Genital Urinary System
Female Reproductive System
Brunner and Suddarth’s
Medical Surgical
Nursing
Text: Ch. 46-48
Behavioral Objectives:
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•
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Review the anatomy and physiology of the female GU systems
Describe the physical assessment of the female GU systems
Discuss the application of the nursing process as it relates to patients with
disorders of the female GU system
Describe etiology, pathophysiology, clinical manifestations, nursing management
and patient education for the following female GU disorders:
– Vaginitis
– Pelvic inflammatory disease (PID)
– Endometriosis
•
•
Discuss incidence, prevention & tx of the pts with CA of the GU system
Discuss the nursing interventions in pre and post-operative care of patients
undergoing the following surgeries
– Hysterectomy
– Mastectomy
Anatomy Review: Breast
• Female breast
development
– 10-16 yrs
• Tail of Spence
– Into axillary area
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•
•
•
Cooper’s ligament
12-20 lobes
Nipple
Areola
Anatomy Review
Internal Reproductive Structures
Vagina
–
–
Mucus membrane
Posterior to bladder &
urethra
Anterior to rectum
Anterior & posterior
walls touch
Upper vagina
surrounds cervix
–
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•
Inferior uterus
Anatomy Review
Internal Reproductive Structures
Uterus
•
Pear-shaped
–
Muscular
Size
–
–
?
Variable
•
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# pg
Anatomy Review
Internal Reproductive Structures
• Location
– Posterior to bladder
• Ligaments
Uterus
• Two parts of the
uterus
– Cervix
• Projects into the
Vagina
– Fundus
• Body of the uterus
• Endometrium:
– Lining of the uterus
Anatomy Review
Internal Reproductive Structures
Ovaries
•
Connected to uterus by
the fallopian tubes
•
Contains
–
•
1000’s of ova @ birth
Ova / Ovum
–
–
–
Egg cells (immature)
Ova – plural
Ovum - Singular
Physiology Review
–
Discharge of a
mature ovum from
the ovary
Start
Ovulation
•
Definition
Physiology Review
Ovulation
•
Follicular Stage
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Ovum enlarges  cyst (graafian follicle)
Reaches the surface (of the ovary)
Ovum is discharged
•
Ovulation
Physiology Review
After Ovulations
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•
•
•
Ovum
Fallopian tube 
Uterus
IF is meets a
spermatozoon
– Union & conception
– Location of
fertilization?
Physiology Review
After ovulation
• Ovum cyst 
– Corpus luteum
– Stays in the ovary
• Produces progesterone
• Prepares the uterus for
the fertilized ovum
The Menstrual Cycle
•
2 system control
menstruation
process
–
–
Reproductive
Endocrine
Hormones
The Menstrual Cycle
•
Ovaries 
– Estrogen
– Progesterone
The Menstrual Cycle
Pituitary gland
• FSH
–
–
•
Stim. Ovaries
to secrete estrogen
LH
–
–
Ovulation
Stim. Progesterone

The Menstrual Cycle
•
Cyclic pattern 
–
–
Changes in the
endometrium and
menstruation
28 day cycle
Follicular Phase
Estrogen
Increasing
Progesterone Low
FSH
High  decreasing
LH
Low  increasing
Ovaries
Growth of follicle
Endometrium Proliferation of superficial layer
Day(s)
5 - 13
Ovulation
Estrogen
High
Progesterone Low
FSH
Low
LH
High
Ovaries
Ovulation
Endometrium Continued growth
Day(s)
14
Luteal Phase
Estrogen
Drops then increases
Progesterone Increasing
FSH
Low
LH
High
Ovaries
Active corpus luteum
Endometrium Highly vascular & thick
Day(s)
15 - 25
Premenstrual Phase
Estrogen
Decreasing
Progesterone Decreasing
FSH
Increasing
LH
Decreasing
Ovaries
Degeneration of corpus luteum
Endometrium Vasoconstriction, degeneration
Day(s)
26 - 28
Menstrual Phase
Estrogen
Low
Progesterone None
FSH
Increasing
LH
Low
Ovaries
follicular development begins
Endometrium Degeneration and shedding of
superficial layer
Day(s)
1-5
Menopausal Period
•
End of reproductive
capacity
Age 45 – 52 yrs
Menstruation ceases
•
•
–
No periods for
1 year
>
Menopausal Period
•
Ovaries not active 
–
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•
•
_?__ estrogen
i
Reproductive organs
i size
No ova mature
Physical assessment
Health history
•
Menstrual hx
– Menarche
•
–
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–
•
Beginning of
menstruation
Length
Amount
Cramps/pain ?
Hx of pregnancies
• Medication history
– Hormone therapy
– Hormonal
contraceptives
– Fertility treatment
Assessment:
History & Clinical Manifestations
•
Pain
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•
Hx vaginal discharge
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•
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Dysmenorrhea
Dyspareunia
Odor
Itching
Hx urinary functions
Hx B&B control
Assessment:
History & Clinical Manifestations
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•
•
•
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Sexual history
History of sexual or physical abuse
History of surgery
History of chronic illness or disability
History of genetic disorders
• Physical Exam
• Breast
– Frequency:
• Monthly
Breast Exam – Assessment
•
•
•
•
•
•
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Palpable masses
Skin changes
Pain
Swelling
Redness
Nipple changes
Self exam
Abnormal breast findings
• Erythema
– Benign local infection or
– Superficial neoplasm
• Prominent venous pattern
– h blood supply required by tumor
• Edema & pitting
– Neoplasm blocking the lymphatic drainage tubes
• Orange-peel appearance / Peau D’orange
(edema)
– Advanced breast cancer
• Nipple inversion
– If new  requires evaluation
• Signs of dimpling, creasing, changes in contour
• Breast Cancer Mass - palpate
– Single mass
– One breast
– Firm, hard, embedded in surrounding tissue
– Non-tender
Mammography
• Duration
– 15 minutes
• Recommended
frequency
– Annually
– > age 40
Physical Assessment
•
Pelvic
–
Frequency
•
–
Initial
•
•
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•
Annual
> age 18
sexually active
breast
pelvic
Positioning
–
Supine lithotomy
position
Physical Assessment
•
Inspection
–
Inspects external
genitilia
Speculum examination
–
•
•
Vaginal canal
Cervix
Physical Assessment
•
Pap smear
–
Tissue sample of cervix

Purpose:
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•
–
Dx Cervical Ca
No douche before visit
Physical Assessment
•
Bimanual palpation
–
–
Cervical palpation
Uterine palpation
• Colposcopy
– Portable microscope
– Obtain sample