Alteration in Reproductive Health

Alteration in Reproductive Health
Introduction to the Reproductive System
Slide 1
The Female Reproductive System: Anatomy and Physiology
External Structures

Mons pubis Vulva Labia majora and minora Clitoris Bartholin glands or bulbourethral glands Fourchette: Trauma provides forensic evidence in rape trials Hymen: Perforation by physical activity; insertion of tampon; pelvic examimation
Slide 2
Figure 58-1 Female external genitalia

Slide 3
Internal Structures
Vagina Uterus Two fallopian tubes Two ovaries
Slide 4
Ovulation
Implantation; FSH, LH; corpus luteum Fertilization; spermatozoon, ovum; zygote
Pregnancy
Menstruation
Endometrium degenerates Occurs 2 weeks after ovulation Normal loss of blood: 30 to 60 mL
Slide 5
Figure 58-5 One menstrual cycle and the corresponding endometrial changes
Slide 6
The Female Reproductive System: Assessment
Health History
General and family history Menarche; LMP; menstrual pattern STD risk; pregnancy; abortion; contraceptive practices Menopause; HRT Gynecologic and breast examination; prior treatments; surgery Drug; allergy; substance abuse; smoking Symptoms of present disorder
Slide 7
The Female Reproductive System
Gynecologic Examination (Pelvic Examination)
Inspection and palpation of pelvic reproductive structures: Procedure; client preparation and teaching
Figure 58-6 Technique for speculum examination of the vagina and cervix
Slide 8
Diagnostic Tests
Cytologic test for cervical cancer (Papanicolaou Test)
Sample of exfoliated cells Removed by scraping and brushing tissue ACS recommendations on initial and subsequent Pap tests Client preparation
Cervical biopsy: Conization Endometrial smears and biopsy
Slide 9
Diagnostic Tests
Dilation and curettage Endoscopic examinations

Culdoscopy Laparoscopy Colposcopy
Hysterosalpingogram Abdominal ultrasonography (sonogram) Laboratory tests
Slide 10
The Breasts
Anatomy and Physiology
Mammary glands: Modified sweat glands Areola; nipple; lymph nodes Primary function: Lactation Influence of hormones

Estrogen Prolactin Progesterone
Slide 11
The Breasts
Figure 58-10 Breast structures
Slide 12
The Breasts: Assessment
Breast Examination
Clinical breast examination

Technique Observe for size; symmetry; unusual changes in the skin and nipples Facilitates early diagnosis and treatment Important for men as well Client teaching: Technique for BSE
Breast self-examination (BSE)

Slide 13
Mammography

Breast cancer detection NCI recommendations Use of cushioning pad to reduce discomfort
Used with mammogram
Ultrasonography
Differentiates fluid-filled cysts from other types of breast lesions
Slide 14
Breast Biopsy

Incisional biopsy Excisional biopsy Aspirational biopsy Nursing management
Teaching: Procedures; discomforts Postprocedure care; symptoms to report Emotional support: Biopsy results and possible diagnosis
Slide 15
The Male Reproductive System: Anatomy and Physiology
External Structures
Penis and scrotum Glans: Tip of the penis Prepuce: Foreskin Scrotum: Divided sac of skin that contains the right and left testes Testes cannot produce viable sperm when temperatures are at or above body temperature
Slide 16
Figure 58-12 Anatomy of the male reproductive system

Slide 17
Internal Structures

The testes; seminiferous tubules; epididymis; ductus deferens; spermatic cord Testosterone
Male sex hormone Affects the development and maintenance of secondary male sex characteristics
Slide 18
Accessory Structures
Seminal vesicles
Join with the ductus deferens to become the ejaculatory duct
Prostate gland Bulbourethral glands
Slide 19
Erection, Emission, and Ejaculation

Normal ejaculate volume
2.5 to 6 mL 400 million Fewer than 20 to 50 million spermatozoa per milliliter Few minutes to a few hours
Average sperm count
Infertility
Absolute refractory period
Slide 20
The Male Reproductive System: Assessment
History
Client; family; sexual
STD risk; contraceptive use; concerns: Sexual activityerection or ejaculation Prior treatment: GU system; description of GU symptoms
Physical Examination
Assessment: Inspection and palpation of external genitalia
Transillumination; digital rectal examination
Slide 21
The Male Reproductive System: Assessment
Diagnostic Tests
Transrectal ultrasonography Cystoscopy Tissue biopsy Cultures Fertility tests Tumor markers

PSA: Blood test that detects prostate cancer Other blood tests
Slide 22
General Considerations
Nutritional Considerations
Nutritional factors that may cause male and female reproductive abnormalities
Reduction in body fat; caffeine; herbal products; nutrient deficiencies
Pharmacologic Considerations
Effects of drugs

