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Reproductive System Ch. 30-33 Female Reproductive Structures • Internal structure – – – – Ovaries Fallopian tubes Uterus Vagina Ovaries • Location – End of fallopian tubes • Produce hormones – Estrogen – Progesterone • Store – Ovum Fallopian tubes • Thin tubes – Smooth muscle – Lined with cilia – Fertilization occurs Uterus • AKA: womb • Location – Between • Bladder • Rectum • Function – Receive fertilized egg – Site for growth & development of the fetus Uterus • 3 parts – Fundus – Body – Cervix Uterus • 3 layers – Perimetrium • Outer layer – Myometrium • Middle layer – Endometrium • Innermost layer Endometrium • Responds to changes in – Estrogen – Progesterone • During the ovarian cycle • To prepare for implantation of the fertilized embryo Vagina • AKA: Birth canal • Fibromuscular tube • Between: – Bladder/urethra – Rectum • Function – Birth canal – Menstrual flow – Intercourse External Genitalia • Mons pubis – Pad of adipose tissue • Labia – Fold of tissue • Vestibule – Area between labia • Clitoris • Vaginal opening • Urethral opening Breast / Mammary glands • Supported by – Pectoral muscles • Richly supplied with – Nerves – Blood – Lymph nodes • Primary purpose – Nourishment Breast • • • • Nipple Areola Mammary glands Tail of Spence Endometrial changes during the menstrual cycle • Menstrual phase – Hemorrhages, sloughs and sheds • Proliferative phase – Repairs and thickens • Secretory phase – h vascularity – Prepares to support fertilized ovum Assessment of Female Reproductive System • Breast Exam – – – – – Size Symmetry Contour Skin color Lesions Assessment of Female Reproductive System • Position – Lithotomy • Inspect • Palpate • Have client “bear down” – Bulging – Protrusion – Incontinence Mammography • X-ray of breast • Purpose: – Screen for breast CA Abdominal Laparoscopy • Visual examination of the abdomen using a fiberoptic tube. • abd. Filled with gas • http://www.google.com/url?url=http://www. youtube.com/watch%3Fv%3DxECrwui9Lks&r ct=j&sa=X&ctbm=vid&ei=jm7TpHyGqOTiAKihrz_BA&sqi=2&ved=0CFEQ uAIwAA&q=laparoscopic+hysterectomy&usg =AFQjCNHWtQoElG3corx6WIgqnaMeykfQjQ &cad=rja • http://www.google.com/url?url=http://www. youtube.com/watch%3Fv%3D7VfLv6gIMTA& rct=j&sa=X&ctbm=vid&ei=jm7TpHyGqOTiAKihrz_BA&sqi=2&ved=0CIgB ELgCMAg&q=laparoscopic+hysterectomy&us g=AFQjCNEnllO1PhW_sOIgCvEF4JkKe08_mw &cad=rja • http://www.google.com/url?url=http://www.yo utube.com/watch%3Fv%3DhzuB2wsY5I&rct=j&sa=X&ctbm=vid&ei=jm7TpHyGqOTiAKihrz_BA&sqi=2&ved=0CGYQuA IwAw&q=laparoscopic+hysterectomy&usg=AFQj CNEpuHV-R9FWz2gNhE_G6mSTAicSNg&cad=rja Nursing Care - Laparoscopy • Before – – – – Informed consent Reinforce teaching Clarify questions NOC before • douche • Antiseptic scrub – Empty bladder – Baseline vital signs Nursing Care - Laparoscopy • After – Monitor Vital signs • Report temp > 101oF – Apply perineal pad • Change q4 – Observe dressing • Drainage • Bleeding • Hematoma formation Nursing Care - Laparoscopy • May occur – Shoulder pain – Gas through vagina – Hiccups • Keep IV until PO resumed • Provide discharge instructions Nursing Care - Laparoscopy • When to notify MD – – – – – – Bleeding Intense abd pain Fever fluid leakage Malaise Difficulty breathing Colposcopy • Examine – Vagina – Cervix • Brightly lighted microscope Colposcopy • http://www.google.com/url?url=http: //medicalvideos.eu/video/c6f9bd5d2 56af06/Getting-a-ColposcopyExam&rct=j&sa=X&ctbm=vid&ei=9Oy 6TrvZFoLTiALEoC4DA&ved=0CFwQuAIwATgK&q=col poscopy&usg=AFQjCNEu7hbpErmFG 94yVa9SKIoXouI6Eg&cad=rja Small Group Questions 1. A patient is going to have a colposcopy. What teaching would you do before the procedure? 2. What would you note in a breast exam as being abnormal and worthy of further investigation? 