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Repro and Breast Study Guide UPDATED-edited

Understand the concepts surrounding each topic, including, but not limited to:
 Assessment (Normal & abnormal
 Treatment of abnormals
 High risk groups
 Clinical manifestations
 Diet
 Nursing and Collaborative
 Patient Teaching
Male Reproductive System
3 primary roles:
1. sperm production and transportation
2. deposition of sperm in the female
reproductive gland
3. hormone secretion
1. Hormones and their function within
the male reproductive system.
a. i.e. Testosterone
 The interstitial cells that lie
between the seminiferous tubules
are the cells that make the male
sex hormone, testosterone.
 Testosterone is responsible for the
development and maintenance of
secondary sex characteristics and
adequate spermatogenesis.
 Testosterone is also responsible
for regulation of libido, bone mass,
fat distribution, muscle mass, and
conversion to estradiol
 Lack of testosterone is related to
lack of sterility or impotence
2. Diagnostics to detect testicular masses
a. i.e. Ultrasound, labs (HCG, AFP)
Large amounts of HCG can indicate
a presence of a mass
High levels of AFP can also indicate
presence of cancerous mass
Painless hard nodule indication for
medical attention after testicular
self exam
3. Testicular CA - Signs and symptoms
and education
 Elevated HCG or AFP
 PSA levels
 Painless lump on scrotum
 Scrotal swelling
 Feeling of heaviness in the
 Dull ache, low back pain, chest
pain, cough, dyspnea, or heavy
sensation in lower abdomen,
perianal area, or scrotum
4. Obtaining health history for males
 Ask about medications, specifically
anti-hypertensive meds since it
can cause erectile dysfunction
 Ask about sexual function and
renal function
 Ask if they have any STI or Hx of
5. Functions of anatomical structures
 The testes, specifically the
seminiferous tubules, are
responsible for forming
 The epididymis, ductus deferens,
ejaculatory duct, and urethra are
responsible for moving the
spermatozoa from the testes into
the female reproductive system.
 The epididymis stores and
matures the sperm and they exit
out through the ductus deferens.
 The ductus deferens, or vas
deferens, travel upward into the
abdominal cavity and behind the
bladder to join the seminal vesicle
which forms the ejaculatory duct.
 Glands are made up of the seminal
vesicle, prostate gland, and
cowper’s (bulbourethral) glands
which make and secrete seminal
fluid (semen). The ejaculate fluid
creates an alkaline, nutritious
environment that promotes sperm
motility and survival.
6. Testicular self-exam
a. Best time to do it? In the shower
 Starting from 15 to 40 years old
 When to get a rectal exam? 50
years old
7. To know:
a. Males testes dangle outside of the
body because they are sensitive to
temperature changes.
b. The ductus deferens is removed
when the male undergoes a
Female Reproductive System
3 primary roles:
1. ova production – in ovaries
2. hormone secretion – estrogen and
 Progestrone:
o Controls menstrual cycle
o Supports and maintain
pregnancy and maintain
implanted egg
 Estrogen:
o Regulates the female
menstrual cycle
o Controls development of
female sex organs
o Thickens the lining of the
uterus during menstrual
 Androgens:
o Small amounts
o Plays a role in male traits
and reproductive activity
3. protect and facilitate the development
of the fetus in a pregnant female
8. Anatomical structures & functions
Ovaries are responsible for
creating ova and release gametes
and sex hormone
Uterus strong muscular sac that
fetus can be develop in
Cervix functions to secrete mucus,
to help transport sperm, and to
prevent microorganisms from
entering uterus.
9. Pap smears- when should they be
done and not be done. (i.e when they
should be deferred)
 Pap smears should be done
every 3 years, but pap smears
should be deferred when you
are on your period or you have
a yeast infection
 Done to assess abnormal cells
and screen for cancer
10. D&C education to the patient
a. What should patient expect when
they go home?
Before: teach patient about
procedure and sedation
After: assess degree of bleeding
with frequent pad checl during the
first 24 hrs
11. Ways that women track ovulation
a. Checking temperature and why?
Occur every 21 – 35 days, average
of 28 days
App or calendar tracking
Ovulation may increase basal body
temperature, therefore, it allows
determination when a female is
most fertile
Females are most fertile 2 – 3 days
before an increase in temperature
A prolonged increase in basal
temperature, roughly 18 or more
days after ovulation, may indicate
12. Gerontologic Considerations
a. i.e. vaginal dryness (refer to
Vaginal dryness can lead to
urogenital atrophy and changes in
vaginal microbiome.
