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Female Reproductive Disorders
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Menstrual Disorders
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Premenstrual Syndrome
Why is PMS know as a syndrome and not a disease? a Group of physiological and psychological symptoms
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Premenstrual Syndrome
What are the symptoms? Remember – these can vary from month to month?
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Premenstrual Syndrome Treatment and Nursing Care
Stress Reduction Techniques Initiation of an Exercise Program Diet Therapy Avoid caffeine and alcohol Eat complex carbohydrates, high-fiber Reduce salt intake Increase vitamin B12 , calcium and magnesium
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Premenstrual Syndrome Treatment and Nursing Care
Drug Therapy Selective Serotonin reuptake inhibitors Prozac Zoloft Diuretics - spironolactone Prostaglandin inhibitors - ibuprofen Antidepressants, antianxiety - Xanax Oral contraceptives
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Dysmenorrhea Discomfort associated with menstruation
Cause - excessive prostaglandins * What is the action of prostaglandins on smooth muscles? Signs and Symptoms In addition to Abdominal what will the patient complain of? ?
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Dysmenorrhea Treatment and Nursing Care Drug Therapy
NSAIDS/ Prostaglandin blockers - Oral Contraceptives Relaxation Techniques Heat Therapy Exercise Other Acupuncture Transcutaneous nerve stimulation
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Abnormal Vaginal Bleeding
Oligomenorrhea – long interval between menses Amenorrhea - absence of menses Menorrhagia – prolonged menstrual bleeding Metrorrhagia – irregular bleeding
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Complications of Vaginal Bleeding
Anemia Order lab work – CBC, Hgb, Hct Assess for excessive fatigue Monitor vital signs Provide for safety with the weak patient Toxic Shock Syndrome (TSS) Assess for high fever, vomiting, diarrhea, weakness, myalgia, and sunburn-like rash Patient teaching – avoid use of superabsorbent tampons and pads; change pads and tampons frequently
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Abnormal Vaginal Bleeding
Treatment and Nursing Care Drug Therapy Oral Contraceptives Baloon Thermotherapy Myomectomy
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Endometrial Ablation A resectoscope is a special type of telescope inserted inside the uterus. It has a built in wire loop that uses high-frequency electrical energy to cut or coagulate or ablate tissue. The resectoscope has the advantage of being able to remove polyps and some fibroids at the time of ablation.
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Menopause Cessation of menses
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Menopause Menopause is related to a decrease in the production of _______ and ___________. or Surgically induced
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Menopause Clinical Manifestations
Cessation of menses Occasional vasomotor symptoms Atrophy of genitourinary tissue Stress incontinence Osteoporosis Sleep disturbances
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What laboratory tests would confirm the diagnosis of menopause?
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Menopause Treatment and Nursing Care
Drug Therapy NO longer encourage the use of Hormone Replacement Therapy – related to increase in risk for development of breast cancer, stroke, heart disease, DVT, pulmonary emboli Antidepressants Selective estrogen receptor modulators raloxifene (Evista) Bisphosphonates Fosamax or Actonel
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Menopause Treatment and Nursing Care
Non-hormonal Therapy Cool environment Loose fitting clothing Moisturizing soaps and lotions Healthy diet with vitamin D Vitamin and mineral supplements Exercise
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Review To prevent or decrease age-related changes that occur after menopause in a patient who chooses not to take HRT, the nurse teaches the patient that the most important self-care measure is Maintain sexual activity Increase intake of dairy products Performing regular aerobic, weight-bearing exercise Taking vitamin E and B6 supplements
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Infection of uterus, fallopian tubes, ovaries, and peritoneal cavity
Pelvic Inflammatory Disease Infection of uterus, fallopian tubes, ovaries, and peritoneal cavity
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Pelvic Inflammatory Disease
Cause – gonorrhea and chlamydial infections spread up the reproductive system into the peritoneal cavity Manifestation Abdominal pain Fever Vaginal discharge Diagnosis Vaginal culture
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Pelvic Inflammatory Disease
Complications Septic Shock Infertility Ectopic pregnancy Treatment and Nursing Care Drug Therapy Positioning Force fluids Heat to abdomen or Sitz bath Patient teaching – prevention of re-infection
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Ask Yourself? The nurse caring for a patient with PID places her in a semi-fowlers position in order to: Relieve pain Prevent the complication of sterility Promote drainage and prevent abscess Improve circulation and promote healing
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Presence of normal Endometrial Tissue outside the uterine cavity
Endometriosis Presence of normal Endometrial Tissue outside the uterine cavity
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Answer this! What is the big deal about endometrial tissue being outside the uterus?
