The Reproductive System Male & Female & STD’s
Male
Anatomy & Physiology
Review
Testes
Scrotum
Epididymis
Vas Deferens
Ejaculatory Ducts
Penis
Accessory Glands
Seminal vesicles
Prostate Gland
Bulbourethral Glands
Nursing Assessment
Of The
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…
Male Reproductive
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
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
Prostatectomy
1. TURP
2. Suprapubic
3. Retropubic
4. Perineal
5. 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
Female Reproductive System
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
Nursing Assessment
of
The Female Reproductive System
Start w/ the Chief Complaint…
 Present Illness
 Past Medical History
 OB/GYN history
 Family History
 Review of Systems
 Functional History
Female Reproductive
Disorders
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?
Breast Cancer
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
Vesico-Vaginal Fistula
Diagnostic Tests & Procedures
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
Sexually Transmitted Diseases
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.
HIV and AIDS
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 T-suppressor 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, Hispanic-Americans, 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
Opportunistic Infections
PCP
Histoplasmosis
Tuberculosis
Mycobacterium Avium Complex (MAC)
CMV
Toxoplasmosis
Cryptococcosis
Kaposi’s Sarcoma
Thrush