Reproductive System
Ch. 30-33
Female Reproductive Structures
• Internal structure
–
–
–
–
Ovaries
Fallopian tubes
Uterus
Vagina
Ovaries
• Location
– End of fallopian tubes
• Produce hormones
– Estrogen
– Progesterone
• Store
– Ovum
Fallopian tubes
• Thin tubes
– Smooth muscle
– Lined with cilia
– Fertilization occurs
Uterus
• AKA: womb
• Location
– Between
• Bladder
• Rectum
• Function
– Receive fertilized egg
– Site for growth &
development of the
fetus
Uterus
• 3 parts
– Fundus
– Body
– Cervix
Uterus
• 3 layers
– Perimetrium
• Outer layer
– Myometrium
• Middle layer
– Endometrium
• Innermost layer
Endometrium
• Responds to changes in
– Estrogen
– Progesterone
• During the ovarian cycle
• To prepare for
implantation of the
fertilized embryo
Vagina
• AKA: Birth canal
• Fibromuscular tube
• Between:
– Bladder/urethra
– Rectum
• Function
– Birth canal
– Menstrual flow
– Intercourse
External Genitalia
• Mons pubis
– Pad of adipose tissue
• Labia
– Fold of tissue
• Vestibule
– Area between labia
• Clitoris
• Vaginal opening
• Urethral opening
Breast / Mammary glands
• Supported by
– Pectoral muscles
• Richly supplied with
– Nerves
– Blood
– Lymph nodes
• Primary purpose
– Nourishment
Breast
•
•
•
•
Nipple
Areola
Mammary glands
Tail of Spence
Endometrial changes during the
menstrual cycle
• Menstrual phase
– Hemorrhages, sloughs
and sheds
• Proliferative phase
– Repairs and thickens
• Secretory phase
– h vascularity
– Prepares to support
fertilized ovum
Assessment of Female Reproductive
System
• Breast Exam
–
–
–
–
–
Size
Symmetry
Contour
Skin color
Lesions
Assessment of Female Reproductive
System • Position
– Lithotomy
• Inspect
• Palpate
• Have client “bear
down”
– Bulging
– Protrusion
– Incontinence
Mammography
• X-ray of breast
• Purpose:
– Screen for breast CA
Abdominal Laparoscopy
• Visual examination of
the abdomen using a
fiberoptic tube.
• abd. Filled with gas
•
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•
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•
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Nursing Care - Laparoscopy
• Before
–
–
–
–
Informed consent
Reinforce teaching
Clarify questions
NOC before
• douche
• Antiseptic scrub
– Empty bladder
– Baseline vital signs
Nursing Care - Laparoscopy
• After
– Monitor Vital signs
• Report temp > 101oF
– Apply perineal pad
• Change q4
– Observe dressing
• Drainage
• Bleeding
• Hematoma formation
Nursing Care - Laparoscopy
• May occur
– Shoulder pain
– Gas through vagina
– Hiccups
• Keep IV until PO
resumed
• Provide discharge
instructions
Nursing Care - Laparoscopy
• When to notify MD
–
–
–
–
–
–
Bleeding
Intense abd pain
Fever
fluid leakage
Malaise
Difficulty breathing
Colposcopy
• Examine
– Vagina
– Cervix
• Brightly lighted
microscope
Colposcopy
•
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Small Group Questions
1. A patient is going to have a colposcopy. What
teaching would you do before the procedure?
2. What would you note in a breast exam as being
abnormal and worthy of further investigation?
3. Identify the anatomical structures that an ovum
travels through and then exits the body (and
their functions)
4. What is the endometrium and how is it different
than other tissue of the body?
5. What would you teach your client following a
laparoscopic procedure?
