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GU System - Handout Female Reproduction Text: Brunner & Suddarth’s Medical Surgical Nursing: Ch. 46-48 Behavioral Objectives: By the end of this lecture the student will be able to: Review the anatomy and physiology of the female genito-urinary 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: o Vaginitis o Pelvic inflammatory disease (PID) o Endometriosis Discuss incidence, prevention and treatment of the patient with cancer of the GU system Discuss the nursing interventions in pre and post-operative care of patients undergoing the following surgeries o Hysterectomy o Mastectomy I. Review the anatomy and physiology of the genito-urinary systems a. Brunner and Suddarth’s Medical Surgical Nursing pg 1614 b. Breast i. Female breast development _________ - _______ years ii. Tail of ____________________ iii. _______________________ ligament iv. 12-20 _______________ v. Nipple vi. Areola c. External Genitalia d. Internal Reproductive Structures i. Vagina 1. ___________ membrane 2. Posterior to _______________ & _______________ 3. Anterior to ________________ 840986711 5/6/2017 1 4. Anterior & Posterior walls _____________ 5. Upper vagina surrounds _______________ a. “Inferior ______________________” ii. Uterus 1. ____________ shaped: _____________________ 2. Size _____________ variable: _________________ 3. Location: posterior to the ___________________ 4. Ligaments: ____________________________________ 5. Cervix: _________________ into the vagina 6. Fundus: _______________ of the uterus 7. Endometrium: __________________ of the uterus iii. Ovaries 1. Connected to the uterus by _______________ ________ 2. Contains: _____________________________________ 3. Ova / ovum: __________________________________ e. Ovulation Process (pg 1615) i. Definition: __________ of a __________ ovum from the _______ ii. Follicular Stage 1. ovum ____________ _________(graafian follicle) 2. reaches ____ ________ (of the ovary) 3. ovum _______________ iii. Ovulation iv. After ovulation 1. Ovum ______________________ _____________ a. If meets a spermatozoon 840986711 5/6/2017 2 i. _______________& ________________ 2. Ovum cyst Corpus Luteum stays in the __________ a. Produces ________________ b. Prepares the ____________ for the _______ ovum f. The Menstrual Cycle (pg 1615-1616) i. Two system control menstruation: ______________ & _________ ii. Hormones 1. Ovaries a. _____________ & _________________ 2. Pituitary a. ______________ Stim. _________ to _______ b. __________ Stim. ___________ __________ iii. Cyclical Pattern (see table 46-1 pg. 1617) 1. Changes in ______________ & __________________ 2. __________ day cycle Menstrual Follicular Phase Ovulation Luteal Phase Premenstrual Phase Phase Estrogen Estrogen Estrogen Estrogen Estrogen Progesterone Progesterone Progesterone Progesterone Progesterone FSH FSH FSH FSH FSH LH LH LH LH LH Endometrium Endometrium Endometrium Endometrium Ovaries Endometrium Day g. Menopausal Period: (Pg. 1616) i. End of reproductive __________ 840986711 5/6/2017 3 ii. Age _________ - __________yrs iii. Menstruation ________________: No menses _______________ iv. _________ not active ____________ estrogen 1. Reproductive organs ___________________________ 2. ___________ ova mature II. Describe the physical assessment of the GU system: pg 1616 a. Health history and clinical manifestations i. Menstrual history 1. Menarche: ______________ of menstration ii. Hx of pregnancies iii. Hx of medications 1. _____________ therapy 2. Hormonal _______________________ 3. ___________________ treatment iv. Pain 1. Dysmenorrhea: Painful _____________________ 2. Dyspareunia: Painful _____________________ v. Hx of vaginal discharge vi. Hx of urinary problems vii. History of B&B control viii. Sexual history ix. Hx of abuse x. Hx of surgery xi. Hx of chronic illness or disability xii. Hx of genetic disorders b. Physical Assessment (Pg. 1623-1626) i. Breast: Frequency of self exam: ___________________ 1. Assessment question a. Palpable ____________ b. ________________ changes c. Pain, swelling, redness 840986711 5/6/2017 4 d. ____________________ changes 2. Findings a. Erythema i. Benign local _________________________ or ii. Superficial _______________ b. Prominent venous pattern i. _____ blood supply required by _______________ c. Edema & ____________ i. Neoplasm blocking the ______________ drainage tubes d. __________-peel appearance / Peau D’Oragne (__________) i. Advanced breast ___________________ e. _________________ inversion f. Sign of dimpling, creasing, changes in contour g. Palpation – Breast Cancer i. ______________ mass ii. ______________ breast iii. _______________, hard, embedded in tissue iv. ______-_________________ ii. Mammography 1. Duration: ___________________________ 2. Recommended frequency a. ___________________ b. > ______________ years iii. Pelvic 1. Frequency: ___________ 2. Initial: Age ___________ or ____________ ____________ iv. Positioning: ___________________________________________ v. Inspection 1. Inspects ____________ genitilia 840986711 5/6/2017 5 2. __________ examination a. ___________ canal b. ___________ vi. Pap smear (pg 1627) 1. _____________ sample of the ________________ 2. Purpose: Dx. ___________________________ 3. Do not ___________________ before Dr. visit vii. Bimanual palpation (pg. 1626) 1. ___________ palpation 2. ____________ palpation viii. Colposcopy (pg. 1628) 1. Portable _________________________ 2. Obtain _________________ III. Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for – Vaginitis: (pg 1661 -6) a. Pathophysiology of Vaginitis i. Vaginitis : inflammation of the ___________ ii. Normal pH _________ - __________ iii. Lactobacillus acidophilus, 1. ___________the growth of anaerobes 2. produces ___________ ________ ______ pH 3. Produces: hydrogen ____________ iv. risk if a. _______________ c. Altered ____________ b. _______________ d. ________________ v. Candida,Trichomonas or other ________________invade the vagina. b. Clinical manifestations: General 1. Vaginal discharge +… 840986711 5/6/2017 a. Itching e. Edema b. Odor f. Aggravated by ________ c. Redness g. Urethritis 6 d. Burning c. Candida / Vulvovaginal Candidiasis (pg. 1662) i. Fungal or ____________ infection ii. Asymptomatic symptomatic (risk factors) 1. Use of _____________ bacteria protective organisms 2. ________________ 3. Diabetes ______________ 4. Human immunodeficiency virus (HIV) 5. ________________ treatment 6. Oral _________________________ therapy iii. Clinical manifestations 1. Vaginal discharge a. Color: __________, cottage cheese like b. The pH of the discharge is ____________ c. ________________ iv. Medical Management 1. _______ ___________ agents a. Miconazole (Monistat); Nystatin (Mycostatin) b. Available without prescription d. Bacterial Vaginosis i. Overgrowth of ______________________bacteria ______________found in the vagina and _____________________of lactobacilli ii. Characterized by: 1. ________________-like odor 2. ________________ vaginal pH 3. ________________ discharge a. Color: _______________________ 4. _____________ discomfort iii. Medical Management 1. Metronidazole (Flagyl) 2. Clindamycin (Cleocin) 840986711 5/6/2017 7 e. Trichomonas AKA “Trich” (pg 1664) i. _______ ___________ ______________ ii. ________________ carrier iii. Clinical manifestations 1. Vaginal discharge a. ___________________ c. ___________________ b. ___________________ d. ___________________ 2. Cervical ________________ 3. Multiple small _________________ 4. pH ________________________ iv. Complications 1. ___________ life threatening v. Medical Management 1. Metronidazole (Flagyl) a. Anti______________ agent b. Anti _____________ agent 2. ______________ partners f. Nursing process of Patients with Vulvovaginal infection i. Assessment 1. Examine: Do not __________________ 2. Observe the area for: a. ___________________ c. ___________________ b. ___________________ d. ___________________ 3. Describe symptoms a. __odor_____________ c. ______burn_________ b. __itch_____________ d. _____dysuria_______ 4. Prep a ________________ _____________ 5. Test _____________ of discharge 6. Factors that might contribute a. Physical /chemical factors i. Constant ___________; tight / synthetic ________ 840986711 5/6/2017 8 ii. Perfumes & __________ iii. ______________ / ______________ baths iv. Poor _____________ v. ______________ hygiene products b. Psychogenic factors i. ___________ ________________ ____________ c. Medical conditions i. __________________ ii. ________________ iii. _____________ partners ii. Diagnosis 1. ______________related to burning, odor or itching from the infectious process 2. _____________ related to stressful symptoms 3. Risk for _____________ or spread of infection 4. Deficient _____________about proper hygiene and preventive measures iii. Planning and Goals