3. Identify the anatomical structures that an ovum travels through and then exits the body (and their functions) 4. What is the endometrium and how is it different than other tissue of the body? 5. What would you teach your client following a laparoscopic procedure? Endometriosis • -osis – Abnormal condition • Endometri/0 – Inner lining of the uterus • Endometrial tissue is found outside the uterus Endometriosis • Ectopic locations – Pelvic organs – Diaphram Endometriosis • Ectopic tissue respond to ovarian cycle – – – – Inflammation Cysts Scarring Adhesions S&S: Endometriosis • Just before / during menses – – – – – Dysmenorrhea Backache Cramps Dysuria Infertility Dx: Endometriosis • Laparoscopy Rx: Endometriosis • Pain – Mild analgesics – NSAIDS • Suppress ovarian function – Oral contraceptives – Pg Pelvic Inflammatory Disease (PID) • Infection of the pelvic organs – – – – Fallopian tubes Ovaries Uterus Cervix • Cause by infection – Gonorrhea – Chlamydia • Major cause of female infertility • Pathophysiology – Organism travels up vagina – spreads S&S: PID • • • • • • High fever Vaginal discharge Severe lower abd pain Nausea Malaise Dysuria Rx: PID • Antibiotics • Analgesics • Treat the partner too! Small Group Questions 1. 2. 3. 4. 5. 6. Describe the pathophysiology of endometriosis? What are the S&S of endometriosis? What are the complications of endometriosis? What is the pathophysiology of PID? What is the primary cause of PID? What is the usual treatment option for PID? S&S: Breast Cancer • Small hard painless lumps or masses • Change in size/shape of breast • Dimpling • Rash, discharge, flaking • Location – Upper outer quadrant Breast cancer is the 2nd leading cause of cancer deaths in women, what is the leading cause of cancer deaths in women? A. Cervical B. Ovarian C. Stomach D. Lung E. Uterine Breast Exam • Emphasize the importance of continuing regular breast exams after menopause because the risk for breast cancer increases with age. Mastectomy • Before surgery – Preoperative care – Reinforce teaching – Allow access to support persons – Offer emotional support Mastectomy • After surgery – Routine post-op care – Reinforce teaching Mastectomy • Teaching – Empty the drain and replace dressing daily – Return for drain removal in 2-4 days per order – Take analgesics before pain becomes severe per order – Report excessive bleeding Mastectomy • Numbness & tingling in axillary are common • Arm / shoulder exercises per MD order • Drive – within 7-10 days • Return to work – 4-6 weeks • Don’t lift with arm on operated side Nrs Dx Mastectomy Grieving • • • • Listen attentively Spend time Explain feelings are normal Enlist support Nrs. Dx. Mastectomy Risk for infection • • • • • • Assess dressing, incisions Enc well balanced diet Teach incision care Report S&S of infection avoid deodorant skin care Nrs. Dx. Mastectomy Risk for Injury • • • • Use nonsurgical side Elevate arm on a pillow Enc. ROM Teach protective measures Nrs. Dx. Mastectomy Risk for Disturbed Body Image • • • • • • Enc. Verbalization Explain Include partner Provide resources Enc. to look at the incision Reassure Cervical Cancer • Common • Most r/t – Human papillomavirus (HSP) – STD/STI Cervical Cancer is highly treatable if found in the early stages. What is the best way to detect cervical cancer? A. B. C. D. E. Signs and symptoms MRI CT-Scan Pap smear Palpation (via a self physical exam) S&S: Cervical Cancer • Early – Asymptomatic • Invasive CA – – – – Bleeding White discharge Pain (back / thighs) Weight loss DX: Cervical Cancer • Papanicolaou (Pap) smear – Cells collected from the cervix Pap smear • Schedule test when not menstruating • Avoid sex, douching or vaginal meds 48 hours before exam • Void before exam • Lithotomy positing • Support client After procedure • Provide tissue/towelette for cleaning • Provide mini-pad to protect garments • Allow privacy while client dresses • Prepare requisition & slides • Provide info + Pap smear • Colposcopy • MRI • CT-scan Cervical Biopsy • Before – Explain – Empty bladder Cervical Biopsy • After – Cleanse area – Perineal pad – Minor bleeding and vaginal discharge normal – No tampon x 1 wk – No sex until discharge cleared – Notify MD if heavy bleeding, foulsmelling