Download Reproductive years assessment and health promotion

Assessment of the
Female Reproductive
System
Female Reproductive System
External genitalia: vulva, labia majora,
labia minora, clitoris, vestibule,
perineum
 Internal genitalia: vagina, uterus,
corpus, cervix, fallopian tubes, ovaries
 Breasts
 Menstruation and menopause

Assessment Techniques:
Female
History: pain, bleeding, discharge,
masses
 Physical assessment

Breast examination
 Abdominal examination
 Examination of the external genitalia
 Pelvic examination
 Bimanual examination
 Rectovaginal examination

Papanicolaou Test
Client preparation for pap test
 Procedure
 Follow-up care

Blood Studies
Pituitary gonadotropin
 Steroid hormones
 Serologic tests
 Syphilis detection
 Prostate-specific antigen

Other Studies
Urinalysis for steroid hormones
 Wet preparation (smears)
 Cultures
 General x-rays
 CT scans for reproductive system
disorders

(Continued)
Other Studies (Continued)
Hysterosalpingography: an x-ray of the
cervix, uterus, and fallopian tubes
Mammography
 Ultrasonography
 Magnetic resonance imaging to scan
for pelvic tumors
 Colposcopy
 Laparoscopy
 Hysteroscopy
 Cervical biopsy

Other Diagnostic Tests
Needle biopsy of the prostate
 Semen analysis

Interventions for Clients
with Gynecologic
Problems
Primary Dysmenorrhea
One of the most common gynecologic
problems, occurring most often in
women in their teens and early 20s.
 Treatment

Postaglandin synthetase inhibitors, oral
contraceptives
 Complementary and alternative therapy

Premenstrual Syndrome
A collection of symptoms that are
cyclic in nature
 Diet therapy
 Drug therapy: mild potassium-sparing
diuretics, progesterone, bromocriptine
mesylate, Sarafem

Amenorrhea
Absence of menstrual periods
 Primary amenorrhea
 Secondary amenorrhea
 Treatment: hormone replacement,
ovulation stimulation, periodic
progesterone withdrawal

Postmenopausal Bleeding
Manifestation (not disease)—vaginal
bleeding that occurs after a 12-month
cessation of menses after the onset of
menopause
 Atrophic vaginitis
 Endometrial hyperplasia
 Treatment: endometrial biopsy,
hysterectomy, hormonal replacement
therapy, vaginal lubricants

Endometriosis



Endometriosis is usually a
benign problem of
endometrial tissue
implantation outside the
uterine cavity.
Manifestations include pain,
dyspareunia, painful
defecation, sacral backache,
hypermenorrhea, and
infertility.
Erythrocyte sedimentation
rate and white blood cell
Endometriosis:
Interventions
Drug therapy
 Mild analgesics, nonsteroidal antiinflammatory drugs, hormonal
therapies, pseudopregnancy,
pseudomenopause, or medical
oophorectomy
 Complementary and alternative therapy
 Surgical management

Dysfunctional Uterine Bleeding


Nonspecific term to describe bleeding that is excessive or abnormal in
amount or frequency without predisposing anatomic or systemic
conditions
Associated with:







Endocrine disturbances
Polycystic ovary disease
Stress
Extreme weight changes
Long-term drug use
Anatomic abnormalities
Management


Nonsurgical management includes hormone manipulation.
Surgical management includes:



Dilation and curettage procedure
Laser or balloon endometrial ablation
Hysterectomy
Menopause
Normal biologic event marked for most
women by the end of menstrual periods
(6 to 12 months of amenorrhea)
 Role of hormone replacement therapy
in the management of symptoms
 Perimenopause indicated by changes
in ovarian function
 Interventions, including hormone
replacement therapy

Simple Vaginitis
Inflammation of the lower genital tract
 Result of one or more of the following:









Menopause
Trichomonas vaginalis
Candida albicans
Changes in normal flora
Alkaline pH
Foreign bodies
Chemical irritants
Diabetes
Management of Vaginitis
Perineal cleaning after urination or
defecation
 Wearing cotton underwear
 Avoiding strong douches and feminine
hygiene sprays
 Avoiding tight-fitting pants
 Using estrogen creams
 Eating yogurt with antibiotics

Vulvitis
Inflammatory condition of the vulva
(itching) associated with symptoms of
pruritus and a burning sensation
 Other causes include the following:

Atrophic vaginitis
 Vulvar kraurosis
 Vulvar leukoplakia
 Cancer
 Urinary incontinence

Management of Vulvitis
Measures to relieve itching, including
sitz baths
 Prescribed antibiotics
 Treatment of pediculosis and scabies, if
needed
 Laser therapy

Toxic Shock Syndrome (TSS)
First recognized in 1980 when it was
found to be related to menstruation and
tampon use
 Staphylococcus aureus
 Abrupt onset of high temperature,
headache, sore throat, vomiting,
diarrhea, generalized rash, hypotension
 Penicillin or vancomycin

Follicular Cysts
Cyst—usually small and may be
asymptomatic unless it ruptures
 Rupture of a follicular cyst or torsion—
may cause acute, severe pelvic pain
 Medical management
 Surgical management includes:

Cystectomy
 Oophorectomy

Corpus Luteum Cyst
Occurs after ovulation and often with
increased secretion of progesterone;
usually small, purplish red
 May cause unilateral low abdominal or
pelvic pain that is dull or aching
 Intraperitoneal hemorrhage possible if
cyst ruptures

Theca-Luatein Cysts
These cysts are uncommon, often
associated with hydatidiform molar
pregnancy.
 Cysts develop as a result of prolonged
stimulation of the ovaries by excessive
amounts of hCG.
 Cysts regress spontaneously within 3
months with the removal of the molar
pregnancy.

Polycystic Ovary
High levels of luteinizing hormone
overstimulate the ovaries, producing
multiple cysts on one or both ovaries.
 Endometrial hyperplasia or even
carcinoma may result.
 Typical client is obese, hirsute, has
irregular menses, and may be infertile.
 Treatment is with oral contraceptives,
surgery, or clomiphene.

Other Benign
Ovarian Cysts and Tumors
Dermoid cysts
 Ovarian fibromas
 Epithelial ovarian tumors
 Uterine leiomyomas