Decrease in estrogen and other sex
hormones can lead to breast and
genital atrophy, reduced bone
mass, and increased risk for
13. Pelvic ultrasound teaching
a. What education will you give them
Need a full bladder
Useful detecting masses, ectopic
Drink 40 oz of water 1 hr prior
Patient will be uncomfortable
during exam
13. To know:
 Adnexa – appendages of the
uterus (ovaries, fallopian tubes,
 The vagina has secretion from
cervix which allows for sexual
 The pH protects from
 Elevated HCG levels in women
indicate a possibility of
 Educate against douche-ing
since it will alter vaginal pH
and will leave females more
susceptible to vaginal infection
 Check for medications, history
(C-section, surgery, ovary
Pelvic exams starting from 21
years old
 Female exam: check walls of
vagina, cervix, discharge,
polyps, suspicious growth or
 If biopsy is indicated, patient
may cramping, vaginal
discharge for 24 hrs
Breast Cancer/ Breast Disorders
14. Mammogram recommendations
a. Refer to American Society
 At age of 40 start getting
mammograms, then get
ultrasound, then MRI
 Average risk – no family history
 Ages 40 – 44 option to get
mammogram, strong
 Ages 45 – 54 women should get
mammogram every year
 Ages 55 and older should get
mammograms every two years
 For women with increased risk,
start screening at 30 yrs old
15. Breast Cancer Prevention
a. Risk factors- Know modifiable and
 Education why get a mammogram
before age of 40 mammogram:
looking for clear spots, abnormal
in breasts, mammogram for breast
infection, fibrocystic breast
disease, nipple discharge, lumps in
breast, breast pain
 MRI recommended for high risk
women with first degree relative
with BRCA mutation
16. Who is at greater risk for Breast
a. i.e. “45 year old female no kids vs
25 year old with 2 kids”
 Having any first degree family
member with breast cancer.
Menstruation before 12 yrs old
and longer life greater risk for
cancer due to longer exposure to
Having children after 35 or never
having children
Not breastfeeding
17. Modified Radical Mastectomy vs.
Breast Conservation (Lumpectomy)
a. Education you will provide patient
regarding both. What is the
difference and 4522
 With the modified radical
mastectomy, breast removal will
occur, the axillary lymph node will
be dissected, and the pectoralis
muscle will be preserved, while
the lumpectomy, only the tumor
and any surrounding tissue will be
removed to preserve as much of
the breast as possible with a
sentinel lymph node biopsied and
a axillary lymph node dissection.
18. Education after Mastectomy (i.e.
activity, wound education, and
nursing post op interventions)
 Education to provide patients after
a mastectomy would be:
o Impaired arm mobility
o Depending on the surgery,
prolonged treatment may
be required
o Depending on surgery, the
breast may be lost
o May be eligible for breast
reconstruction or
o Changes in the breast
texture and sensitivity may
o Monitor for signs of
soreness, edema, skin
reaction, arm swelling,
sensory changes, numbness
and tingling in same side
arm, lymphedema,
impaired range of motion,
chest wall tightness, and
phantom breast sensation
may occur.
Breast Cancer common location
a. Be able to point out in a chart
 Upper outer quadrant of the breast
Estrogen-receptor negative vs.
Estrogen-receptor positive
a. What medication would patient
receive if estrogen positive
 It is important to know whether
breast cancer cells are estrogenreceptor positive or estrogenreceptor negative to determine the
treatment plan for the patient.
 For estrogen-receptor positive,
hormone therapy drugs can be
used to either lower or stop
estrogen from acting on the breast
cancer cells, but it won’t be
effective for estrogen-receptor
negative cells.
 Estrogen-receptor positive lower
chance of recurrence
 Estrogen-receptor negative higher
chance of recurrence
 Immunohistochemistry (IHC) to
test for negative or positive.
 Tamoxifen, toremifene (Fareston),
and fulvestrant (Faslodex) would
be given for hormone-receptor
positive cells.
Education on why Breast Cancer
commonly spreads
a. i.e. THINK lymph nodes
BRCA1 and BRCA 2
a. How will you explain what these
are and what they do
 Everyone has BRCA genes and the
BRCA genes (BRCA 1 and 2) are
tumor suppressant genes on two
different chromosomes. A
mutation on these genes can result
in increased susceptibility for
tumors to grow.