discharge, fever or malaise Tx: Cervical Cancer • Surgery • Radiation • Chemotherapy Nrs Dx: Cervical Cancer FEAR • Explain 90% survival rate • Allow time to express concerns and ask questions • Refer to counselor or support group Hysterectomy • Removal of the – Uterus • Approaches – Abdominal – Vaginal + Laparoscopy Vaginal vs. Abdominal • Vaginal – Faster recovery • Abdominal – Better access and visualization of pelvic cavity RISK FACTOR • increased the risk of – DVT and PE. • Encourage leg exercises • Advise to stop smoking • Promptly report S&S Nursing Care post-op Hysterectomy • Report – Excessive bleeding • Monitor for complications – Infection – DVT – PE • Assess vaginal drainage • Advise to restrict activities for 4-6 weeks – Heavy lifting – Tampons – Sex • Report – – – – – Temp > 100oF Vaginal bleeding Urinary incontinence Burning / Frequency Severe pain • Enc to express feelings • Provide info about hormone replacement • Reinforce importance of regular OB/GYN exams Small Group Questions 1. What is the most common location for breast cancer to form? 2. What might a women feel on a BSE that would indicate a possibility of breast cancer? 3. What is the #1 cause of cervical cancer? 4. What screening is done for breast cancer and cervical cancer? 5. Differentiate between abdominal and vaginal hysterectomy. How might the nursing care differ? 1. Your client had a hysterectomy 24 hours ago. What would you teach her as part of her discharge teaching? 2. A client had a mastectomy 24 hours ago. You identify a nursing diagnosis of impaired body image. Identify 3 nursing interventions for this client. Testes • Testes produce – Sperm – Testosterone • Testes are encased in – scrotum Ducts & semen • Epididymis – Houses sperm • Vas deferens • Seminal fluid – Epididymis – Prostate gland – Cowper’s gland • Sperm + Seminal fluid = – Semen Prostate Gland • Encircles the urethra • Just below the bladder • Function – Seminal fluid – Aids in ejaculation Penis • Tip – Glans – Covered by • Foreskin • Removal of the foreskin – Circumcision Physical Assessment of Male Reproductive System • Inspect breasts • Palpate inguinal area and groin – Bulges Physical Assessment of Male Reproductive System • Penis – Inspect – Retract foreskin – Inspect urinary meatus • Scrotum – Palpate each testes Physical Assessment of Male Reproductive System • Digital Rectal Exam – DRE – Palpate • prostate Dx Test of Male Reproductive System • Prostate-specific antigen – PSA – Levels rise • Benign prostate hypertrophy • Cancer of the prostate Orchitis • Inflammation of the – Testes • Caused by – Trauma – Infection • Mumps • Pneumonia • TB S&S orchitis • • • • • Pain Swelling *Fever *Scrotal redness Prognosis – Infertility – Sterility Tx: Orchitis • Swelling / pain – – – – Elevate Ice packs Scrotal support Bed rest Rx: orchitis • Analgesic • Antipyretic • If bacterial orchitis – Antibiotics Prostatitis • Inflammation of the prostate gland • Caused by – Bacterial agent • Escherichia coli – E-coli – Non-bacterial agent • Chlamydiae • Viruses S&S: Prostatitis • Pain, burning on urination – Dysuria • Frequency & urgency • Chills & fever • Low back, perineal or genital pain • Pain after ejaculation • Obstructed urinary flow Dx: Prostatitis • Examination of – Urine – Prostatic secretions • DRE A client with prostatitis is being evaluated by the MD. The MD performs a DRE. What S&S would you expect to be noted? A. B. C. D. Pain Pain and swollen prostate No pain, swollen prostate No pain, soft prostate Tx: Prostatitis • Bacterial – Antibiotics • Non-bacterial – Symptomatically – Pain • NSAIDs • Stool softeners – Voiding problems • Anticholinergics Nrs Care: Prostatitis • h fluid intake – 3 L/day – Void often • Sitz baths • Finish antibiotics Phimosis • Constriction of the foreskin • Risk of – Secondary infection – Constriction of glans • Tx – Circumcision Cryptorchidism • Undescended testicle/s Cryptorchidism • The testes develop in the abdominal cavity in early fetal life. By 14 to 