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What is the main symptom of endometriosis?
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Endometriosis Clinical Manifestations Diagnosis
Dysmenorrhea, pelvic pain Dyspareunia, dysuria Infertility Chocolate cysts in ovaries Diagnosis Laproscopy
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Endometriosis How do these medications help in treatment?
Ibuprofen (Advil) Oral contraceptives medroxyprogesterone (Depo-Provera) danazol - Danocrine Gonadotropin-releasing hormone agonists leuprolide (Lupron) Nafarelin (Synarel)
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Endometriosis Treatment and Nursing Care Surgical Therapy Conservative
Laparoscopic laser surgery / laparotomy Used in women who desire to bear children Definitive Hysterectomy Used in women who no longer desire children
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Which of these diagnostic measures is used most often to confirm the diagnosis of endometriosis?
A. CBC with differential C. Pelvic ultrasound D. Exploratory laproscopy E. Biopsy F. Ablation
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Tutorial on endometriosis
Go to the following website for a tutorial on endometriosis:
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Leiomyomas Polycystic ovary
BENIGN REPRODUCTIVE SYSTEM TUMORS Leiomyomas Polycystic ovary
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Uterine Fibroids (Leiomyomas)
Benign smooth muscle tumors in uterus diagnosed with Hysteroscopy Do they grow fast or slow? What makes them grow?
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Leiomyomas Signs and Symptoms Most do NOT have symptoms If they do:
Abnormal uterine bleeding- menorrhagia and metrorrhagia Pain, pelvic pressure
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Uterine Fibroids (Leiomyomas)
Diagnosis Enlarged uterus distorted with nodular masses Treatment and Nursing Care Myeomectomy, Myeolysis hysterectomy Cryosurgery ExAblate 2000 system
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Answer this! A 26 y/o woman who wishes to have children is diagnosed with uterine fibroids (leiomyoma). Which of the following is likely to be the treatment of choice? A hysterectomy will be necessary to remove the tumor A myomectomy may be performed Aspirin and NSAID’s will be used to control the pain Hormonal therapy will be used to shrink the tumor and maintain sterility
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Polycystic Ovaries Chronic endocrine disorder resulting in:
Insulin resistence Hyperandrogenism Altered gonadotropin functioning
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Polycystic ovaries LH, FSH No egg released from ovary Small cysts develop in ovaries rt failure to release egg Estrogen/ testosterone progesterone Diagnosed – Pelvic Ultrasound
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Polycystic Ovaries Signs and Symptoms
Irregular menstrual periods – infrequent or absent Hirsutism Obesity Acne No ovulation These manifestations are related to estrogen and high levels of ____________ and no ________________.
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Polycystic ovaries How do each of these medications assist in treatment? a. oral contraceptives – b. spironolactone (Aldactone) - c. leuprolide (Lupron) - d. Metformin (glucophage) - e. clomiphene (Clomid) – Surgery Oophorectomy
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Additional Treatment Options
Weight management Exercise Monitor lipid profile Monitor glucose levels
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Long-term complication is
Polycystic Ovaries Long-term complication is Infertility
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Female Reproductive System
Cancers of Female Reproductive System
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Diagnostic Testing
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What are the duties of the nurse in assisting with a pelvic exam?
Pelvic Examination What are the duties of the nurse in assisting with a pelvic exam?
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Pap Test
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Colposcopy LUMA Cervical Imaging System
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indicate abnormal cells?