Estrogens; progestins Anabolic steroids; antihypertensives
Slide 23
General Gerontologic Considerations
Physiologic and physical changes that occur in the male or female reproductive systems that occur with aging

Female genitalia; menopause Sperm and testosterone production Prostrate gland
Slide 24
Alteration in Reproductive System

Caring for Female Clients With Disorders of the Pelvic Reproductive Structures
Slide 25
A Nurses Role in All Reproductive Disorders
Nurses Role Providing subjective and objective assessment of the client Assisting with gynecologic examinations Assisting with relief measures Providing perioperative care Evaluating client progress Instructing on self-care including sexual functions
Slide 26
Disorders of Menstruation
Premenstrual Syndrome (PMS) Physical and emotional symptoms Causes: Excess estrogen, hypothalamicpituitary dysregulation Symptoms: Weight gain, headache, pain, irritability Treatment: Healthful lifestyle changes; hormonal therapy Menstrual diary
Slide 27
Dysmenorrhea Primary and secondary Symptoms: Low abdominal pain and cramping Treatment Non-narcotic analgesics Applications of heat Knee-chest position Adequate rest and diet
Figure 59-2 Kneechest position
Slide 28
Amenorrhea Absence of menstrual flow Primary and secondary Oligomenorrhea Infrequent menses Causes Endocrine imbalances and stress Poor nutrition Associated conditions Polycystic ovarian syndrome Premature ovarian failure
Slide 29
Menorrhagia Menstruation longer than 7 days Causes Endocrine and coagulation disorders Management of Menorrhagia NSAIDs; estrogen and progesterone Endometrial ablation Photodynamic therapy Uterine balloon therapy
Slide 30
Figure 59-3 Uterine balloon therapy Top: Insertion of the catheter Bottom: Infusion and heating of fluid within the balloon
Slide 31
Metrorrhagia Unexpected and irregular bleeding Intermenstrual or postcoital bleeding Causes Pituitary or ovarian stimulation Uterine malignancies and cervical irritation Breakthrough bleeding with HRT
Slide 32
Menopause
Introduction Cessation of menstrual cycle Physiologic and surgical menopause Climacteric and postmenopausal period Pathophysiology and etiology Diminishing ovarian function Reduction in hormones Hypothalamic-pituitary stimulation Assessment findings Menstrual irregularities Vasomotor disturbances
Slide 33
Menopause
Medical Management HRT; antidepressants Biphosphonates Symptomatic relief measures Nursing Management Coping strategies Symptomatic relief measures Routine gynecologic and breast examinations
Slide 34
Infectious and Inflammatory Disorders of the Female Reproductive System

Vaginitis Vaginal inflammation Pathophysiology and etiology Chemical or mechanical irritants Pathogenic microorganisms Predisposing factors Assessment Findings Symptoms: Abnormal vaginal discharge, itching, burning, and redness Examination of vaginal secretions
Slide 35
Vaginitis: Medical Management Anti-infective agents Treatment of sexual partner Symptomatic relief measures Nursing Management Vaginal suppositories Regular douching and sitz bath Prevention of recurrence and follow-up
Slide 36
Cervicitis Inflammation of the cervix Pathophysiology and etiology Trauma of gynecologic procedures Chronic cervicitis may lead to infertility Assessment findings History of spotting or unusual bleeding Dyspareunia; unhealthy vaginal discharge Examination of cervix and vaginal smears
Slide 37
Cervicitis: Medical Management Antibiotics; douching Electrocautery; conization Cervicitis: Nursing Management Postelectrocautery instructions Rest Straining or heavy lifting Abstinence from sexual relations
Slide 38
Pelvic Inflammatory Disease Infection of pelvic organs except uterus Pathophysiology and etiology Microorganisms entering through cervix Assessment findings Malodorous vaginal discharge Severe abdominal and pelvic pain Fever, menorrhagia, and dysmenorrhea Diagnosis: MRI, CTS; ultrasonography
Slide 39
Assessment Findings: Medical Management Hospitalization; rest Symptomatic relief measures Emergency surgery for pelvic abscess Nursing Process for the Client With Pelvic Inflammatory Disease: Assessment Symptoms Vaginal smear Douching
Slide 40
Diagnosis, Planning, and Interventions Risk Infection; spread of infection Impaired skin integrity Self-care and self-esteem Pain related to inflammation Expected Outcomes Measures to detect, manage, and prevent infection Control of pain and enhancement of client comfort Perineal skin care
Slide 41