 These genes are inherited. Men
with BRCA gene mutation have an
increased risk for breast and
prostate cancer.
23. Psychosocial problems after a
a. How will you help patients cope
 To help patients cope after a
o Provide safe environment
for expression
o Identify sources of support
and strength
o Encourage patient to
identify and learn person
coping mechanisms
o Promote communication
o Answer questions about
operation and disease
o Provide options for breast
 Psychosocial problems that may
occur with patients after a
mastectomy are:
o Distress or tension,
tachycardia, increased
muscle tension, sleep
problems, restlessness,
changes in appetite or
mood, affect self-perception
of body image, sexual
identity, relationships,
threat to self-esteem and
24. Treatment for Stage 1 breast cancer
a. i.e. educating on breast conserving
 Surgery is the main treatment
consideration for stage 1 breast
Inform the patient that breast
conservation surgery can be done
as an option to preserve the
patient’s breast where only the
tumor and surrounding tissue will
be removed to preserve as much of
the breast as possible. Radiation
therapy will be done afterward to
fully remove the tumor. However,
if recurrence is likely,
chemotherapy may be considered.
25. Fibrocystic Breast conditions
a. Education on nipple discharge.
 Occur in women between 35 – 50
and it occurs in the upper outer
quadrant bilaterally
 The breast may have a milky,
watery-milky, yellow, or green
 Assure that cysts do not become
26. Discharge home education after a
 Teach patient with return
demonstration about management
of drains
 Arm and shoulder exercises will
need to be done to aid in returning
arm function on the affected side
 Notify MD or return if muscle
contractures, shortening occur
 Proper management of pain with
medications and analgesics
 Monitor for fever, inflammation at
surgical site, erythema, unusual
swelling, new back pain, weakness,
SOB, changes in mental state, and
27. Radiation- how does it affect the
 Radiation damages the skin locally
in the treatment field.
 Erythema may develop 1 – 24 hrs,
skin break down may occur with
progressive treatments, protect
skin from temperature changes,
lubricate the skin,
28. Diagnostics for breast lesion
Diagnostics used to detect tumors
 CA-125
 Mammograms be done at the
age of 40 – 45
 Mammogram analyze breast
internal structure and used to
detect suspicious bumps
 Ultrasound is used in
conjuction with a mammogram
 Xray can detect lump approx 1
cm big
 CT and MRI
Mammoplasty – Discharge teaching
 Monitor for signs of hematoma
formation, hemorrhage, infection.
 Inform that the implant, capsular
contracture, and loss of the
implant is possible.
 Assess for temperature change,
change dressing using sterile
technique, wear bra that provides
good support, avoid strenuous
 Assure that breast appearance will
improve when healing is complete
 Can resume normal activity after 2
Modified radical mastectomy
 With the modified radical
mastectomy, breast removal will
occur, the axillary lymph node will
be dissected, and the pectoralis
muscle will be preserved
Stereotactic needle-biopsy education
 Stop blood thinners prior to
 Procedure is done outpatient
 Local anesthesia is used
 After surgery, limit heavy lifting
for a day or two, bruising, swelling,
and a little bleeding may occur at
the site of biopsy.
Notify for any fever, severe pain,
swelling, loss of function or
sensation in arms or chest.
33. To know:
 Each breast contain 15 – 20 lobes
of glandular tissue, which make
the milk
 Self breast exams start at 40,
unless strong family history
 Clinical breast exams every 3 years
between 20 – 30’s
 If patient is to undergo
Stereotactic Core Biopsy, make
sure they can lay on stomach,
educate will have discomfort, and
will have some bruising after
 Don’t do IV, BP, or anything on the
same side that they had a
mastectomy since they will be at
risk for lymphodema
 For lymphodema: have them
exercise, compression sleeve,
avoid injection or IV.
 Mechanism of action – agonist
competitor at estrogen receptors
and bind to DNA after metabolic
activation and to initiate
 Side effects – vaginal bleeding or
spotting, decreased visual acuity,
corneal opacity, retinopathy, hot
flashes, mood swings, vaginal
discharge and dryness,
 Nursing considerations – report
immediately if there is a decreased
in acuity, monitor for DVT,
pulmonary embolism, stroke, SOB,
leg cramps, and weakness.
 PSA – prostate specific antigen
 What would cause increase or
 Identify abnormals
Acute/Chronic Kidney Injury