iv. Nursing Interventions 1. Admin. ______________ 2. ____________ baths 3. ____________powder 4. ______________ patient 5. ______________discouraged 6. __________ fitting underwear = good 7. ____________, _____________, non-________________, heat-_______________ underwear = bad v. Evaluations/Expected patient outcomes IV. Describe etiology, pathophysiology, clinical manifestations, nursing management & patient ed. for – Pelvic Inflammatory disease (pg. 1670-71) a. Pelvic Inflammatory Disease – Pathophysiology 840986711 5/6/2017 9 i. AKA: Pelvic _______________________ ii. PID is an inflammatory condition of the pelvic cavity that begins with cervicitis and may involve the _____________, ________________, ____________ pelvic peritoneum or pelvic vascular system iii. Infection is usually caused by _____________ 1. __________________ and ______________ iv. PID is the most common STD but ______________________ v. Enters through ______________ ___________ canal & _______________ _____________ ______________ tubes & ovaries _____________ b. Risk factors i. Early age ____________ ii. ________ # sexual partners iii. Sex with a partner with an ___________ iv. _____________ of STD’s v. Previous _____________ infection vi. ____________________ procedures c. Clinical manifestation i. Vaginal discharge ii. ____________ iii. _________________ _____________pain iv. ______________after menses. v. Pain while ___________ vi. Other S&S: 1. Fever 3. N/V 2. Gen. malaise 4. H/A d. Complications i. Peritonitis ii. ______________ iii. _______________ / adhesions 1. Chronic pelvic ____________ 840986711 5/6/2017 10 iv. Fallopian tube obstruction 1. _____________ pregnancy 2. Occlude tubes _______________ v. Bacteremia ___________________________ vi. Thrombophlebitis ________________________ e. Medical management i. ______________ _____________ Antibiotics ii. Treat ____________________ iii. Treatment at home: ______________________________ iv. Intensive Therapy / Hospital: ___________; ____________; __________ f. Nursing process of Patients with PID i. Activity: ________________________ ii. Position : _____________________ iii. Vital signs iv. Assess: ____________________________ v. Administer: ____________________________________ vi. Pain Relief: ____________________________________ V. Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for – Endometriosis (pg. 1680) a. Endometriosis – etiology i. “A benign lesion or lesions with cells similar to those lining the uterus grow aberrantly in the pelvic cavity outside the uterus.” ii. __________ pelvic pain & ________________ b. Pathophysiology i. Misplaced endometrial tissue responds to ____________________ ii. During____________________, the extopic tissue bleeds, mostly into areas having no __________ ____________ and _______________ iii. Causes_____________ , _____________ and/or __________________ c. Clinical manifestations 840986711 5/6/2017 i. Dysmenorrhea iii. Pelvic pain ii. Dyspareunia iv. Depression 11 v. Loss of work vii. Infertility vi. Relationship d. Assessment and diagnostic findings i. _________________ ii. _________________ exam iii. __________________ exam (pg 1630) e. Medical managements i. ___________________________ ii. ___________________________ 1. Side effects: _______ retention, weight _________, ____________ iii. Surgery iv. Pregnancy f. Nursing process of Patients with Endometriosis VI. i. Assessment 1. Hx & PE focus on specific symptoms, effects of meds, reproductive plans ii. Diagnosis Planning and Goals 1. Relief of pain, Dysmenorrhea, dyspareunia 2. Avoidance of infertility iii. Nursing Interventions 1. Dispel myths and encourage the patient to seek care if Dysmenorrhea or dyspareunia occurs iv. Evaluations/Expected patient outcomes Discuss incidence, prevention and treatment of the patient with cancer of the female GU system: a. Cancer of the Cervix (pg 1682-85) i. Pathophysiology 1. Predominantly ___________________ cell cancer 2. Age _____________ - _____________ 3. Risk factors a. ___________ sex partners b. _________ age at first coitus c. Sex with men whose partner have had ________________ d. _______ __________ ____________virus 840986711 5/6/2017 12 i. ____________ ii. Causes _________ growths e. _______________ ii. Clinical Manifestations 1. Early ___________________ 2. Late symptoms a. Discharge: __________, _________, _________, ______ b. Irregular _____________ c. Leg __________ d. Dysuria e. ____________ bleeding f. ____________of extremities iii. Assessment and diagnostic findings 1. ________________ smear 2. __________________ 3. Colposcopy a. ___________________ iv. Medical management 1. CRYOTHERAPY 2. Surgery: ____________________________ 3. Radiation b. Cancer of the uterus (pg 1685) i. Pathophysiology ii. Risk factors 1. Age: ________________ 2. Postmenopausal ____________ 3. ____________ 4. Unopposed _____________ 5. Nulliparity /Infertility iii. Assessment 1. Irregular _____________ should be evaluated 840986711 5/6/2017 13 2. Endometrium aspirations 3. Ultrasound iv. Medical management 1. _________________ c. Cancer of the Ovary (pg. 1689) i. Pathophysiology 1. About ________detected in the late stage – with metastasized 2. Age ________ - ___________ 3. Risk factors: _________________ & ____________________ ii. Clinical Manifestations 1. ___________ abdominal girth 2. pelvic ___________ 3. ______________ 4. ______________ 5. ________ waist size 6. _______________pain iii. Assessment and diagnostic findings 1. NONE iv. Medical management VII. Discuss the nursing interventions in pre and post-operative care of patients undergoing hysterectomy (pg 1691) a. Pathophysiology i. Hysterectomy is the surgical removal of the ___________________ ii. Total Hysterectomy: removal of the ____________ & ___________ iii. Sub-total or supra-cervical hysterectomy: removal of the ____________ but not the _______________ iv. Radical hysterectomy: removal of the uterus & , __________ (upper 1/3) pelvic ___________ nodes, _____________ tubes; and __________ 1. Usually performed due to _______________ condition b. Variety of approaches i. ____________________ 840986711 5/6/2017 14 ii. ____________________ iii. ____________________ c. Pre-op management i. _______________? ii. Empty ___________________ iii. Empty ___________________ iv. ________________________ d. Nursing Diagnosis/interventions i. Anxiety related to the diagnosis of cancer, fear of pain, possible perception of loss of femininity, and disfigurement 1. ___________________________ 2. ___________________________ ii. Disturbed body image related to altered fertility and fear about sexuality and relationships with partner and family 1. Discuss _____________________ 2. Orgasm iii. Acute pain related to surgery and other adjuvant therapy 1. Assess: ________________ 2. Administer: __________________________ 3. Teach alternatives a. _________________ techniques b. Early _________________ c. _____________________ e. Potential complications i. Hemorrhage 1. Assess _________ pads 2. Assess _____________ 3. Educate on ______________ restrictions ii. Deep vein thrombosis 1. Prevention a. Elastic compression _________________ 840986711 5/6/2017 15 b. Early _________________ 2. Assess for DVT’s a. ______________ ( ______________; __________; _____________; ____________) 3. Assess of PE a. ________________ pain b. __________ pulse c. ___________________ iii. Bladder dysfunction / Urinary ______________ 1. ______________ 2. Assess bladder _______________________ 3. Stim. bladder: _________________________________________ 4. ____________ VIII. Breast Cancer a. Risk Factors i. Gender ________________________ ii. Age: __________________________ iii. Personal History ____________________________________ iv. Hormonal factors 1. Early _____________________ 2. _________parity 3. ____________ menopause v. ____________________ vi. ____________________ use vii. **No evidence that oral _____________________________increase risk! b. Characteristics i. Most common location: _________________________________ ii. __________-tender iii. __________________, ____________________, Irregular boarders c. Advanced signs i. _______________dimpling 840986711 5/6/2017 16 ii. Nipple _____________________ iii. _____________________ ulceration d. Types of surgeries i. Modified Radical Mastectomy 1. Removal of a. _____________________ b. Nipple –areola c. __________________ lymph nodes 2. Not removed a. Pectoralis major and pectoralis minor _________________ ii. Total mastectomy 1. Removal of a. ___________________ b. Nipple-areola 2. Not removed a. Axillary ___________________ nodes b. _________________ groups iii. Breast Conservation Treatment / AKA (_____________________) 1. _________________ or segmental mastectomy 2. Removal of _________________ 3. May include axillary ___________________________ IX. Discuss the nursing interventions in pre and post-operative