Evaluation of Expected Outcomes Monitor vital signs and leukocyte count Toxic Shock Syndrome Type of septic shock Pathophysiology and etiology Unhygienic use of tampons Chemicals produced by bacteria Assessment findings Signs and symptoms Diagnostic findings
Slide 42
Toxic Shock Syndrome Medical management Maintenance of body fluids; adrenergics Aerobic metabolism at cellular level Nursing management Vital signs; cell count; renal functions First dose of antibiotics Perineal hygiene
Slide 43
Structural Abnormalities
Endometriosis Pathophysiology and etiology Adhesions and sterility Assessment findings Dysmenorrhea; chocolate cyst Medical and surgical management Removal of cysts; panhysterectomy Nursing management Diagnosis and relief measures Regular gynecologic checkup
Slide 44
Vaginal Fistulas Definition and types Pathophysiology and etiology Surgical injury; cancer therapy Congenital anomaly; ulcerative colitis Assessment findings Leakage of urine or stool through vagina Medical and surgical management Symptomatic relief measures; surgery
Slide 45
Nursing Process: Assessment Vaginal drainage, meatus, and vault Diagnosis, Planning, and Interventions Repair of fistula; indwelling catheter Postoperative care; maintain self-esteem and skin integrity; promote sexual activity Evaluation of Expected Outcomes Positive self-image; self-confidence Skin integrity
Slide 46
Pelvic Organ Prolapse Cystocele; rectocele Pathophysiology and etiology Weakness in muscles and fascia Urinary and bowel alterations Irritation of protruding cervix Assessment findings: Signs and symptoms Difficulty standing for long or walking Cystocele; uterovaginal prolapse
Slide 47
Pelvic Organ Prolapse Assessment findings: Diagnostic findings Pelvic examination; urinary test Medical and surgical management Pessary; Kegel exercises Transvaginal repairs Nursing management Knee-chest position Heavy lifting Intermittent catheterization
Slide 48
Uterine Displacement Retroversion; may cause infertility Pathophysiology and etiology Positional displacement Assessment findings Backache; dysmenorrhea; dyspareunia Medical and surgical management Pessary; knee-chest position Nursing management Uterine relocation
Slide 49
Tumors of the Female Reproductive System
Uterine Leiomyoma Pathophysiology and etiology Sites of occurrence Assessment findings Menorrhagia; dysmenorrhea; anemia Medical and surgical management D and C; myomectomy; hysterectomy Nursing management Gynecologic examination
Slide 50
Cervical and Endometrial Cancer Age; history of diethylstilbestrol; sexual activity Assessment findings: Signs and symptoms Bleeding; pain; pressure on bladder Medical and surgical management Surgery: Hysterectomy; chemotherapy Nursing management Heavy lifting; sexual activity Exercise; douching
Slide 51
Cervical and Endometrial Cancer Nursing management (contd) Preoperative and postoperative care Client and family teaching Ovarian Cysts and Benign Tumors Pathophysiology and etiology Types; affects menstruation and fertility Assessment findings Menstrual irregularities, low abdomen discomfort, and backache
Slide 52
Ovarian Cysts and Benign Tumors Diagnosis Pelvic examination; USG; laparoscopy Nursing management Pain relief measures; gynecologic examinations Cancer of the Ovary Pathophysiology and etiology Hereditary; nulliparous women Assessment findings Abdominal discomfort; urinary frequency
Slide 53
Cancer of the Ovary Medical and surgical management Oophorectomy; panhysterectomy Nursing management Emotional support Preoperative and postoperative care Cancer of the Vagina Age of occurrence Pathophysiology and etiology HPV infection; diethylstilbestrol
Slide 54
Cancer of the Vagina Assessment findings Abnormal vaginal bleeding; dyspareunia Vaginal canal examination; biopsy Medical and surgical management Laser photovaporization treatments Total vaginectomy; radiotherapy Nursing management Emotional support; physical comfort
Slide 55
Cancer of the Vulva Pathophysiology and etiology High incidence in HPV and herpes Assessment findings Pruritus and genital burning White raised patches on labia Bloody discharge; enlarged lymph nodes Medical and surgical management Vulvectomy; laser photovaporization
Slide 56
Nursing Process for the Client With Cancer of the Vulva Undergoing Surgery Assessment Pain; skin integrity Homans sign Diagnosis, Planning, and Interventions Biopsy; surgery Self-care activities Control of thrombophlebitis Prevention of infection
Slide 57
Diagnosis, Planning, and Interventions Client education Maintain skin integrity and self-esteem Promote sexual intimacy Evaluation of Expected Outcomes Wound healing Reduction of dependent edema Sitz bath Stool softeners
Slide 58
General Nutritional Considerations
Considerations Large doses of vitamin B6 can cause sensory neuropathy Clearly defined relationship between nutrients and PMS Soy products may help alleviate menopausal symptoms
Slide 59
General Pharmacologic Considerations
Estrogen Therapy Side effects; diuretics; thromboembolism Risk of osteoporosis and renal calculi Androgen Therapy Recalcification of bone Initial increased bone pain Alendronate Prevents bone resorption Raloxifene Danger of prolonged antibiotics
Slide 60
Pruritus Age of occurrence Cause Pessary usage for prolapse Thorough investigation HRT
Slide 61

