The Reproductive System

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Male
Anatomy & Physiology
Review
 Testes
 Scrotum
 Epididymis
 Vas Deferens
 Ejaculatory Ducts
 Penis
Accessory Glands
Seminal vesicles
Prostate Gland
Bulbourethral Glands
Male Reproductive System
Q Age-related changes in the
Male?
 Male climacteric
 s/s are similar to menopause, hot-flashes, feelings of
suffocation, psychic disorders
Health History includes:
 Present illness/chief complaint
PMhx
Family History
Review of Systems
Functional Assessment
Physical Exam…
Disorders
Diagnostic Tests & Procedures
 Semen analysis
 Endocrine studies--- hormones
 Tumor Markers
 General labs
 Radiologic studies
Prostatitis
Inflammation of the prostate
Bacterial or nonbacterial
Acute or chronic
Treated with antibiotics,
analgesics and sitz baths
Epididymitis/Orchitis
Inflammation of epididymis
Inflammation of testes
Sterile or nonsterile
inflammation
Sterile Inflammation
Direct injury
Reflux of urine down the vas
deferens
Non Sterile Inflammation
Gonorrhea
Chlamydia
Mumps
Tuberculosis
Prostatitis
urethritis
Epididymitis
If bilateral  sterility
If untreated testicular tissue
necrosis, septicemia & death
Sign/Symptoms
Sudden severe pain
Scrotal swelling
Fever
Dysuria
pyuria
Treatment
Antibiotics
Injection of procaine
Scrotal support
Cold packs as tolerated
Monitor temp,edema,comfort
Testicular Torsion
Twisting of the spermatic cord
Can cause testicular necrosis
Adolescents & young men
Commonly occurs:
When scrotum is warm &
relaxed
By testicular strain
Extreme cold
Spontaneous
Symptoms
Acute onset of N & V
Abdominal pain
Severe scrotal pain
Surgical Treatment
Surgical detorsion
Bilateral orchiopexy
What are the post op nursing
interventions for this patient?
Hydrocele
Accumulation of fluid on the
testicle
Infection or injury
Aspiration or plication
Cold packs, scrotal support &
emotional support
Varicocele
Abnormal dilatation of
testicular veins
Unilateral or bilateral
More common on left side
May effect sperm count
Symptoms
 Dull pain in affected scrotum
 Swelling & nagging pain
 Surgical ligation
 Scrotal support
Cryptorchidism
Undescended testicle
Unilateral or bilateral
Correct early in life
orchiopexy
Phimosis & Paraphimosis
Constriction of prepuce
May be caused by injury
Txcircumcision
Paraphimosis opposite of
phimosis.
Hypospadius is ??
Benign Prostatic Hyperplasia
Progressive enlargement of
prostate gland
Results in urinary outlet
obstruction
s/s described as obstructive
BPH
Symptoms
Hesitancy
Decreased force of stream
Frequency
Nocturia
Diagnostic Tests
Digital rectal examination
PSA
Residual urine
Cystoscopy
IVP
US
Medical Treatment
Urethral stent
Drugs
Surgical Treatment
1.
2.
3.
4.
5.
Prostatectomy
TURP
Suprapubic
Retropubic
Perineal
TULIP or TUNA
Post Op
Complications
Hemorrhage
Infection
Urine leakage/incontinence
Retrograde ejaculation
Erectile Dysfunction
Nursing Interventions
Monitor urinary output
Inc. irrigant if clots noted
Enc. 2500-3000cc fluids/day
Mon. for bladder spasms
Analgesics/antispasmodics
B & O suppository
Class Activity
YOUR SCENERIO
 An 83-year-old man had a
suprapubic prostatectomy
yesterday for prostatic
cancer. He is confused,
disoriented, and crying in
pain.
YOUR ASSIGNMENT
 Have each group discuss
five nursing interventions
for this patient and the
rationales. Then have the
groups present their
material to the class.
