This is Chapter 72
Assessment of the
Reproductive System
Female Reproductive System
• External genitalia—vulva, labia majora, mons
pubis, labia minora, clitoris, vestibule,
perineum
• Internal genitalia—vagina, uterus, corpus,
cervix, fallopian tubes, ovaries
• Breasts
• Menstruation and menopause
Internal Female Genitalia
Female Breast
Male Reproductive System
• External genitalia—penis, scrotum
• Internal genitalia—testes and prostate gland
• Inguinal area
Internal Male Genitalia
Assessment Methods
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Patient history
Nutrition history
Family history and genetic risk
Genitoreproductive history
Current health problems—pain, bleeding,
discharge, masses
Assessment Techniques: Female
• History—pain, bleeding, discharge, masses
• Physical assessment:
– Breast examination
– Abdominal examination
– Examination of the external genitalia
Assessment Techniques: Female
(Cont’d)
– Pelvic examination
– Bimanual examination
– Rectovaginal examination
Bimanual Pelvic Examination
Assessment Techniques: Male
• Examination of the external genitalia
• Examination for inguinal hernia
• Examination of the rectum and prostate
Papanicolaou Test
• Patient preparation for Pap test
• Procedure
• Follow-up care
Blood Studies
• Hormone levels
• Serologic testing
• Venereal Disease Research Laboratory (VDRL)
test
• Rapid plasma reagin (RPR) test
• HIV testing
• Prostate-specific antigen (PSA)
• Cultures
Other Studies
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Urinalysis for steroid hormones
Wet preparation (smears)
Cultures
General x-rays
CT scans for reproductive system disorders
Hysterosalpingography—an x-ray of the cervix,
uterus, and fallopian tubes
Other Studies (Cont’d)
• Mammography
• Ultrasonography
• Magnetic resonance imaging to scan for pelvic
tumors
• Colposcopy
• Laparoscopy
• Hysteroscopy
Other Studies (Cont’d)
• Cervical biopsy
• Endometrial biopsy and aspiration
• Breast biopsy and aspiration biopsy of breast
fluid or tissue
Laparoscopy
Other Diagnostic Tests
• Needle biopsy of the prostate
• Semen analysis
This is Chapter 76
Care of Patients with Sexually
Transmitted Disease
Sexually Transmitted Diseases (STDs)
• Caused by infectious organisms that have
been passed from one person to another
through intimate contact, usually oral or
vaginal intercourse.
• Others can be transmitted by parenteral
exposure to infected blood, fecal-oral
transmission, intrauterine transmission to the
fetus, and perinatal transmission from mother
to neonate.
Syphilis
• Can become systemic and cause serious
complications and even death
• Affected nearly 25% of the U.S. population
before penicillin (1940s)
• Primary syphilis ulcer—a chancre
• Secondary syphilis—develops 6 weeks to 6
months after onset
• Early and late latent syphilis
• Tertiary syphilis
Palmar and Plantar Secondary Syphilis
Assessment
• Obtain history of lesions or rash.
• Question penicillin allergy.
• Wear gloves when performing physical
assessment.
• Obtain specimens.
• Send for Venereal Disease Research
Laboratory (VDRL) serum test.
Drug Therapy
• IM benzathine penicillin G
• Jarisch-Herxheimer reaction may follow
antibiotic therapy for syphilis; caused by a
rapid release of products from the disruption
of the organism cells:
– Symptoms—generalized aches, pain at the
injection site, vasodilation and hypotension,
increase in temperature
– Symptomatic treatment
Nursing Management
• Reinforce information about cause of
infection, treatment, side effects, possible
complications of untreated or incompletely
treated disease, and the need for follow-up
care.
• All sexual partners must be adequately
treated as soon as possible.
Nursing Management (Cont’d)
• Urge the patient to adhere to the treatment
regimen and sexual abstinence until treatment
is completed.
