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Stressors of the
Female and Male
Reproductive Systems
NUR240
JBorrero 10/08
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 count rule out pelvic
inflammatory disease.
• Laparoscopy is the key diagnostic
procedure.
Collaborative Management
• Nonsurgical management includes
hormone manipulation.
• Surgical management includes:
– D&C- Dilation and curettage
– Laser or balloon endometrial ablation
– Hysterectomy
Uterine Prolapse
• Stages of uterine prolapse are
described by the degree of descent of
the uterus.
• Dyspareunia, backache, pressure in the
pelvis, bowel or bladder problems
• Pessaries
• Surgery
Cystocele
• Protrusion of the bladder through the
vaginal wall due to weakened pelvic
structures
• Difficulty in emptying bladder, urinary
frequency and urgency, urinary tract
infection, stress urinary incontinence
• Kegel exercises
• Surgery
Rectocele
• Protrusion of the rectum through a
weakened vaginal wall
• Constipation, hemorrhoids, fecal
impaction, feelings of rectal or vaginal
fullness
• High-fiber diet, stool softeners,
laxatives
• Surgery
Fistulas
• Abnormal openings between two
adjacent organs or structures
• Etiology
• S&S
• Nonsurgical treatment
• Surgical treatment
Bartholin Cyst
• Obstruction of the duct of the
Bartholin’s gland
• Simple incision and drainage
• Marsupialization (formation of a pouch)
• Postoperative care
Uterine Tumors
Nonmalignant:
Fibroids or Leiomyomas
Malignant:
Endometrial Cancer
• Endometrial cancer is a reproductive
cancer, of which adenocarcinoma is the
most common type.
• The main symptom is postmenopausal
bleeding.
Endometrial Cancer
Dx Tests
• Diagnostic assessment includes the
following tests:
– CA-125 tumor marker
– Chest x-ray
– Barium enema
– CT of the pelvis
– Liver and bone scans
– Functional dilation and curettage (D&C)
TX: Radiation Therapy
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External and internal
Teletherapy
Brachytherapy
Intracavitary radiation
Surgical Management
• Total abdominal hysterectomy and
bilateral salpingo-oophorectomy
• Radical hysterectomy with bilateral
pelvic lymph node dissection for stage
II cancer
Cervical Cancer
• Common reproductive cancer among
women in the U.S.
• Disorder is a progression: from totally
normal cervical cells to premalignant
changes in appearance of cervical cells
(dysplasia), to changes in function,
ultimately to transformation to cancer
• HPV- Human papillomavirus
• Gardasil Vaccine- 3 doses
• Carcinoma in situ
• Preinvasive or invasive
Clinical Manifestations
• Client often asymptomatic
• Classic symptom: painless vaginal
bleeding
• Watery, blood-tinged vaginal discharge
that may become dark and foul-smelling
as the disease progresses
• Leg pain
• Flank pain
• Unexplained weight loss, pelvic pain,
dysuria, hematuria, rectal bleeding, chest
pain and cough
Diagnostic Assessment
• Pap smear
• Colposcopic examination
• Endocervical curettage
Nonsurgical Management
• Local ablation of using the loop
electrosurgical excision procedure
• Laser therapy
• Cryotherapy
• Radiation therapy
• Chemotherapy
• Conization
Surgical Management
• Clinical staging performed before
surgery to establish extent of the
disease
• Simple hysterectomy
• Radical hysterectomy
• Pelvic exenteration
Postoperative Care
• Early stages of recovery, assess for:
– Hemorrhage and shock
– Pulmonary complications
– Fluid and electrolyte imbalances
– Renal or urinary complications
– Pain
Postoperative Care
• Later stages of recovery, assess for:
– Deep vein thrombosis
– Pulmonary emboli
– Paralytic ileus
– Wound infections
– Wound dehiscence
– Wound evisceration
– Pain
Ovarian Cancer
• Most common type—serous
adenocarcinoma
• Vague abdominal discomfort,
dyspepsia, indigestion, gas, and
distention
• Ovarian antibody CA-125, ultrasound,
intravenous pyelography, barium
enema, upper gastrointestinal
radiographic series to rule out tumors
Management
NONSURGICAL
• Chemotherapy with agents such as
cisplatin, carboplatin, and paclitaxel
• Radiation therapy
Management
SURGICAL
• Total abdominal hysterectomy and
bilateral salpingo-oophorectomy
• Staging
• Second-look procedure usually after 1
year of chemotherapy
Assessment
• Urinary pattern, frequency, nocturia,
and other symptoms of bladder neck
obstruction
• Lower urinary tract symptoms
• Hesitancy, intermittency, reduced force
and size of urinary stream, a sensation
of incomplete bladder emptying, and
postvoid dribbling
• Hematuria
Laboratory Assessment
• Urinalysis
• Complete blood count
• Blood urea nitrogen and creatinine
levels
• Prostate-specific antigen
• DRE
• C&S
Drug Therapy
• Finasteride ( Proscar) to shrink the
prostate gland and improve urinary
flow
• Terazosin hydrochloride (Hytrin)
• Doxazosin mesylate (Cardura)
• Tamsulosin hydrochloride (Flomax)
• Estrogens and androgens
Surgical Procedures
• Transurethral resection of the prostate
AKA TURP
• Suprapubic prostatectomy
• Retropubic prostatectomy
• Perineal prostatectomy
Continuous Bladder Irrigation
CBI
• Goal: To maintain clear urine flow
• Three-way urinary catheter with a 30- to
45-mL retention balloon through the
urethra into the bladder
• Traction via taping to client’s abdomen
or thigh
• Uncomfortable urge to void
continuously
• Antispasmodic medications
Postcatheterization Care
• Client feels burning on urination as well
as some urinary frequency, dribbling,
and leakage.
• Symptoms are normal and will subside.
• Monitor fluid intake.
Prostate Cancer
• Most common invasive cancer among
men in the U.S.
• One of the slowest growing
malignancies; metastasizes in a
predictable pattern
• First symptoms related to bladder neck
obstruction
• Hormonal dependent
Prostate Cancer: Dx
• Digital rectal examination
• Prostate-specific antigen (PSA)
• Biopsy necessary to confirm suspected
prostatic cancer
Surgical Treatment: Radical
Prostatectomy
Post op Care:
• Caring for wound drains
• Preventing emboli
• Preventing pulmonary complications
• Antibiotics
• Analgesics
• Laxative and stool softener
• Indwelling urinary catheter
• Antispasmotic
Complications
• Urinary incontinence
• Erectile dysfunction
Nonsurgical Management
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Radiation therapy
Hormonal therapy
Chemotherapy
Targeted therapy
Testicular Cancer
• Although uncommon, this cancer is the
most common malignancy in men 15 to
35 years of age.
• With early detection by testicular selfexamination and treatment with
combination chemotherapy, testicular
cancer can be cured.
Diagnostics
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Alpha-fetoprotein
Beta subunit of hCG
Ultrasound
Computed tomography
Magnetic resonance imaging
Lymphangiograms
Risk for Sexual Dysfunction
Oligospermia, azoospermia
Interventions include:
– Health teaching about reproduction,
fertility, and sexuality
– Sperm storage
– Other reproductive options
Potential for Metastasis
• Interventions include:
– Surgical management
– Preoperative care
– Operative procedures: radical
retroperitoneal lymph node dissection,
orchiectomy
– Post op care : Pain, Immobilty,
Wound/Drain Care
Nonsurgical Management
• Chemotherapy
• Radiation therapy
• Stem cell transplantation