1120 FEMALE REPRODUCTION
BY DIANA BLUM RN MSN
METROPOLITAN COMMUNITY COLLEGE
ANATOMY
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EXTERNAL GENITALIA
• MONS PUBIS} PAD OF FATTY TISSUE THAT COVERS AND PRTECTS THE
SYMPHYSIS PUBIS
• LABIA MAJORA} COVER AND PROTECT INNER VULVULAR STRUCTURES (MONS
PUBIS TO PERINEUM
• LABIA MINORA} THIN FORDS OF SMOOTH SKIN THAT FORM A PREPUCE
(HOOD) OVER THE CLITORIS
• HAVE SEBACEOUS GLANDS, NERVES, & BLOOD VESSELS
• URETHRAL MEATUS} BELOW CLITORIS
• VAGINAL OPENING IS COVERED BY THE HYMEN
INTERNAL GENITALIA
• VAGINA} CANAL FROM VULVA TO UTERUS
• UTERUS} FIRM PEAR SHAPED HOLLOW ORGAN. LOWER SEGMENT IS THE
CERVIX
• ENDOMETRIUM }INNER LINING OF THE UTERUS
• FUNDUS] UPPER SEGMENT OF UTERINE BODY
• FALLOPIAN TUBES} 2 THIN HOLLOW CILIA LINES TUBULAR STRUCTURES THAT
HAVE FUNNEL SHAPED ENDS
• SERVE AS PASSAGE FOR OVA TO TRAVEL FOR FERTILIZATION
• OVARIES} 2 ALMOND SHAPED STRUCTURES. HOLD MATURING OVUM AND
SECRETE HORMONES (ESTROGEN, PROGESTERONE, ANDROGENS, AND
RELAXIN)
The Breasts
• Accessories to reproductive process
• Nourish infants after birth
• Inner structure
• Gland and duct tissue
• Fibrous tissue
• Fat
• Divided into several lobules
• Contain alveoli that produce milk when stimulated by pituitary
hormone prolactin
• Milk transported to nipple by the lactiferous ducts
• Areola} pigmented area that surrounds nipple
• Mongomery’s tubercles} small round sebaceous glands that produce a
lubricant that protects nipple tissue (visible and under areola)
Menstrual Cycle
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Result from interaction of hypothalamus, anterior pituitary, and ovary
Interaction causes ovulation
• Ovary releases ovum
• Prepares uterine lining to receive and nourish ovum if fertilized
Menstruation} passage through the vagina a mixture of blood and other
fluids and tissue formed in the lining of the uterus to receive fertilized
ovum
• Avg.: 28-30 days
• Affected by stress, activity, and illness
Cycle progression:
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Menstruation day 1-7
Maturation of ovarian follicle with rupture and release of ovum (days 1-14)
Estrogen production (day 6-14)
Progesterone production (day 15-26)
Uterine prep (day 6-26)
Implantation ( day 14)
Unfertilized does not implant
See pg 1078
Menstrual cycle
Assessment
• Hx: look at s/s, reason for visit
• PMH: age menarche (menstruation begins), date of last onset,
usual # of days b/w periods, # of days period lasts, ask if any
problems like bleed b/w periods, abd pain, cramping mood
changes, also look for menopause
• Obstetric Hx: # pregnancies, # of live births, # of
abortions(spontaneous or induced) and when did it happen in
pregnancy
• Fam Hx: DM, Ca, pregnancy complications, genetic disorders,
congenital anomalies
• System Review
• Functional Assessment: diet, supplements (calcium, iron),
exercise, occupation hazards
Diagnostics
• Pelvic exam
• Smears and cultures
• Bx
• Cervical bx done to dx cancer
• 2 types: multi punch-painful multi specimen taken done outpt
:cone- invasive and done as outpt surgery
• Colposcopy: inspects cervix under magnification
• Culdoscopy: simplest way to directly visualize pelvic cavity, scope
inserted into small incisionin posterior vagina. Looks at ectopic
pregnancies, masses, infertility, pain
• Laparoscopy: done to visualize organs
• D & C:diagnostic and tx purpose (cancer , abnormal bleed, abortion)
• mammogram
BSE
• See video and diagram
http://www.metacafe.com/watch/564612/self_breast_exam/
http://www.youtube.com/watch?v=RNsWzFd1yxw
disorders
• Breast abcess
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Infected area of breast tissue
Becomes filled with pus when body fights infection
Involves breast tissue, nipple milk glands and mild ducts
Assessment: Breast pain, tenderness, redness or hardness,Fever
and chills, General ill feeling, Tender lymph glands in the
underarm area
• Teach: Teach client to clean nipples and breast before and after
nursing, Lubricate nipples after nursing with A&D ointment or
other recommended topical application, Avoid clothing that
irritates the breast, Don’t allow infant to chew nipples
disorders
• Mastitis} Infection based inflammation of breast
tissue in lactating woman (page 1096)
• Caused by staph aureus, E-Coli, and streptococci that
enter through cracked nipples
• Assessment: Localized pain,fever, tachycardia, general
malaise, purulent discharge from nipple
• Client teaching about application of heat, and drug
therapies
disorders
• Breast Cancer 3 types
• Ductal
• Lobular
• Nipple
• Treatment:
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Breast bx
Lumpectomy
Radiaton
chemo
Mastectomy and
reconstruction
• Assess:
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Physical manifestations of the disease
like lumps, redness , etc.