Genital Herpes
• Acute, recurring, incurable viral disease
• Assessment—patient history, physical
examination, and viral culture
• Treatment—symptomatic with goals to
decrease discomfort, promote healing without
secondary infection, decrease viral shedding,
and prevent infection transmission
Drug Therapy
• Antiviral drugs do not cure the infection but
do decrease the severity, promote healing,
and decrease the frequency of recurrent
outbreaks while they are being used.
• Acyclovir, famciclovir, valacyclovir may be
prescribed.
Nursing Management
• Patient counseling and education about the
infection, the potential for recurrent episodes,
the correct use and possible side effects of
antiviral therapy, viral shedding even when
the patient is symptom free, and sexual
transmission
• Assessment of the patient’s psychological
responses to the diagnosis of genital herpes
Condylomata Acuminata (Genital
Warts)
• Condition that is caused by certain types of human
papillomavirus (HPV)
• HPV infection is thought to be the primary risk factor
for development of cervical cancer
• Initially single, small papillary growth that may grow
into large, cauliflower-like masses
• Goals of management—to remove the warts, treat the
symptoms, and prevent development of atypical or
dysplastic cells to cancer
Treatment Options
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Gels
Creams
Cryotherapy
Podophyllin
TCA/BCA
Carbon dioxide laser
Treatment Options (Cont’d)
• Intra-lesion interferon injections
• Surgical removaal
• Treatment of sexual partners
Gonorrhea
• Sexually transmitted bacterial infection
• In men, dysuria and penile discharge
• In women, change in vaginal discharge,
urinary frequency, or dysuria; ascending
spread that can cause endometritis,
salpingitis, and pelvic inflammatory disease
Gonorrhea (Cont’d)
• Anal manifestation possible
• Oral manifestations related to throat infection
Gonorrhea (Cont’d)
Drug Therapy
• Ceftriaxone, or cefixime plus azithromycin
• Treatment of sexual partners
• Rarely, meningitis and endocarditis
Nursing Management
• Topics for teaching:
– Transmission and treatment
– Necessity of taking medications for the prescribed
time
– Possibility of re-infection
– Avoidance of sexual activity until the antibiotic
therapy is complete and symptoms disappear
Chlamydial Infection
• Chlamydia trachomatis is an intracellular
bacterium and the causative agent of genital
chlamydial infections.
• It invades the columnar epithelial tissues in
the reproductive tract.
• C. trachomatis is now reportable to the local
health departments in all states.
• Many women with chlamydial infections are
asymptomatic.
Interventions
• Azithromycin
• All sexual contacts should be tested and
treated, whenever possible
• Expedited partner therapy (EPT)
• Patient and partner education
Pelvic Inflammatory Disease
• Complex infectious process in which
organisms from the lower genital tract
migrate from the endocervix upward
through the uterine cavity into the
fallopian tubes.
• Resultant infections include:
– Endometritis
– Salpingitis
– Oophoritis
Pelvic Inflammatory Disease (Cont’d)
– Parametritis
– Peritonitis
– Tubal or tubo-ovarian abscess
• Rule out ectopic pregnancy and appendicitis.
• STDs are most often responsible for PID.
• Sepsis and death can occur, especially if
treatment is delayed or inadequate.
Pelvic Inflammatory Disease (Cont’d)
Assessment
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Physical assessment
Clinical manifestations
Psychosocial assessment
Laboratory assessment
Other diagnostic tests
Community-Based Care
• Home care management
• Health teaching
• Health care resources
Vaginal Infections
• Trichomonas vaginalis
• Candida, C. albicans
• Bacteria—Gardnerella vaginalis, Mycoplasma
hominis, and anaerobes Prevotella and
Mobiluncus species
Other Sexually Transmitted Diseases
• Lymphogranuloma venereum
• Chancroid
• Granuloma inguinale
This is Chapter 23
Cancer Development
Cell Growth
Neoplasms
Tumor Growth
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Tumor Cell Division
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Features of Normal Cells
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Limited cell division
Apoptosis
Specific morphology
Small nuclear-to-cytoplasmic ratio
Differentiated function
Tight adherence
Nonmigratory
Contact inhibition
Normal chromosomes
Features of Early Embryonic Cells
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Rapid and continuous cell division
Anaplasia
Large nuclear-to-cytoplasmic ratio
Pluropotency
Loose adherence
Migration
No contact inhibition
Normal chromosomes
Features of Benign Tumor Cells
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Continuous or inappropriate cell growth
Specific morphology
Small nuclear-to-cytoplasmic ratio
Specific differentiated functions
Tight adherence
No migration
Orderly growth
Normal chromosomes
Features of Cancer Cells (Malignant)
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Rapid or continuous cell division
Anaplasia
Large nuclear-to-cytoplasmic ratio
Specific functions lost
Loose adherence
Migration
No contact inhibition
Abnormal chromosomes
Cancer Development
• Carcinogenesis/oncogenesis are names for
cancer development.