Caring for Clients With Breast Disorders
Slide 62
Infectious and Inflammatory Breast Disorders: Mastitis
Pathophysiology and Etiology

Plugged lactiferous ducts Staphylococcus aureus

Fever; malaise Breast tenderness, pain, redness, and hardness Crack in the nipple or areola Enlarged axillary lymph nodes Culture and sensitivity test
Assessment Findings

Slide 63
Infectious and Inflammatory Breast Disorders: Mastitis
Medical Management

Antibiotics; analgesics; heat application Breasts are emptied using a breast pump Systemic antibiotics
Nursing Management
Obtain health history Prepare client: Physical examination Collect breast milk specimen Client teaching: Self-administering antibiotics; principles of medical asepsis; breast feeding techniques and alternatives
Slide 64
Infectious and Inflammatory Breast Disorders: Breast Abscess
Pathophysiology and Etiology S. aureus Complication of postpartum mastitis Assessment Findings Signs and symptoms of mastitis; pus may drain from the nipple Physical examination; culture and sensitivity test Medical and Surgical Management Hospitalization; contact isolation; IV antibiotics; incision and drainage of abscess
Slide 65
Infectious and Inflammatory Breast Disorders: Breast Abscess
Nursing Management
Remove and reapply dressings Use aseptic technique Emotional support Promote comfort
Binder; zinc oxide; arm and shoulder support; axillary hair; breast milk removal Termination of breast feeding
Application of tight-fitting brassiere
Slide 66
Benign Breast Lesions: Fibrocystic Breast Disease

Hormonal changes during menstrual cycle Aggravated by caffeine and nicotine Breast cysts: Single; multiple
Assessment Findings
Signs and Symptoms: Tender, painful breasts; multiple lumps in breast tissue; mastalgia; influence of menstrual cycle Diagnostic findings: Physical and cytologic examination; incisional biopsy; mammography; ultrasonography
Slide 67
Benign Breast Lesions: Fibrocystic Breast Disease
Medical and Surgical Management

Analgesics; oral contraceptives Drug therapy Cyst removal; mastectomy
Nursing Management
Health history; questions related to symptoms menstrual cycle Diagnostic tests: Preparation and support Client teaching: BSE; medication use; physical examination; diet; activity; breast care
Slide 68
Benign Breast Lesions: Fibroadenoma
Hormonal influence Single nodule; no change with menstrual cycle Painless and nontender lump Encapsulated, mobile, and firm lesion Ultrasound Excisional biopsy
Assessment Findings

Slide 69
Benign Breast Lesions: Fibroadenoma
Medical and Surgical Management Observation Excision or tumor removal Nursing Management Provide emotional support Client teaching Monthly BSE; mammography Symptoms to report: Mass change; pregnancy Pre- and postoperative care: Wound care; brassiere; medication; emergencies
Slide 70
Malignant Breast Disorders: Cancer of the Breast
Pathology and Pathophysiology

Mass of abnormal cells Risk factors: Female; >50 years; family history
Signs and symptoms: Painless mass in breast; bloody discharge from nipple; dimpling of skin; nipple retraction; asymmetrical breast size; orange peel skin Diagnostic findings: Mammography; biopsy; microscopic cell examination
Assessment Findings
Slide 71
Figure 60-3 Locations of primary malignant breast tumors Slide 72
Figure 60-4 Signs and symptoms of breast Slide cancer 73
Treatment depends on stage of tumor
Figure 60-5 Breast cancer stages Slide 74
Surgery

Lumpectomy; partial mastectomy; segmental mastectomy; mastectomy Sentinel lymph node mapping Lymphedema Destruction of cancer cells that have escaped surgery Drugs administered: Tamoxifen
Chemotherapy

Slide 75
Radiation therapy

Before or after surgery; prophylactically Side effects: Fatigue; skin redness; rash; minor discomfort; pain
Nursing Management

Emotional support: Sexuality or body image disturbance Pre- and postoperative care: Complications; pain; wound care
Slide 76
Nursing Management
Discharge or client teaching

Complications: Lymphedema Self-care measures Chemotherapy: Side effects Medication; alopecia Wound care; exercise; prosthesis care
Slide 77
Malignant Breast Disorders: Metastatic Breast Cancer
Pathophysiology

Spread by direct extension: Lymphatics; bloodstream; CSF Lymph node; skeletal; pulmonary systems; brain; liver Signs and symptoms
Assessment Findings
Pain; pathologic fractures
Slide 78
Malignant Breast Disorders: Metastatic Breast Cancer
Assessment Findings
Diagnostic findings
Radiographs; MRI; CT; lymph node dissection
Medical Management
Palliative treatment Intramuscular androgen therapy Radiation therapy
Slide 79
Malignant Breast Disorders
Breast Cancer Prevention
Long-term follow-up Bilateral prophylactic mastectomy Chemoprevention