17 weeks of intrauterine life they migrate to an opening in the body wall known as the inguinal canal. After 28 weeks they pass through the canal and by 35 to 40 weeks reach the scrotum. • Undescended testicles are fairly common in premature infants. They occur in about 3 - 4% of full-term infants. In most cases the testicles descend by the time the child is 9 months old. • Increased risk of – Testicular cancer – Infertility Nrs Care: • Teach men with HX to be vigilant about testicular self-exam Testicular Cancer • Most common cancer in men between age 15-35 • One of the most curable cancers – 90% • Cause – Unknown Testicular Cancer • Risk Factors – Age • 15-40 – Cryptorchidism – Family Hx – Race / ethnicity • USA Testicular Cancer • Pathophysiology – Cancer in testicle replacing normal cells – Affects one testicle – Spreads rapidly, but only locally Testicular Cancer • Stage 1 – Testicle only • Stage 2 – Testicle – Lymph node • Stage 3 – Metastases Testicular Cancer • S&S – Painless hard nodule – Dull ache in pelvis or scrotum Dx: Testicular Cancer • Ultrasound of testicle • CT-scan – Detect metastasis • Biopsy Tx: Testicular Cancer • Orchiectomy – Remove testicle • Radical orchiectomy – Testicle – Spermatic cord – Lymph nodes • Prosthesis Tx: Testicular Cancer • Chemotherapy • Radiation therapy Prostate Cancer • http://www.google.com/url?sa=t&rct =j&q=turp&source=video&cd=4&ved =0CGYQtwIwAw&url=http%3A%2F%2 Fwww.youtube.com%2Fwatch%3Fv% 3Db8MAxz_L930&ctbm=vid&ei=bq5TqaZB6eOigKz8aDZBA&usg=AFQjCN GRIz8J9oqyTt56fvTy7urxmu7slg&cad =rja • TURP beginning of surgery Prostate Cancer • http://www.google.com/url?sa=t&rct=j&q =turp&source=video&cd=1&ved=0CFEQt wIwAA&url=http%3A%2F%2Fwww.youtub e.com%2Fwatch%3Fv%3DWNCsunVC4Rs &ctbm=vid&ei=bq5TqaZB6eOigKz8aDZBA&usg=AFQjCNFLrd 5eavDeA9O09n6Mf5l2IPQRug&cad=rja • Turpsurgery • http://www.google.com/url?sa=t&rct=j&q =turp&source=video&cd=3&ved=0CF8Qt wIwAg&url=http%3A%2F%2Fwww.youtub e.com%2Fwatch%3Fv%3DtcUaAXVd4Hg& ctbm=vid&ei=bq5TqaZB6eOigKz8aDZBA&usg=AFQjCNGyW hWVyEDTeD3qENUhNJ0aQvHISQ&cad=rja • turp Prostate Cancer • Most common type of cancer in men Prostate cancer is the 2nd leading cause of cancer death of men in North America. What is the leading cause of cancer death in men? A. B. C. D. Stomach Lung Testicular Brain Prostate Cancer • Risk factors – Age – African-American men – Family hx Prostate Cancer • Prognosis – Detected early • Curable – If confined to prostate • 5+ year survival = – 100% – Slowly or aggressive progression Small Group Questions 1. Follow the path of sperm from formation to ejaculation. 2. What is orchitis and what is its cause? 3. What are the symptoms of prostatitis? 4. How is prostatitis treated? 5. What are the S&S of testicular cancer? 6. What is the treatment for phimosis? 7. What is the complication associated with Cryptorchidism? Chlamydia • Most common STD in the USA • Leading cause of PID • Pathophysiology – Bacteria that behaves like a virus S&S: Chlamydia Female • Asymptomatic • * dysuria • * discharge • * vaginal bleeding • * pelvic pain • *Maybe Male • * Asymptomatic • Dysuria • White or clear urethral discharge • Testicular pain Chlamydia • Even though they are asymptomatic, they are still potentially infectious. Dx: Chlamydia • The CDC recommends screening asymptomatic women who are at high risk for Chlamydia. • Blood test What is the causative agent for Chlamydia? A. Bacteria B. Virus C. Fungus D. Yeast E. Other Rx: Chlamydia • Doxycycline PO for 7 days Complications: Chlamydia Female • PID • Infertility • Pelvic abscesses • Spontaneous abortion • Stillbirth Neonate • Conjunctivitis • pneumonia Male • Urethritis • Prostatitis Gonorrhea • AKA – GC – The Clap • Most common reportable STI in the US Reporting STI’s • All states require reporting of syphilis, gonorrhea and HIV/AIDS to state and federal agencies. Chlamydia is reportable in most states. (California is a required reporting state) Mode of transmission • Sex • Delivery as the neonate passes through