Prostate Cancer
Unknown etiology
Adenocarcinomas
Mets  bone, lymph nodes,
brain & lungs
Prostate Cancer
Risk Factors
Over 50 yrs old
Excessive ETOH
High fat diet
Family history
Environmental Exposure
Medical Diagnosis & Diagnostic
Tests
PSA
Prostatic biopsy
Rectal exam
Symptoms
Dysuria
Weak urinary stream
Frequency
Hematuria
Hesitancy
Medical/Surgical TX
“Watchful Waiting”
Radiation
Transrectal radioactive seed
implant
Radical Prostatetectomy
Hormonal Therapy
Testicular Cancer
18-34 yrs
Self-exam & early diagnosis
Look for any changes from normal
Orchiectomy
Medical Treatment
 Radio or Chemo therapy
 Orchiectomy (curative in Stage 1)
 Monitor tumor markers x 5 yrs
 X-rays of lymph nodes
 Fertility & erections may be
affected
Infertility
 Varicoceles
 Cryptorchidism
 Impaired or insufficient
number of sperm
 Infections
 Hormonal imbalance
Diagnostic Tests
Semen analysis
Testicular biopsy
Testing/analysis of sex
chromosomes
Treatment Plan
Well-balanced diet
Vitamins
Surgical intervention
Testosterone or thyroid extracts
Anatomy & Physiology
Internal Organs
Ovaries
Fallopian Tubes
Uterus
Vagina
External Genitalia
Vulva
Mons pubis
Labia minora
Bartholin’s glands
Clitoris
Breasts
Effects of Aging…
Heart disease
Osteoporosis
Urinary incontinence
Breast tissue changes
Painful intercourse
The Female Reproductive System
Start w/ the Chief Complaint…
Present Illness
Past Medical History
OB/GYN history
Family History
Review of Systems
Functional History
Infertility
Primary
Secondary
Anatomic
Endocrine
Low progesterone levels
Diagnostic Tests
Basal Body Temperature
Hormone levels (LH &
progesterone )
Post coital test
Laparoscopy
Med/Surgical TX
Artificial insemination
In vitro fertilization
Clomid
Pergonal
Pregnyl
KEY WORDS
Amenorrhea
Menorrhagia
Metrorrhagia
Dysmenorrhea
Coitus
Conization
Uterine Fibroid
Menopause
Climacteric/Change of life
Natural hormonal decline
Surgically induced
Onset range is 40-55 yrs
Reproductive capability is lost
Symptoms
Menstrual cycles become
further apart
Relaxation of pelvic support
structures
Vaginal dryness, insomnia, HA,
nausea
Increased risk for CAD over 50
yrs old
Osteoporosis
Medical Trmt
 ERT
 Insomnia, hot flashes, mood
swings and lack of
concentration
 Effects HDL and LDL
ERT
Oral
Transdermal patch
Vaginal cream
Nursing Interventions
Education empowers
Calcium rich products
Herbal teas, Vitamin E
Exercise/swimming/biking
Toxic Shock Syndrome
Cau. By a toxin prod. By certain
types of Staph. Bacteria
Assoc. w/ tampon use
Causes prob. w/ functions of
several body functions
Symptoms
Vomiting and diarrhea
Drop in blood pressure
Weakness,dizziness,confusion
Sunburn-type widespread rash
 No single test
 Dx is based on clinical symptoms
 Tx Antibiotics, fluids, methods to
maintain BP
 This cond. May be deadly in up to 50%
if untreated.
Pt. Instructions :
Avoid use of highly absorbent
tampons
Use tampons intermittently
Careful when inserting to avoid
abrasions
Wash hands before insertion
Premenstrual Syndrome (PMS)
0ccurs in 40-50 % of women
Symptoms move severe when over
the age of 35
Symptoms appear 7-14 days before
onset of monthly menses
Treatment & Nursing
Considerations
Low salt diet
Decrease sugar intake
Stress management techniques &
support groups
Exercise
Critical Thinking Q ??
 An 18-year-old teenager who wants to begin
taking birth control pills comes to the Family
Planning Clinic. She is visibly nervous and
tells the nurse that she has never had a
gynecological examination. What can the
nurse say to lessen her fears? How should the
nurse assist her during the pelvic
examination? What additional information
can the nurse provide?
STATISTICS
2ND major cause of cancer death
in women
I in every 8 or 9 will develop
breast cancer
Twice the incidence for women
over 65
IMPORTANT !!
NO cause identified
NO race or culture is exempt
See Box 47-2 for Risk Factors
Signs & Symptoms
Painless mass or thickening
Nipple discharge or retraction
Redness with swelling
Puckering
Medical Testing
Mammogram
Ultrasound
Breast biopsy
ER + or ER BSE pg. 1085
Medical/Surgical TX
Radiation
Chemotherapy
Surgery
Types of Surgery
Lumpectomy
Simple mastectomy
Modified mastectomy
Radical mastectomy
Reconstructive Surgery
Determined by amt. Of breast
tissue and muscle remaining
Helps client deal with
disfigurement
Nursing Interventions
Help client to identify and
verbalize feelings
Promote psychological healing
process and acceptance of the
altered body image.