Tamoxifen; raloxifene Breast cancer vaccine: Under research
Slide 80
Cosmetic Breast Procedures
Breast Reconstruction
Refashioning of area of a mastectomy Simulation of breast contour Optional: Nipple; areola
Artificial implants

Silicone gel; saline-filled FDA approval Natural look and feel
Autogenous tissue
Slide 81
Reduction Mammoplasty

Breast size reduction
Clients with D cup or larger brassiere
Overnight surgical procedure
Opposite Breast Reduction

Corrects asymmetry Reduce healthy breast to resemble size of a reconstructed breast Similar to mammoplasty
Slide 82
Breast Lift
Mastopexy Corrects ptosis and drooping Breast enlargement using saline implant Nurses role

Breast Augmentation

Pre- and postoperative care: Semi-Fowlers position; pain management Client teaching: Mammogram; BSE; brassiere; exercise
Slide 83
Possible dietary considerations

High-fat diet Role of fruits and vegetables Soy and fiber
Alcohol consumption and risk of breast cancer
Slide 84

Metastases of breast cancer: Antineoplastic drugs Pain management: Opioid analgesics Monitoring and client teaching: Drug administration; effects; side effects Risk for breast cancer increases with age Client teaching: Risks; prevention measures; physical examination; treatments
Gerontologic Considerations

Slide 85

Caring for Clients With Disorders of the Male Reproductive System
Slide 86
Cryptorchidism

Testes undescended; empty scrotum Lie in inguinal canal, abdominal cavity Unknown cause; asymptomatic Impact on sperm production, fertility Risk for testicular cancer Treatment: Androgen therapy; orchiopexy Nursing management: Pre- and postoperative care Client teaching: Testicular self-examination
Slide 87
Torsion of the Spermatic Cord

Twisted spermatic cord; artery kinked; compromised blood flow to testicle Spermatic cords congenitally unsupported Signs and symptoms: Sudden, sharp testicular pain; local swelling; nausea, vomiting, chills, and fever Diagnosis: Physical examination Treatment: Immediate surgery Nurses role: Pain relief; scrotal support; medication; pre- and postoperative care
Slide 88
Phimosis and Paraphimosis

Occur among uncircumcised males Opening of the foreskin is constricted Signs and symptoms

Pain with erection and intercourse Difficulty cleaning under foreskin Painful swelling of glans Edema; urinary retention Circumcision; hygiene
Treatment
Slide 89
Hydrocele, Spermatocele, and Varicocele

Swelling of the scrotum Hydrocele and spermatocele: No treatment Varicocele: Surgically repaired; cause of male infertility
Figure 61-3: Causes of scrotal swelling

Slide 90
Infectious and Inflammatory Conditions
Prostatitis

Inflammation of the prostate gland Escherichia coli; microbes that cause STDs; psychosexual problem Signs and symptoms
Glandular swelling; tenderness Perineal pain; unusual sensation prior to or after ejaculation Low back pain; fever Chills; dysuria; urethral discharge
Slide 91
Prostatitis

Treatment
Antibiotic therapy; analgesics; sitz baths Treatment: Client; sexual partners Avoid caffeine; prolonged sitting; constipation Prostate gland drainage: Masturbation; intercourse Medication: Compliance; pain relief
Nursing management: Client teaching
Slide 92
Epididymitis and Orchitis

May occur alone or simultaneously Causes

Infectious agent causing prostatitis Infection in body Noninfectious epididymitis: Long-term indwelling catheter; genitourinary procedures Orchitis: Viral mumps after puberty Bilateral epididymitis
Slide 93
Signs and symptoms

Pain and swelling in inguinal area and scrotum; fever; chills Physical examination
Treatment
Bed rest; scrotal elevation; local cold applications; analgesics Anti-inflammatory agents; antibiotic therapy; epididymectomy
Slide 94
Nursing management

Pain relief measures; fluid intake Client teaching

Home care treatments: Sitz baths; local heat application Limitation in activity: Lifting; sexual intercourse Medication Immunization
Slide 95
Erection Disorders: Erectile Dysfunction

Ineffective neurologic stimulation, arterial blood flow, or trapping of venous blood Physical and psychological origins Signs and symptoms
Assessment Findings
Difficulty in achieving or maintaining an erection; insufficient rigidity Nocturnal penile tumescence and rigidity test; vascular ultrasound studies
Diagnostic findings
Slide 96
Erection Disorders: Erectile Dysfunction

Change in drugs that cause impotence Drug therapy; treatments to facilitate penile engorgement Vascular surgery; penile implants Client teaching

Nursing Management
Vasodilator self-injection: Techniques; frequency; side effects Penile implants: Assessment; self-care Possible complications after discharge
Slide 97
Erection Disorders: Priapism
Priapism