care of patients undergoing mastectomy: (pg. 1716-1725) a. Postoperative nursing diagnosis and interventions i. Pain 1. Assess 2. Administer a. Analgesics b. Oxycodone & acetominaphen (Percocet) c. Propoxyphene & acetominaphen (Darvocet) 3. Non-pharmaceutical measures 840986711 5/6/2017 17 a. ___________________________________ b. Position __________________________ c. ____________________ techniques 4. Report a. ____________________________________ ii. Impaired skin integrity 1. _________________ tubes in place 2. _____________of tubes 3. Hematoma’s 4. ___________ packs iii. Risk for infection 1. Drainage tubes duration: ________________ 2. Teach: a. ____________, ______________, _____________ b. ______________ care c. S&S of _______________ i. _____________ drainage ii. _______________ d. No _____________ until completely healed iv. Disturbed body image 1. Support v. Impaired sensory perception related to sensations in arm, breast, or side 1. Tightness, pulling, burning, tingling in the chest wall, axilla, upper arm 2. ____________ with healing lasts ____________ diminishes 3. Teach “this is ______________” 4. exercise _________ sensation vi. Knowledge deficit: Prevent complications from surgery – lymphedema 1. Results when lymphatic ____________ are inadequate to return flow of lymph fluid. 2. Transient _____________ 840986711 5/6/2017 18 3. Medication: __________________________ 4. ____________________ 5. Manual lymph drainage: a. Light____________________________, b. performed by a _________________________ c. assists moving the _____________________ to other parts of the body 6. Compression bandaging: a. multi-layered _________________________after massage b. keep the fluid out of the arm 7. _______________________________ 8. Do not perform ____________________ on affected arm 9. Do not take _________________________ on affected arm 10. Avoid ________________________ arm position 11. Compression garment: a. _______________ b. helps maintain _______swelling achieved during treatment X. Study questions for Female GU a. Describe anatomically the location of the vagina, uterus and ovaries b. Describe the processes of ovulation c. What hormones are involved with menstruation d. What happens to the ovum after ovulation? e. What happens to the ovum cyst after ovulation? f. Where does fertilization take place? g. What are the hormonal changes during the follicular phase of menstruation? h. What physiological changes happen during the proliferative phase of menstruation? i. What are the hormonal changes during the ovulation phase of menstruation? j. What physiological changes happen during the phase of menstruation? k. What are the hormonal changes during the Luteal phase of menstruation? l. What physiological changes happen during the luteal phase of menstruation? 840986711 5/6/2017 19 m. Define menopause. n. What is the average age of menopause o. Name 10 questions you would ask a women during a GU assessment? p. What two exams should be done annually on a women? q. What is a pap smear? What is it used to diagnose? r. Bimanual palpation is palpation of what two things? s. What is vaginitis? t. What is the normal pH of the vagina? What maintains this pH? u. Describe the common S&S of vaginitis. v. What increases the risk of developing Candida? w. What is the typical vaginal discharge like for a patient with candida? x. How is Candida treated pharmacologically? y. What increases the risk of developing Trichomonas? z. What is the typical vaginal discharge like for a patient with Trichomonas? aa. How is Trichomonas treated pharmacologically? bb. Identify 8 nursing measures/interventions for a patient with vaginitis cc. Define PID dd. What are risk factors for PID ee. Name 6 clinical manifestations of PID ff. What is peritonitis gg. Name 6 complications of PID hh. What medications are used to treat PID? ii. Name 6 nursing interventions for a patient with PID jj. Define/describe endometriosis kk. What are the clinical manifestations of endometriosis? (name 4) ll. What is the medical management of a patient with endometriosis? mm. What are the risk factors for cervical cancer? nn. What are the S&S for cervical cancer? Early and late stage oo. What are the risk factors for uterine cancer? pp. What are the S&S for uterine cancer? qq. What are the risk factors for ovarian cancer? 840986711 5/6/2017 20 rr. What are the S&S for ovarian cancer? Early and late 840986711 5/6/2017 21