What happens if the pap test Or colposcopy indicate abnormal cells?
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Conization Loop Electrosurgery Excision Procedure
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Endometrial Biopsy Teach what to “Call the Doctor” for.
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Cervical Cancer
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Cervical cancer What are the risk factors that could lead to cervical cancer?
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Staging and Treatment
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Endometrial Cancer
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Endometrial Cancer Major Risk factor Other Risk factors
Prolonged exposure to Estrogen Other Risk factors Age - >60 Infertility Diabetes Family history, other cancers Lifestyle – obesity, smoking
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What brings a woman to her doctor?
Endometrial Cancer What brings a woman to her doctor?
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Endometrial Cancer Treatment and Nursing Care
Diagnosed Endometrial biopsy Treatment: Surgical Therapy Hysterectomy – first choice of treatment Chemotherapy Radiation - brachytherapy
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Brachytherapy Internal radiation implantation which delivers a high dose of radiation to a localized area. The radiation device is placed near the tumor (in vagina) seeds, needles, catheters Radioisotopes are loaded into the device after correct placement.
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Nursing Care for Brachytherapy
What are the special considerations and nursing care related to the woman undergoing brachytherapy for endometrial cancer?
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Postop interventions for PanHysterectomy
Analgesia Ambulation I & O Passage of flatus Heat to abdomen Psychological support Teaching for home care
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Ovarian Cancer
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Ovarian Cancer Greatest risk factor is family history
Other risk factors include Age High-fat diet Greater number of ovulatory cycles Hormone replacement therapy Use of infertility drugs 90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells
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Clinical Manifestations
Explain why how these symptoms are related to ovarian cancer. Increase in abdominal girth Bowel and bladder dysfunctions Persistent pelvic or abdominal pain Menstrual irregularities Ascites Vague, undiagnosed, persistent gastrointestinal symptoms should alert the nurse to the possibility of an early ovarian malignancy
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Ovarian Cancer Diagnosis
Screening for high risk women should include CA-125, ultrasound, and yearly pelvic examination CA-125 is positive in 80% of women with ovarian cancer What is the only way to confirm the diagnosis of ovarian cancer?
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Tutorial on ovarian cancer
Treatment of Ovarian Cancer Surgery – most common Chemotherapy
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Vaginal Cancer Risk Factors Elderly
Cancer of the cervix or endometrium Young women - DES exposure Manifestations Bleeding not related to menses Dyspareunia, Dysuria Vaginal discharge
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Vulvar Cancer Risk Factors 50 plus Chronic irritation
History of HPV or Herpes 2 Manifestations Pruritus Burning Enlarged inguinal lymph nodes Asymmetry Lesions or mass Change in color
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Treatment options for all Caners
Surgery Oophorectomy, Panhysterectomy Pelvic Exenteration Chemotherapy Radiation External Brachytherapy
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Try This? Nursing responsibilities related to the patient receiving brachytherapy for endometrial cancer include: Maintaining bedrest Allowing the patient bathroom privileges only Limiting an individual nurses’ contact with the patient to 1 hour per day Allow visitors as long as they stay 6 feet away from the bed
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Problems with Pelvic Support
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Uterine Prolapse Downward displacement of uterus into vagina
Second degree First degree Third Degree
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Uterine Prolapse Signs and symptoms Treatment and Nursing Care
Stress incontinence Dyspareunia Heavy feeling in pelvis Treatment and Nursing Care Pessary Hysterectomy with A&P repair
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Cystocele and Rectocele
Cystocele – support is lost and bladder protrudes into the vagina Rectocele – support is lost and rectum protrudes into the vagina
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Treatment and Nursing Care
Patient teaching – Kegels exercises Surgery Anterior or Posterior colporrhaphy Post-op nursing care Patient teaching Prevent straining at Bowel Movement by using a Low residue diet and stool Restriction of heavy lifting and prolonged standing, walking or sitting Prevention of urinary retention
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That’s all folks!
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