Persistent erection without sexual stimulation Etiology: Vascular problem; medical condition; side effect of medication Symptoms: Discomfort; interference with arterial blood flow and urinary elimination; tissue damage Treatment: Vasoconstrictive medications; draining trapped blood; emergency surgery Emotional support
Slide 98
Erection Disorders: Benign Prostatic Hyperplasia

Increased number of cells in prostate Decreasing diameter of the prostatic section of the urethra
Assessment Findings
Signs and symptoms
Gradual onset; difficulty urinating and emptying bladder; nocturia; urgency DRE; cystoscopy; IVP; blood chemistry tests; PSA; transrectal ultrasound
Diagnostic findings
Slide 99
Erection Disorders: Benign Prostatic Hyperplasia

Monitoring with DREs Drug therapy; alternative therapy Surgical procedures: TURP; TUIP; TULIP; TUNA; prostatectomy Teaching: Optimal bladder emptying Clients undergoing surgery: Support; information; deep breathing; leg exercises; catheterization; CBI; pre- and postoperative care
Nursing Management

Slide 100
Malignancies of the Male Reproductive System: Cancer of the Prostate

Increased testosterone; high-fat diet; family history Occurs in periphery of the gland; GU symptoms; untreated cells spread by bloodstream and lymphatics Signs and symptoms: Frequent urination; nocturia; dysuria; hematuria; hemospermia; erectile dysfunction; back pain, pain down legmetastasis
Assessment Findings
Slide 101
Assessment Findings
Diagnostic findings: Rectal examination; PSA; transrectal ultrasound; radiographs; MRI; CT; IVP; elevated serum acid phosphatase Screening: At age 40 for men with family history of early-age prostate cancer Treatment: Observation, surgery, radiation, hormone therapy, or combination
Slide 102
Surgery
Suprapubic prostatectomy; radical prostatectomy; bilateral orchidectomy; potential complications Used alone or with other therapies; side effects Men with D stage carcinoma; antiandrogenic or estrogenic drugs; feminizing side effects
Radiation therapy
Hormone therapy
Slide 103
Nursing Process: The Client With Prostatic Cancer
Assessment
History

Health: Changes in urinary elimination, hematuria, and low back pain Family: Prostatic cancer Signs of infection Urinary incontinence Sexual dysfunction
After surgical treatment

Slide 104
Nursing Process: The Client With Prostatic Cancer
Diagnosis, Planning, and Interventions
Risks: Infection; total urinary incontinence; sexual dysfunction; impotence; metastasis; client teaching
No infection; urinary continence; sexual expression; monitor for recurrence of primary cancer and metastasis Discharge plan of care: Medication; diet; support group; consult physician before taking herbal supplements
Evaluation of Expected Outcomes
Slide 105
Malignancies of the Male Reproductive System: Cancer of the Testes

Cryptorchidism Early degeneration of cells in undescended testis or testes; abnormal cellular changes Seminomas; nonseminomas Scrotal swelling; hard, nontender nodule; abdominal pain; general weakness; aching in the testes Tumor markers; IVP; lymphangiography; CT; MRI
Assessment Findings

Slide 106

Treatment depends on the stage of the disease Autologous bone marrow transplantation; sperm banking Surgery
Radical inguinal orchiectomy; ligation of the spermatic cord Radical retroperitoneal lymph node dissection
Slide 107
Chemotherapy

Multiple antineoplastic drug regimen Usually instituted after surgery Initial sperm destruction or mutation Later spermatogenesis resumes Seminomas are sensitive to radiation Radiation to retroperitoneal lymph nodes
Radiation

Slide 108
Nursing Management
Preoperative period

Emotional support Provide private opportunities for the client to ask questions about

Life-threatening diagnosis Unfamiliar surgical experience Confronting alterations in body image, sexuality, and fertility
Therapeutic communication techniques
Slide 109
Nursing Management
Postoperative period

Scrotal support; drainage; medication; infection prevention; pain relief Opportunity for safe expression of emotions Client and family teaching
Diet; exercise; self-care; hygiene; medication Testicular prosthesis; fertility concerns; sperm banks
Slide 110
Malignancies of the Male Reproductive System
Cancer of the Penis

Rare; occurs more often in men who are uncircumcised Probable progress

Chronic irritation; precancerous skin lesion; malignancy Biopsy; CT; MRI Tumor excision; chemotherapy External or interstitial radiation therapy Amputation
Diagnosis
Treatment

Slide 111
Elective Sterilization
Vasectomy

Minor surgical procedure; ligation of vas deferens Permanent sterilization: Interruption of the pathway that transports sperm Procedure has no effect on erection or ejaculation Nursing management