• Malignant transformation occurs through
these steps:
– Initiation
– Promotion
– Progression
– Metastasis
Metastasis
• Metastasis occurs through a progression of
steps:
– Extension into surrounding tissues
– Blood vessel penetration
– Release of tumor cells
– Invasion
– Local seeding
– Bloodborne metastasis
– Lymphatic spread
Lymphatic Spread of Tumor Cells
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Steps of Metastasis
Cancer Classification
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Grading
Ploidy
Staging
TNM (tumor, node, metastasis)
Doubling time and mitotic index
Cancer Etiology and Genetic Risk
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Oncogene activation
Chemical carcinogenesis
Physical carcinogenesis
Viral carcinogenesis
Dietary factors
Personal factors, immune function, age, and
genetic risk
Cancer Prevention—Primary
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Avoidance of known or potential carcinogens
Modification of associated factors
Removal of “at-risk” tissues
Chemoprevention
Vaccination
Cancer Prevention—Secondary
• Regular screening
• Altering damaged genes
• Genetic screening
This is Chapter 24
Care of Patients with Cancer
General Disease-Related
Consequences of Cancer
• Impaired immune and blood-producing
function
• Altered GI structure and function
• Motor and sensory deficits
• Decreased respiratory function
Surgery as Cancer Treatment
• Oldest form of cancer treatment used
for:
– Prophylaxis
– Diagnosis
– Cure
– Control
– Palliation
– Second-look surgery
– Reconstruction or rehabilitation
Resection of Pancreatic Tumor
Radiation Therapy for Cancer
• Purpose—to destroy cancer cells with minimal
exposure of the normal cells to the damaging
actions of radiation
• Teletherapy
• Brachytherapy
Radiation Therapy
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Side Effects of Radiation Therapy
• Vary according to the site
• Local skin changes and hair loss that will likely
be permanent depending on the total
absorbed dose
• Altered taste sensations
• Fatigue related to increased energy demands
• Inflammatory responses that cause tissue
fibrosis and scarring
Nursing Care of Patients
Undergoing Radiation Therapy
• Teach accurate objective facts to help patient
cope.
• Do not remove markings.
• Administer skin care.
• Do not use lotions or ointments.
Nursing Care of Patients
Undergoing Radiation Therapy
(Cont’d)
Avoid direct exposure of the skin to the sun.
•
• Care for xerostomia (dry mouth).
• Bone exposed to radiation is more vulnerable
to fracture.
Chemotherapy
• Treating cancer with chemical
agents
• Major role in cancer therapy
• Used to cure and increase
survival time
• Some selectivity for killing
cancer cells over normal cells
• Normal cells most affected—
the skin, hair, intestinal
tissues, spermatocytes, and
blood-forming cells
Chemotherapy
Chemotherapy Drugs
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Antimetabolites
Antitumor antibodies
Antimitotic agents
Alkylating agents
Topoisomerase inhibitors
Miscellaneous chemotherapeutic agents
Combination chemotherapy
Treatment Issues
• Drug dosage
• Drug schedule
• Drug administration:
– Extravasation
– Vesicants
Side Effects of Chemotherapy
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Anemia, neutropenia, thrombocytopenia
Alopecia or hair loss
Nausea and vomiting
Mucositis in the entire GI tract
Skin changes
Anxiety, sleep disturbance
Altered bowel elimination
Changes in cognitive function
Chemotherapy Patient-Centered
Nursing Care
• Infection risk
• Chemotherapy-induced nausea and vomiting
(CIN)
• Mucositis
• Alopecia
• Changes in cognitive function
• Peripheral neuropathy
Hormonal Manipulation
• Some hormones make hormone-sensitive
tumors grow more rapidly.