 Avoid kinks in hemovac tubing
 Teach to avoid carrying items in the
affected arm or wearing purse
straps over the affected shoulder
 No vaccinations, lab tests, or blood
draws on affected side
Fibrocystic Breast Disease
Chronic cystic mastitis
Lumpy breast syndrome
Most common breast lesion
Usually occurs between 35-50
yrs.
Incidence of developing breast
cancer is increased 3-4 times
Many cases of FBD subside after
menopause
Familial tendency
Diagnosis & Treatment
Routine mammograms
Biopsy
BSE pg. 1038
1) one week after menses
2) use pads of fingertips
Med/Surg Treatment
Aspiration
Surgical excision
Pharmacological & Diet TX
Vitamin E 600 mg/daily
Eliminate caffeine-containing
products
Endometriosis
Cause is uncertain
Endometrial tissue grows
outside the uterus
Implants
Adhesions & scar tissue
Inflam. & pain
Symptoms
Pain
Dysmenorrhea
Pelvic heaviness
Dysmpareunia
May result in infertility
Medical Tx
Suppress ovulation and
menstruation, reduce
symptoms & cause implants to
shrink
NSAIDS  pain
Contraceptives
Surgical Tx
 Laparoscopy
Cauterization or laser
vaporization
Hysterectomy (TAH/BSO)
Hysterectomy
Vaginal
Abdominal
Total
subtotal
Pre-op Nursing Considerations
Betadine douche
See Pre-Op Teaching Careplan (
pg. 1104)
Post-op Nursing Considerations
 Mon. VS, TC & DB
 Early Ambulation
 IV Fluids, foley care
 Check abd. drsg. & Perineal Pad
 Teach to avoid fecal contamination,
good perineal care & good
handwashing
PID
Pathogenic invasion of the
fallopian tubes, ovaries or both
as well as any vascular or
supporting structures within
pelvis, except uterus.
Cause & Risk Factors
STD’s Chlamydia most common
Staph & Strep
Immunocompromised
Malnourished
Promiscuous
Douching
Symptoms
May be asymptomatic
Symptomatic gradual or
sudden abd. Pain
Fever
Vag. Discharge
Dyspareunia
Medical Interventions
Antibiotics
Treat partner
Discourage sexual intercourse (
for 3 wks )
hysterectomy
Nursing Considerations
Semi-fowlers position
Sitz baths
Standard precautions
Avoid douches and intercourse
Structural Disorders
Associated with relaxation of
the pelvic muscles that support
the uterus, bladder and rectum
Multiple pregnancies, perineal
lacerations, aging
Uterine Displacement
Weakness of supportive
structures
Cystocele vagina & bladder
Rectocele vagina & rectum
Typically occur together
Symptoms
Stress incontinence
Incomplete bladder emptying
Diff. expelling feces
Incontinence of flatus
Treatment
1. Kegal exercises
2. Pessary
3. Anterior & Posterior
colporrhaphy ( A & P repair )
Nursing Interventions
 Pre-Op  douche & foley
 Post-Op Teaching:
 1) Kegal
 2) Keep stool soft
 3) Delay intercourse
 4)Manage pain & identify s/s of
infection
Urethrocele
Downward displacement of the
urethra into the vagina
Tx Marshal Marchetti
Procedure
Prolapsed Uterus
Downward displacement of the
uterus into the vagina
First degree
Second degree
Third degree
Symptoms
Nagging backache
Pelvic heaviness
Dyspareunia
Cystocele & rectocele us.
accompany
Med/Surg Treatment
Vaginal hysterectomy
Pessary
Procedentia
Vesico-Vaginal Fistula
For Reproductive System Health
Define……
Pelvic examination
Pap test
Mammography
Breast ultrasound
Define….
Laparoscopy
Colposcopy
Cervical biopsy ( Punch &
Conization )
D & C
INFECTIONS OF THE REPRODUCTIVE
TRACT
Vulvitis & Vaginitis
Inflam. of vulva and vagina
Fungal, protozal infections
Inflammation of sweat glands
Rx to chemical irritants
Consequence of aging process
Symptoms
 Inflammation
 Intense pruritis
 Vaginal Discharge (depending
on causative agent)
Treatment
Topical antifungal creams
Oral antiprotozoal agents
Antibiotics
Vaginal suppositories
Cervicitis
• Inflam. Of the cervix
• Infectious process
• Physical or chemical trauma
• Asymptomatic
• Antimicrobials or estrogen
Ovarian Cancer
High mortality rate
No specific etiology
Rarely found in women who
have had children or used birth
control pills
Ovarian Cancer
Symptoms
Abdominal pain and bloating
Flatulence
Urinary tract complaints
Diagnosis & Treatment
CTS and US
CA-125
Exploratory lap
TAH & BSO
Chemo & radiation therapy
Infibulation
 Also known as FGM or FGC
 Practiced throughout the world
 Marks transition from childhood to womanhood
 Intended to impart the skills & info a woman needs to
fulfill her duties as a wife and mother
Map: Estimated Prevalence of Female Genital Cutting (FGC) in Africa. Data based on uncertain estimates.