Client teaching: Contraception; sperm bank; home care Vasovasostomy; vasoepididymostomy
Slide 112
Risk of prostate cancer: High-fat diet; inactive lifestyle and being overweight
Drug therapy for testicular cancer: Administration, effects, and side effects Client and family teaching: Pulmonary toxicity; Raynauds phenomenon; nephrotoxicity; ototoxicity; fluid retention Chemotherapy: Increases risk for infection, anorexia, vomiting, and hair loss
Slide 113


Adverse reactions; anaphylactoid reactionsymptoms to report Medications that may cause sexual dysfunction: Client teaching; treatment
Gerontologic Considerations
Impotence increases with age; not a normal part of aging Penile cancer more common in older men Changes in genitalia, sperm production, and testosterone as age increases
Slide 114

Caring for Clients With Sexually Transmitted Diseases
Slide 115
Epidemiology
Introduction

Study of the occurrence, distribution, and causes of human diseases Role of Centers for Disease Control and Prevention (CDC): Gathers statistics
Reportable diseases Diseases not reportable by law: Genital herpes; hepatitis B; venereal warts
Women acquire STDs more often than men
Slide 116
Epidemiology
Assessment

Obtain a sexual history
Ask questions nonjudgmentally Curing disease Education and counseling Screening; counseling; treating the sexual partner(s)
Treatment includes
Slide 117
Common Sexually Transmitted Diseases: Chlamydia

Chlamydia trachomatis Spread by: Sexual intercourse; genital contact without penetration Transmission to infant during birth Autoinoculation: Ophthalmic infections Increased risk for other STDs Sterility in women
Slide 118
Assessment Findings

Sparse, clear urethral discharge; redness and irritation of infected tissue Burning on urination Women: Lower abdominal pain Men: Testicular pain Microscopic examination; culture of secretions Concurrent infections
Medical Management
Antimicrobial drugs
Slide 119
Nursing Management

Obtain sexual history Assist in specimen collection Physical examination
Follow precautions to prevent infection transmission Treatment Preventing reinfection
Client teaching

Slide 120
Common Sexually Transmitted Diseases: Gonorrhea

Neisseria gonorrhoeae Facilitates HIV transmission Signs and symptoms
Assessment Findings
Men: Urethritis with purulent discharge; pain on urination Women: White or yellow vaginal discharge; intermenstrual bleeding; painful urination Skin rash; fever; painful joints
Slide 121
Assessment Findings
Diagnostic findings
Microscopic or culture tests
Medical Management

Resistant to penicillin; tetracyclines Drug therapy
CDC recommendations Hospitalization IV multiple-drug therapy; repeat antibiotic therapy
Complicated gonococcal infections

Slide 122
Nursing Management

Similar to that of chlamydia Culture collection

Moisten speculum with water Lubrication may destroy the gonococci and cause inaccurate test results
Slide 123
Common Sexually Transmitted Diseases: Syphilis

Treponema pallidum Three distinct stages Transmission from blood of infected person

Directly from lesion Across the placenta to an unborn infant Figure 62-1 Syphilitic chancres
Slide 124
Assessment Findings
Signs and symptoms

Primary
Genital; anal; cervical chancre Fever; malaise; rash; headache; sore throat; lymph node enlargement Tabes dorsalis; ataxia; Charcots joints; cardiovascular complications
Secondary
Tertiary
Slide 125
Assessment Findings
Diagnostic findings

Microscopic examination of chancre VDRL test; rapid plasma reagin FTA-ABS test; CSF examination
Medical Management

Antibiotic therapy
Penicillin G-IM; tetracycline; doxycycline
Follow-up examinations and laboratory tests
Slide 126
Nursing Management

Collect history: Health; allergy; sexual Provide emotional support Client preparation: Diagnostic tests Inform client: Case finding is reported to the public health department Client teaching: Treatment; prevention; reinfection
Slide 127
Common Sexually Transmitted Diseases: Herpes Infection

HSV2: Genital; perineal lesions HSV-1: Cold sores; anogenital lesions Transmission: Direct or sexual contact; autoinoculation
Assessment Findings
Single or multiple vesicles on penis, prepuce, buttocks, thighs, introitus, and cervix Lesions; ulcers; swelling of inguinal lymph nodes; flulike symptoms; headache
Slide 128
Assessment Findings

Inspection of lesions Microscopic examination Self-limiting infection
Medical Management
Treatment may be unnecessary Antiviral drug therapy

Figure 62-2 Herpes genitalis lesions
Slide 129
Nursing Management

Collect health and sexual data Assist in specimen collection; physical examination
Use of standard precautions Treatment; prevention of reinfection Inform all potential sexual partners Use condom; lesions care; bathing Clothing; hygiene; follow-up treatment Stress management
Client teaching