• Some tumors actually require specific
hormones to divide. Therefore decreasing the
amount of these hormones to hormonesensitive tumors can slow the cancer growth
rate.
Side Effects of Hormone Therapy
• Androgens and antiestrogen receptor drugs
cause masculinizing effects in women.
• For men and women receiving androgens,
acne may develop, hypercalcemia is common,
and liver dysfunction may occur with
prolonged therapy.
Side Effects of Hormone Therapy
(Cont’d)
• Feminine manifestations often appear in men
who take estrogens, progestins, or
antiandrogen receptor drugs.
• Gynecomastia.
Gynecomastia
Photodynamic Therapy
• Selective destruction of cancer cells through a
chemical reaction triggered by different types
of laser light
• Patient teaching
• General sensitivity to light for up to 12 weeks
after the photosensitizing drug is injected
Immunotherapy: Biological
Response Modifiers (BRMs)
• Drugs that modify the patient’s biological
responses to tumor cells
• Cytokines—enhance the immune system
• Interleukins, interferons
• Side effects—generalized and sometimes
severe inflammatory reactions, peripheral
neuropathy, skin rashes
Gene Therapy
• Experimental as a cancer treatment
• Renders tumor cells more susceptible to
damage or death by other treatments
• Injection into tumor cells, enabling the
immune system to better recognize cancer
cells as foreign and kill them
• Human leukocyte antigen (HLA)
• Cytokines, IL-2
Targeted Therapy
• Combination of gene therapy and
immunotherapy
• Side effects:
– Allergic reaction
– Skin, mucous membranes, GI tract lining
Oncologic Emergencies
• Sepsis and disseminated intravascular
coagulation
• Collaborative management includes:
– Prevention (the best measure)
– IV antibiotic therapy
– Anticoagulants, cryoprecipitated clotting factors
Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)
• Water is reabsorbed to excess by the kidney
and put into system circulation.
• SIADH is most commonly found in carcinoma
of the lung.
• Collaborative care:
– Patient safety
– Restore normal fluid balance
– Provide supportive care
Spinal Cord Compression
Spinal Cord Compression (Cont’d)
• Collaborative management includes:
– Early recognition and treatment
– Palliative
– High-dose corticosteroids
– High-dose radiation
– Surgery
– External back or neck braces to reduce pressure in
the spinal cord
Hypercalcemia
• Occurs most often in patients with bone
metastasis
• Fatigue, loss of appetite, nausea and vomiting,
constipation, polyuria, severe muscle
weakness, loss of deep tendon reflexes,
paralytic ileus, dehydration,
electrocardiographic changes
Hypercalcemia (Cont’d)
• Collaborative management includes:
– Oral hydration
– Normal saline IV
– Drug therapy
– Dialysis
Superior Vena Cava Syndrome
• Superior vena cava is compressed or
obstructed by tumor growth.
• Condition can lead to a painful, lifethreatening emergency.
• Signs include edema of face, Stokes’ sign,
edema of arms and hands, dyspnea,
erythema, and epistaxis.
Superior Vena Cava Syndrome
(Cont’d)
Collaborative Care: SVC Syndrome
• High-dose radiation therapy
• Metal stent in the vena cava
Tumor Lysis Syndrome
• Large numbers of tumor cells are destroyed
rapidly, resulting in intracellular contents
being released into the bloodstream faster
than the body can eliminate them.
• Collaborative management includes:
– Prevention
– Hydration
– Drug therapy
Tumor Lysis Syndrome (Cont’d)