Reproductive Health
Ch 46, 47
Nursing Role in Women’s
Health
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Health promotion
Illness prevention
Provide support & counseling
Encourage women in their health goals and
behaviors
– personal hygiene, detecting & preventing diseases
(STDs), diet & exercises, sexuality issuesmenopause, contraception, preconception, pre/postnatal care, stress management & well-being,
healthy lifestyles, & avoiding risky behaviors
Nursing Role in Women’s Health
• Nurses need to model that lifestyle for
patients
• Recommend & promote regular
examinations
• Non-judgmental, understanding &
sensitive
• Screen for/and recognize s/sx. abuse
• Recognize cultural differences & beliefs
• Respect sexual orientation
External genitals of the female
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Female Reproductive System
oviduct
oviduct
ovary
uterus
urinary bladder
pubic symphysis
fimbriae ovary
cervix
rectum
urethra
vagina
anus
uterus
vagina
Function of Female Reproductive System
• Ovulation – ova begins to mature & enlarge
until discharged
– Migrates toward & enters oviduct where
possible fertilization may take place
• Mentrual Cycle – involves production of
estrogen & progesterone
• Menopausal period – end of woman’s
reproductive capacity.
• Early menopause – surgical removal of
ovaries, chemotherapy, radiations, unknown
etiology
Assessment
• Health Hx. – past illnesses, STDs,
treatments, hx sexual/physical abuse,
• Sexual Hx. – PE findings, lab results
• Female genital mutilation –
– Cutting, partial/total removal of external
genitalia
– Cultural passage to womanhood: Africa,
Middle East. Crime in the U.S.
– Type I, II, III, IV
p 1620
Assessment
• Domestic violence
– Physical: for child, elderly; men & women
– Emotional degradation, coercive control,
threats, intimidation.
– Sexual assaults
• The need to maintain control of a partner
is rooted in sex role inequality.
• Sensitive care is required if a woman
states that she is being hurt.
• Report & provide safety for pt. (p.1621)
Physical Assessment
• Periodic examination/ pelvic & breast
• Routine cancer screening
• Positioning: supine lithotomy, upright
lithotomy vs. Sims position (left side)
• Proper equipment
• Inspection : lesions of the labia
majora/minora (venereal warts,
melanoma lesions) trauma to the
vaginal wall, cystocele, rectocele,
presence of a hymen
Assessment
• Women with disabilities experience
increase risk for abuse
– Inquire about barriers to health care
– Any healthcare limitations
– Cognitive or developmental changes
affecting understanding
• Gerontology considerations
– Facing health disparities or end-of-life
issues
Physical Assessment
Speculum Examination:
• Cervix – 2-3 cm, smooth vs. laceration
• Malignant changes
• cysts, polyps
• Discoloration
• Cauliflower-like growth (cancer)
• Vaginal discharge
Inspection
of the
Cervix
Diagnostic Testing
• PAP Smear – cytology for detecting cervical
cancer
– Atypical cells: Human papillomavirus (HPV)
• Colposocpy – visual examination with a
portable microscope
• Cervical biopsy – analysis of cervical tissue
• Cryotherapy/laser therapy – freezing cervical
tissue with nitrous oxide
• Cone Bx Loop Electrosurgical Excision
Procedure (LEEP) – surgical procedure using
laser beam
Diagnostic Testing
• Endometrial Aspiration Bx. – allows for
detection of cellular changes in the
endometrium
• Dilation & Curettage (D&C) – surgery;
dilation if cervical canal and scraping of
endometrial/endocervical tissue for
cytology
• Endoscopic laparoscopy – visualization of
the pelvic structures
Diagnostic Testing
• Hysteroscopy – visualization of all the
parts of the uterine cavity
• Hysterosalpingography or
Uterotubography – x-ray of uterus &
fallopian tubes.
• Computed Tomography (CT) – transverse
radiographic images
• Ultrasonography – ultra sound images.
• Magnetic Resonance Images (MRI) –
definitive images using magnetic waves
Management of Physiologic
Processes
• Menstruation – 28-day cycle during
reproductive years
– Understand cutural beliefs, customs &
values, psycological consideration, NSAID
• Perimenopause – 1st sign of menopause:
hot flashes, vaginal dryness, irregular
menses.