Slide 130
Common Sexually Transmitted Diseases: Venereal Warts

Human papillomavirus (HPV) Transmission: Genitalgenital, genitalanal, or genital oral contact; autoinoculation Uterine cervical abnormalities
Painless Appearance: Single lesion; cluster of soft, fleshy growths on genitalia, on cervix, in vagina, on perineum, in anus, in throat, or on mouth; resemble a cauliflower
Assessment Findings

Slide 131
Assessment Findings
Application of vinegar; visual inspection
Figure 62-3 Venereal warts

Slide 132
Self application of

Podofilox (Condylox) solution or gel Imiquimod (Aldara) cream
Application of chemicals: Podophyllum Surgical excision; laser therapy; electrocautery; cryosurgery Parenteral administration of natural or recombinant interferon
Slide 133
Nursing Management
Client history: Health and sexual history Client preparation: Medical examination; diagnosis; treatment Client teaching

Avoid intimate contact Treatment; condom use; stress; genital trauma; yearly examination Provide information in future health histories
Slide 134
Other Sexually Transmitted Diseases
Granuloma Inguinale

Calymmatobacterium granulomatis Characterized by lesions in

Genital areas Inguinal areas Anal areas Antimicrobials
Treatment
Slide 135
Chancroid

Haemophilus ducreyi bacillus Characterized by

Macule Vesiclepustule formation Painful genital ulcer Enlarged, tender lymph nodes in inguinal area Azithromycin; ceftriaxone Ciprofloxacin; erythromycin
Treatment

Slide 136
Lymphogranuloma Venereum
C. trachomatis Characterized by

Small erosion or papule Enlargement of adjacent lymph nodes
Usual site of infection
Genital area
Doxycycline or erythromycin
Treatment
Slide 137
Obtain an allergy history Client teaching
Prescribed drug regimen; effects; side effects; contraindications Doxycycline Azithromycin
Contraindicated during pregnancy

Monitor clients for allergic reaction
Slide 138

Obtain history: Health; sexual Abandon bias: Older adults and sexuality; same risks of acquiring STD if sexually active Syphilis causes approximately 10% of cases of heart disease in those older than 50 years of age Client teaching: STD transmission; treatment; prevention; follow-up examination or tests
Slide 139

Alteration in Reproductive Health

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Alteration in Reproductive Health

Introduction to the Reproductive System

The Female Reproductive System: Anatomy and Physiology

The Female Reproductive System: Anatomy and Physiology

Figure 58-1 Female external genitalia

The Female Reproductive System: Anatomy and Physiology

Vagina Uterus Two fallopian tubes Two ovaries

The Female Reproductive System: Anatomy and Physiology

Implantation; FSH, LH; corpus luteum Fertilization; spermatozoon, ovum; zygote

Endometrium degenerates Occurs 2 weeks after ovulation Normal loss of blood: 30 to 60 mL

The Female Reproductive System: Anatomy and Physiology

The Female Reproductive System: Assessment

The Female Reproductive System

Gynecologic Examination (Pelvic Examination)

The Female Reproductive System

Cytologic test for cervical cancer (Papanicolaou Test)

Cervical biopsy: Conization Endometrial smears and biopsy

The Female Reproductive System

Dilation and curettage Endoscopic examinations

Culdoscopy Laparoscopy Colposcopy

Hysterosalpingogram Abdominal ultrasonography (sonogram) Laboratory tests

Anatomy and Physiology

Estrogen Prolactin Progesterone

Figure 58-10 Breast structures

The Breasts: Assessment

Clinical breast examination

Breast self-examination (BSE)

The Breasts: Assessment

Differentiates fluid-filled cysts from other types of breast lesions

The Breasts: Assessment

Incisional biopsy Excisional biopsy Aspirational biopsy Nursing management

The Male Reproductive System: Anatomy and Physiology

The Male Reproductive System: Anatomy and Physiology

Figure 58-12 Anatomy of the male reproductive system

The Male Reproductive System: Anatomy and Physiology

The Male Reproductive System: Anatomy and Physiology

Join with the ductus deferens to become the ejaculatory duct

Prostate gland Bulbourethral glands

The Male Reproductive System: Anatomy and Physiology

Erection, Emission, and Ejaculation

Normal ejaculate volume

Average sperm count

Absolute refractory period

The Male Reproductive System: Assessment

Client; family; sexual

Assessment: Inspection and palpation of external genitalia

Transillumination; digital rectal examination

The Male Reproductive System: Assessment

Reduction in body fat; caffeine; herbal products; nutrient deficiencies

Estrogens; progestins Anabolic steroids; antihypertensives

General Gerontologic Considerations

General Gerontologic Considerations

Female genitalia; menopause Sperm and testosterone production Prostrate gland

Alteration in Reproductive System

A Nurses Role in All Reproductive Disorders

Figure 59-2 Kneechest position

Infectious and Inflammatory Disorders of the Female Reproductive System

Infectious and Inflammatory Disorders of the Female Reproductive System