

48. Radiation Therapy: Cancers of Female Reproductive System External Radiation Therapy Brachytherapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 48

49. Nursing Management: Cancers of Female Reproductive System Nursing Assessment Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 49

50. Nursing Management: Cancers of Female Reproductive System Nursing Implementation Health promotion Acute intervention related to surgery Hysterectomy Salpingectomy and oophorectomy Vulvectomy Pelvic exenteration Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 50

51. Nursing Management: Cancers of Female Reproductive System Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Fig. 54-12. Total exenteration is removal of all pelvic organs with creation of an ileal conduit and a colostomy.

52. Nursing Management: Cancers of Female Reproductive System Nursing Implementation, continued Acute intervention with radiation therapy Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 52

53. Problems With Pelvic Support Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 53

54. Uterine Prolapse Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 54 Fig. 54-13. Uterine prolapse. A, First-degree prolapse. B, Second-degree prolapse. C, Third-degree prolapse.

55. Cystocele and Rectocele Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 55 Fig. 54-14. A, Cystocele. B, Bladder has prolapsed into the vagina, causing a uterine prolapse.

56. Cystocele and Rectocele Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 56 Fig. 54-15. A, Rectocele. B, Rectum has prolapsed into the vagina.

57. Nursing Management: Problems With Pelvic Support Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 57

58. Fistula Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 58 Fig. 54-16. Common fistulas involving the vagina.

59. Nursing Management: Fistulas Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 59

60. Sexual Assault Clinical Manifestations Physical Psychologic Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 60

61. Nursing Management: Sexual Assault Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 61