– Consider issues in sexuality, fertility,
STD,oral contraceptives, breast cancer,
Management of Physiologic
Processes
• Menopause – permanent physiologic cessation
of menses
• Associated with decrease ovarian function,
some breast & genital organ atrophy
• Irregular menses, breast tenderness, mood
changes, hot/warm flashes, noc sweats, sleep
disturbances, gradual thinning of pubic hair,
shrinkage, fatigue, forgetfulness
• Be sensitive to all possible side effects
• Tx – hormone therapy
Management of Menstrual Disorders
• PMS - prementstrual syndrome:
• Irritability, fatigue, bloating, edema, HA,
depression, low back pain, painful breast, mood
swings
• Tx symptoms, promote exercise, avoid caffeine &
high-fat diets
• Vit. B, E, magnesium, oil of primrose are used
but show no evidence of effectiveness
• Selective serotonin reuptake inhibitors (Prozac,
Sarafem, Fluoxetime, Ibuprofen, Naproxenk
Anaprox, diuretics, antianxiety, calcium
supplements
Management of Menstrual Disorders
Nursing management:
• Establish nurse/pt rapport, for good
health history
• Nutrition history
• Minimize side effects, stress-coping
strategies
• Pt educ: avoid caffeine, alcohol, eating
diet low in essential nutrients. Teach how
to record timing & intensity of symptoms
Menstrual Disorders
Dysmenorrhea: painful menstruation,
severe crampings
• Tx: relieve discomfort, A.S.A. NSAIDs,
low level local heat
– Contraindicated with peptic ulcers
Amenorrhea – absence of menstrual cycle
• Allow pt to express concerns, PE,
medical hx., stress level, pregnancy,
eating disorders, anorexia & bulimia
Menstrual Disorders
• Menorrhagie – excessive menstruation;
profuse, prolong flow during regular
periods
• Related to endocrine distrubances,
inflammatory disturbances, uterine tumors
• Can result in anemia; need to see MD
– Count # pads, & saturation (absorbency)
Menstrual Disorders
• Metrorrhagie – heavy uterine bleeding between
periods; irregular
– May signal cancer, benign tumors of the
uterus
– Health hx., taking oral contraceptives or HR?
• Hypomenorrhea – scanty flow
• Oligomenrrhea – reduced frequency of periods
Contraception
• Abstinenece – practice celibacy; only
effective method
• Sterilization
– Bilateral tubal ligation: laparoscopy
procedure
• Fellopian tubes are coagulated,
sutured, or ligated with bands/clips.
• Transcervical tubal occlusion
– Vasectomy – excision of the vas
deferens
Contraception
• More than half of pregnancies in the U.S.
are unintended
• Nurses can assist in providing information
and support
• Family planning resources
• Listen, educate and take time to answer
questions
• Be unbiased and nonjudgmental
• Understand the risks & benefits
Contraception
• Hormonal – use of estrogens & progestins by
women.
• Block ovarian stimulation, prevent release of
FSH from the anterior pituitary gland.
• Benefits: reduce incidence of benign breast
disease, uterine & ovarian cancers, anemia,
pelvic infections; Improves acne.
• Risks: DVT, breast soreness, HA, nausea, leg
cramps
** Inform pts that hormonal contraception protects
against pregnancy but not from STD of HIV
Contraception
• Intrauterine device (IUD) – a plastic, t-shaped
device inserted into the uterine cavity to prevent
pregnancy.
• Causes local inflammation, which is toxic to
sperm & blastocysts; therefore prevents
fertilization
• May cause excessive bleeding, cramps,
backaches, slight risk of tubal pregnancy,
perforation of cervix and uterus is rare
Contraception
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Mechanical barriers – diaphragm
Cervical cap
Contraceptive spong
Female condom (p1645)
Male condom
Spermicides
Coitus interruptus (withdrawal)
Rhythm & natural method – “safe period”
Emergency contraception – morning after pill
Contraception
• Abortion –
• Spontaneous abortion
• Habitual (recurrent) abortion
– After 2 consecutive abortion, pt is referred
to genetic counseling and testing
• Elective abortion – voluntary
– Pt education & counseling on choices
– Explore pts fears, feelings and options
– Review use of birth controls methods
Nursing management
• For spontaneous abortion - provide bed
rest, sexual abstinence, no straining on
defecation
• Allow expression of feelings: listen
• Pt education: available forms of
contraception, community resources
• Counseling
• Pelvic exam, lab studies, RhoGAM,
STD screening
Infertility
• The couple’s inability to achieve
pregnancy after 1 yr. of unprotected
intercourse.
• Ovarian/ovulation factors
• Tubal factors
• Uterine factors
• Semen & other male factors
Artificial Insemination
• Deposit of semen into the female genital tract
by artificial means
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Sperm cannot penetrate the cervical canal
Donor or partner/husband semen is frozen
Written consent
Safeguards set in place for legal, ethical, emotional &
religious issues
• Must meet certain condition: the women should
have no genital abnormalities, require patent
fallopian tubes, available ovum.
• Viable sperm: normal shape, amount, motility
and endurance
Ectopic Pregnancy
• Decreasing in rate, but remains the
leading cause of pregnancy related
dealth in 1st trimester
• Acute condition – require surgery
• Relieve acute pain
• Monitor potential complications–
prevent hemorrhage, shock.
• Provide emotional support