the birth canal S&S Gonorrhea a Female • Asymptomatic • *Vaginal discharge • * Abnormal menses • * Dysuria Male • Dysuria • Frequency • Purulent urethral discharge Complications: Gonorrhea a Female • PID • Sterility • Ectopic Pg • Abdominal adhesions Male • Prostatitis • Urethritis • Nephritis • Epididymitis • Sterility Tx: Gonorrhea a • Cephalosporins – IM x 1 • Drug resistance is becoming a problem! • Shortly after a neonate is delivered, erythromycin is instilled into the neonate’s eyes. This drug is given to prevent: A. Ophthalmia neonatorum B. Retrolental fibroplasias C. Corneal keratitis D. Acute uveitis Syphilis • Systemic STI if not treated can lead to – – – – Blindness Paralysis Mental illness Death S&S: Syphilis • Primary – Painless chancre at site of exposure – Lymphadenopathy S&S: Syphilis • Secondary – – – – Skin rash Oral mucous patches Fever Malaise S&S: Syphilis • Tertiary – Tumors of the • Skin • Bone • Liver – Inflammation of the aorta – CNS degeneration Tx: Syphilis • Treatable – early • Penicillin – IM x1 Complications: Syphilis • 1o & 2o – Disease progression • Tertiary – – – – – Heart failure Blindness Skin ulcers Liver failure Mental illness Genital herpes • Herpes simplex virus – Usually type 2 S&S: Genital herpes • “Single or multiple small painful vesicles on an erythematous base on the genitals with associated pruritus, followed by painful ulcers” Complications: Genital Herpes Female • Herpes keratitis • Cervical cancer Neonates • Herpes affection the – – – – Eyes Skin Mucous membranes CNS Male • Herpes keratitis • Neuralgia • Meningitis • Urethral strictures • Pus forming in lymph nodes Rx: Genital Herpes • NO CURE! • Symptom relief – Acyclovir • PO • 7-10 days Nrs Dx: Impaired skin integrity • Keep perineal tissue clean and dry • Clean from to back – After urinating – After defecating • Soap and water • Cotton underwear • No • Avoid – – – – Powders Sprays Tight fitting jeans Pantyhose Nrs. Dx Risk for injury • Take all Rx • Abstain from sex until client and partner are cured • Use a condom • Teach S&S of infection Nrs Dx Anxiety • Emphasize most STIs can be effectively treated • C-section can prevent transmission to baby Nrs Dx Situational Low Self-Esteem • Create an environment where the client feel respect and safe • Provide privacy and confidentiality • Communicate caring for the client Nrs Dx Sexual Dysfunction • Provide support, nonjudgmental environment to discuss feelings and questions • Offer information and support groups Nrs Dx Impaired Social Interaction • STI is a consequence of sexual behavior, not a punishment, and that it can be avoided in the future. AIDS • Causative agent – Human Immunodeficiency virus – HIV AIDS • Mode of transmission – Sexual contact – Direct injection of contaminated blood – Mother to fetus AIDS • Causes destruction of Thelper cells • immunodeficiencies Manifestations of HIV • 3 stages: – Primary infection – Asymptomatic period – AIDS & opportunistic disorders HIV: Primary infection • • • • • • • • Fever Sore throat General malaise/fatigue H/A Rash N&V Night sweats Wt loss HIV: Asymptomatic period • Chronic – @ 10 years HIV: AIDS & Opportunistic disorders • Respiratory – Pneumocystis carinii pneumonia • Skin – Kaposi’s sarcoma • Gastrointestinal – wasting syndrome Kaposi’s Sarcoma • -oma – Cancer • Most common cancer assoc. with HIV • Tumors on blood vessels • Reddish-purple lesions on the skin and mucous membrane • Painless painful Wasting syndrome • Unplanned weight loss – >10% • Chronic Diarrhea • Fever • Emaciated Rx: HIV • Antiretroviral medication – Combine 3-4 drugs – HAART – Highly Active Antiretroviral Therapy Small Group Questions 1. What is wasting syndrome in AIDS patients 2. What is the most common form of cancer associated with HIV? What are its symptoms? 3. What are the S&S of Chlamydia, Gonarrhea, Syphilis, and genital herpes? How are they each cured? 4. What can one do to prevent from getting an STI? 5. What is Herpes keratitis and which STI can cause it?