Be sure to read Trichomoniasis and all STD’s not just
those discussed on PPT !
Gonorrhea
Gonococcus (Neisseria
gonorrhoeae)
One of the most commonly
reported STD’s
Sexual contact/neonates/HC
personnel
Symptoms
 2-10 days after exposure
 Pain on urination and a puralent
drainage from penis or vagina
 If untreatedSterility
 Sx disappear after a few wks;
bacteria remains; highly infectious
Medical Treatment
Single dose of Rocephin IM
Cipro followed by 7 days of
Vibramycin
EES ophthalmic oint neonate
Follow up care encouraged
Chlamydia
Chlamydia trachomatis
Most common STD in USA
Sx similar to Gonorrhea
If untreated sterility
Med Dx & Tx
DX based on hx & lab studies
Single dose ( Zithromax) or 7 dys of
Vibramycin
Repeat culture in 3-4 months to
confirm successful trmt.
Syphillis
Treponema pallidum
 Transmitted by direct
contact/breaks in
skin/congenital
 If untreated, s/s progress
through 4 Stages
First Stage
1-12 wks
PapuleChancre
Lasts several wks, disappears
but organism now moved into
blood
Stage 2
Occurs 1-6 mos. After contact
Primary symptom is rash
Palms of hands, soles of feet
Low-grade fever
Pt is contagious
Latent Stage
No symptoms for many years
Organism is invading organs
Disease not spread by sex but by
blood
Late Stage
 3 yrs. After contact
 Heart, eyes, brain, nervous system,
bones, joints or any other part of
the body.
 Results in heart disease, blindness,
neurologic disorders
Medical Diagnosis
 PE
 VDRL
 RPR
 FTA-ABS
 HIV test recommended
 PCN-G ( 1 or more doses)
Herpes Simplex(HSV 2)
 Transmitted by sexual contact
 Painful, itching sores or blisters
 ^ risk of cervical CA
Teach to have annual Pap smears
Meds include Zovirax, Valtrex & Famvir
Class Activity
 A breast-feeding mother of a
week-old infant comes to the
doctor’s office with a complaint
of left breast tenderness and a
low-grade fever.
 A woman is seen in the clinic
with dull, steady, low
abdominal pain and dysuria.
 A woman with menorrhagia and
severe dysmenorrhea says that
she hasn’t gained any weight, but
she notices that her lower
stomach seems to be getting
larger. She is not sexually active.
 –
A woman is seen by the
doctor for a complaint of general
pelvic pain and heaviness. She
has also recently noticed pain in
her lower abdomen when she has
a bowel movement.
Informational Reading
General Information
First reported in 1981 in U.S.
Progressively fatal
* Retrovirus
www.avert.org/usa-statistics.htm
Following exposure,
Incubation period
2-4 weeks
Flulike symptoms
HIV test is negative
2-3 wks symptoms disappear
Phases of Disease
Initial exposure
Acute Infection
Asymptomatic HIV infection
Symptomatic Infection
Advanced HIV disease (AIDS)
Pathophysiology
Immune system is affected
Progressive depletion of CD4 T-
helper cells
Normal ratio of T-helper to Tsuppressor cells is 2:1
Diagnostic Tests
ELISA
Western Blot
HIV/AIDS Epidemic
Growing rapidly among
minority populations
Leading cause of death of
African-American males
African-American, HispanicAmericans, Whites
Modes of Transmission
Blood
Semen
Vaginal secretions
Breast milk
High Risk Behaviors
Unprotected sexual intercourse
Multiple sex partners
Sharing needles or syringes
Pharmacological TX
Goal
Seroconversion
AZT – slows viral spread
N, V and other GI sx are common
w/ trmt
PCP
Histoplasmosis
Tuberculosis
Mycobacterium Avium Complex
(MAC)
CMV
Toxoplasmosis
Cryptococcosis
Kaposi’s Sarcoma
Thrush
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