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Chapter 12 Care of the Patient with a Reproductive Disorder Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1 Slide 1 Slide 2 Slide 2 Slide 3 Slide 3 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Figure 12-1 (From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.) Longitudinal section of the male pelvis showing the location of the male reproductive organs. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 1 Figure 12-2 (From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.) Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell (ovum) surrounded by sperm at time of fertilization (right). Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 4 Slide 4 Slide 5 Slide 5 Slide 6 Slide 6 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) Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Figure 12-3 (From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.) Longitudinal section of the female pelvis showing the location of the female reproductive organs. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 2 Figure 12-4 (From Thibodeau, G.A., Patton, K.T. [2004]. Structure and function of the body. [12th ed.]. St. Louis: Mosby.) Sectioned view of the uterus showinag relationship to the ovaries and vagina. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 7 Slide 7 Slide 8 Slide 8 Slide 9 Slide 9 Figure 12-6 (From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.) Lateral view of the breast (sagittal section). Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Figure 12-7 (From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.) Mammalian ovary showing successive stages of ovarian (graafian) follicle and ovum development. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 3 Figure 12-15 (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. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 10 Slide 10 Human Sexuality • Sexual identity 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 11 Slide 11 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 12 Slide 12 4 Laboratory and Diagnostic Examinations • Diagnostic tests for the male Testicular biopsy Semen analysis Prostatic smears Cystoscopy Prostate specific antigen (PSA) Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 13 Slide 13 Slide 14 Slide 14 Slide 15 Slide 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 5 The Reproductive Cycle • Dysmenorrhea (continued) Medical management/nursing interventions • • • • • Exercise Nutritious foods, high in fiber Heat to pelvic area Mild analgesics Prostaglandin inhibitors Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 16 Slide 16 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 17 Slide 17 The Reproductive Cycle • Premenstrual syndrome (PMS) Etiology/pathophysiology • 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 18 Slide 18 6 The Reproductive Cycle • Premenstrual syndrome (PMS) (continued) Medical management/nursing interventions • Analgesics; diuretics; progesterone • Diet 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 19 Slide 19 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 20 Slide 20 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 21 Slide 21 7 The Reproductive Cycle • Menopause (continued) Medical management/nursing interventions • Estrogen therapy Premarin Provera • Calcium supplements Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 22 Slide 22 Slide 23 Slide 23 Slide 24 Slide 24 The Reproductive Cycle • Male climacteric Etiology/pathophysiology • Gradual decrease of testosterone levels and seminal fluid production; 55-70 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. The Reproductive Cycle • Impotence Etiology/pathophysiology • Inability of an adult man to achieve penile erection • Functional; anatomical; atonic Medical management/nursing interventions • • • • Remove cause if possible Treat diseases Viagra Mechanical devices: penile prosthesis Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 8 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 25 Slide 25 Slide 26 Slide 26 Slide 27 Slide 27 Infections of the Female Reproductive Tract • Simple vaginitis Etiology/pathophysiology • Common vaginal infection • Causitive 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 9 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 28 Slide 28 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 29 Slide 29 Slide 30 Slide 30 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 • Bedrest Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 10 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 31 Slide 31 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 32 Slide 32 Slide 33 Slide 33 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 11 Figure 12-10 (From Herbst, A.L., et al. [1992]. Comprehensive gynecology. [2nd ed.]. St. Louis: Mos by.) Common sites of endometriosis. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 34 Slide 34 Slide 35 Slide 35 Slide 36 Slide 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Figure 12-11 (From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.) Types of fistulas that may develop in the vagina and uterus. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 12 Disorders of the Female Reproductive System • Displaced uterus Etiology/pathophysiology • Congenital • Childbirth • Backward displacement Retroversion Retroflexion • Forward displacement Anteversion Anteflexion Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 37 Slide 37 Slide 38 Slide 38 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 39 Slide 39 13 Figure 12-12 (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. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 40 Slide 40 Slide 41 Slide 41 Slide 42 Slide 42 Disorders of the Female Reproductive System • Uterine prolapse (continued) Medical management/nursing interventions • Pessary • Surgery Vaginal hysterectomy Anteroposterior colporrhaphy Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 14 Figure 12-13 (From Lewis, S.M., Heitkem per, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and management of clinical problems. [6th ed.]. St. Louis: Mosby.) A, Cystocele. B, Rectocele. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 43 Slide 43 Slide 44 Slide 44 Slide 45 Slide 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Disorders of the Female Reproductive System • Leiomyomas of the uterus 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 15 Figure 12-14 (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 diseas e in adults and children. [4th ed.]. St. Louis: Mosby.) Leiomyomas. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 46 Slide 46 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 47 Slide 47 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 48 Slide 48 16 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 49 Slide 49 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 50 Slide 50 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 51 Slide 51 17 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 52 Slide 52 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 53 Slide 53 Cancer of the Female Reproductive Tract • Cancer of the ovary (continued) Medical management/nursing interventions • Surgery TAH-BSO and omentectomy • Radiation and/or chemotherapy Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 54 Slide 54 18 Hysterectomy • Total 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 55 Slide 55 Slide 56 Slide 56 Slide 57 Slide 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 19 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 58 Slide 58 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 59 Slide 59 Disorders of the Female Breast • Breast cancer (continued) Medical management/nursing interventions • Depends on the stage Radiation Chemotherapy Surgery o Lumpectomy o Mastectomy—partial, subcutaneous, simple, radical Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 60 Slide 60 20 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 61 Slide 61 Slide 62 Slide 62 Slide 63 Slide 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 • Bedrest • Elevate scrotum; cold compresses • Antibiotics Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 21 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 64 Slide 64 Slide 65 Slide 65 Slide 66 Slide 66 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 • Bedrest; elevate scrotum; cold compresses Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 • Bedrest • Elevate scrotum; cold compresses Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 22 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 67 Slide 67 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 68 Slide 68 Sexually Transmitted Diseases • Genital herpes (herpes simplex virus type II) 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) Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 69 Slide 69 23 Figure 12-20 (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. Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 70 Slide 70 Sexually Transmitted Diseases • Genital herpes (herpes simplex virus type II) (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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 71 Slide 71 Slide 72 Slide 72 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 24 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 73 Slide 73 Sexually Transmitted Diseases • Syphilis (continued) Medical management/nursing interventions • Penicillin • Tetracycline or erythromycin, if allergic to penicillin • May be treated in any stage; damage will not be reversed • Treat all sexual contacts Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 74 Slide 74 Slide 75 Slide 75 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 25 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 76 Slide 76 Slide 77 Slide 77 Sexually Transmitted Diseases • Gonorrhea (continued) Medical management/nursing interventions • • • • Penicillin Rocephin Doxycycline or tetracycline TREAT ALL SEXUAL CONTACTS Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 78 Slide 78 26 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 79 Slide 79 Slide 80 Slide 80 Sexually Transmitted Diseases • Trichomoniasis (continued) Medical management/nursing interventions • Metronidazole (Flagyl) • TREAT ALL SEXUAL CONTACTS Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 81 Slide 81 27 Sexually Transmitted Diseases • Candidiasis (continued) Medical management/nursing interventions • Treat underlying condition • Nystatin (Mycostatin) • Topical amphotericin B Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 82 Slide 82 Slide 83 Slide 83 Slide 84 Slide 84 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 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 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 • Tetracycline; doxycycline; Zithromax • TREAT ALL SEXUAL CONTACTS Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. 28 Nursing Process • Nursing diagnoses Anxiety Body image, disturbed Coping, ineffective Fear Fluid volume, deficient Health maintenance, ineffective Infection, risk for Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Knowledge, deficient Pain, acute and chronic Self-esteem, situational low Sexual dysfunction Skin integrity, impaired Tissue perfusion, ineffective Urinary elimination, impaired Slide 85 Slide 85 29