Review of body systems
Psychological and physical effect of
treatment
Psychosocial factors
Level of knowledge
• s/s:
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Nipple dc or retraction
Skin retraction
Breast thickening or lump
Dimpling of the skin
Breast edema
Dilated blood vessels
Ulceration & hemorrhage
Dry patchy skin (Paget’s disease)
disorders
• Breast cancer continued
• Nursing Interventions
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Allow expression of feeling
If has rad. mastectomy, take BP on unaffected side
Help client with mobility exercises
Contact Reach for Recovery volunteer and make sure
client has info about prosthesis and bras
• Teach about follow-up care, and chemo & radiation if
needed
Surgical procedures
• Breast Biopsy
• Lumpectomy
• Tumor of the breast is removed that contains the cancerous tissue
with a margin of healthy tissue
• Preserves breast
• Take as little tissue as needed
• Followed by chemo and/or radiation
• Lumpectomy with Node Dissection
• Tumor of the breast is removed that contains the cancerous tissue
with a margin of healthy tissue
• Preserves breast
• Take as little tissue as needed
• Followed by chemo and/or radiation
• Mastectomy
• Diagnosis by inspection, palpitation, mammography, ultrasound, needle
biopsy
Preop lumpectomy
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Same as breast bx, done under general anesthesia
Responsibility for consent and vitals
Client NPO for 8 hours if having a general anesthetic
Have client Turn. Cough .Deep breath after surgery
Post op lumpectomy
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Look at dressings and drains
Monitor vitals every 15 min until stable
Management of pain
I&O
Inspection of dressings
Monitor for bleeding and infection
mastectomy
• Removal of entire breast
• Radical-removal of breast tissue, skin, axillary lymph
nodes and underlying pectoral muscle
• Modified Radical-removal of breast tissue and axillary
lymph nodes
• Post op
• Same as for lumpectomy
• Client teaching and emotional support imperative
• Otherwise, post –op interventions as in lumpectomy
disorders
• Cysts
• Fibrocystic Disease
• DX: palpation, mammography, ultrasound
• Treatment: oral analgesics, heat applications, caffeine
and salt restrictions and vitamin supplements (E)
• Hormone therapy with low dose estrogen and
progestins
Common Uterine Therapies see
page 1086
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Douching
Cauterization
Heat
Topical meds
disorders
• Uterine bleed
• Metrorrhagia} bleed b/w periods
• Menorrhagia} profuse or prolonged period
• amenorrhea} pregnancy, wt loss, stress, gland
disorders
• Risk Factors
• Hormone dysfunction, tumor, coagulation problems,
contraceptives, etc
• TX: depends on cause
• NSG Dx: Anxiety, knowledge deficit
• NSG interventions: teach about tx, encourage feeling
expression, listen, explain procedures
disorders
• Infection
• Physiological effect} infertility
• Psychological effect} change in relationships, distrust,
shame, embarrassment, low self esteem, denial,
defensive, etc
• Interventions: show acceptance, educate about
hygiene and sex practice, teach about creams, jellies,
and suppositories
Vulvitis and vaginitis
• Difference is that vaginal discharge is present with
vulvitis
• s/s: pruritis is the most common
• 2 most comon causes: candida albicans (cottage
cheese discharge) and trichomonias vaginalis
(profuse, frothy, yellow grey discharge with fish
odor)
• Both are sexually transmitted
• Tx: topical antifungals, oral antiprotozoal, antibiotics,
vaginal suppositories
• Advise client not to scratch, avoid sex during tx
• See pg 1093
Uterine Displacement
• Cystocele: weakened support between vagina and
bladder
• Rectocele: weakened support between vagina and
rectum
• Causes: pregnancy
• s/s: pain, infections, etc, see page 1103
• Uterine prolapse: uterus descends into the vagina
• 3 degrees (read page 1107-1109)
cystocele
rectocele
Uterine prolapse
infertility
• Inability to conceive within 1 year of regular
unprotected sex or inability to deliver live infant
• 40% r/t female problems
• 40% r/t male problems
• 20% unknown
• Conception is based on: timing, ovum production,
sperm ejaculated, patent fallopian tubes, temperature
etc.
• see page 1121-1122
conception
baby
20 week
The end or is it the beginning