Endometriosis
• -osis
– Abnormal condition
• Endometri/0
– Inner lining of the uterus
• Endometrial tissue is
found outside the
uterus
Endometriosis
• Ectopic locations
– Pelvic organs
– Diaphram
Endometriosis
• Ectopic tissue respond
to ovarian cycle
–
–
–
–
Inflammation
Cysts
Scarring
Adhesions
S&S: Endometriosis
• Just before / during
menses
–
–
–
–
–
Dysmenorrhea
Backache
Cramps
Dysuria
Infertility
Dx: Endometriosis
• Laparoscopy
Rx: Endometriosis
• Pain
– Mild analgesics
– NSAIDS
• Suppress ovarian
function
– Oral contraceptives
– Pg
Pelvic Inflammatory Disease (PID)
• Infection of the pelvic
organs
–
–
–
–
Fallopian tubes
Ovaries
Uterus
Cervix
• Cause by infection
– Gonorrhea
– Chlamydia
• Major cause of female
infertility
• Pathophysiology
– Organism travels up
vagina 
– spreads
S&S: PID
•
•
•
•
•
•
High fever
Vaginal discharge
Severe lower abd pain
Nausea
Malaise
Dysuria
Rx: PID
• Antibiotics
• Analgesics
• Treat the partner too!
Small Group Questions
1.
2.
3.
4.
5.
6.
Describe the pathophysiology of endometriosis?
What are the S&S of endometriosis?
What are the complications of endometriosis?
What is the pathophysiology of PID?
What is the primary cause of PID?
What is the usual treatment option for PID?
S&S: Breast Cancer
• Small hard painless
lumps or masses
• Change in size/shape of
breast
• Dimpling
• Rash, discharge, flaking
• Location
– Upper outer quadrant
Breast cancer is the 2nd leading cause of
cancer deaths in women, what is the
leading cause of cancer deaths in women?
A. Cervical
B. Ovarian
C. Stomach
D. Lung
E. Uterine
Breast Exam
• Emphasize the importance of continuing
regular breast exams after menopause
because the risk for breast cancer increases
with age.
Mastectomy
• Before surgery
– Preoperative care
– Reinforce teaching
– Allow access to support
persons
– Offer emotional support
Mastectomy
• After surgery
– Routine post-op care
– Reinforce teaching
Mastectomy
• Teaching
– Empty the drain and
replace dressing daily
– Return for drain removal
in 2-4 days per order
– Take analgesics before
pain becomes severe per
order
– Report excessive
bleeding
Mastectomy
• Numbness & tingling in
axillary are common
• Arm / shoulder
exercises per MD order
• Drive
– within 7-10 days
• Return to work
– 4-6 weeks
• Don’t lift with arm on
operated side
Nrs Dx Mastectomy
Grieving
•
•
•
•
Listen attentively
Spend time
Explain feelings are normal
Enlist support
Nrs. Dx. Mastectomy
Risk for infection
•
•
•
•
•
•
Assess dressing, incisions
Enc well balanced diet
Teach incision care
Report S&S of infection
avoid deodorant
skin care
Nrs. Dx. Mastectomy
Risk for Injury
•
•
•
•
Use nonsurgical side
Elevate arm on a pillow
Enc. ROM
Teach protective measures
Nrs. Dx. Mastectomy
Risk for Disturbed Body Image
•
•
•
•
•
•
Enc. Verbalization
Explain
Include partner
Provide resources
Enc. to look at the incision
Reassure
Cervical Cancer
• Common
• Most r/t
– Human papillomavirus
(HSP)
– STD/STI
Cervical Cancer is highly treatable if found
in the early stages. What is the best way to
detect cervical cancer?
A.
B.
C.
D.
E.
Signs and symptoms
MRI
CT-Scan
Pap smear
Palpation (via a self physical exam)
S&S: Cervical Cancer
• Early
– Asymptomatic
• Invasive CA
–
–
–
–
Bleeding
White discharge
Pain (back / thighs)
Weight loss
DX: Cervical Cancer
• Papanicolaou (Pap)
smear
– Cells collected from the
cervix
Pap smear
• Schedule test when not
menstruating
• Avoid sex, douching or
vaginal meds 48 hours
before exam
• Void before exam
• Lithotomy positing
• Support client
After procedure
• Provide
tissue/towelette for
cleaning
• Provide mini-pad to
protect garments
• Allow privacy while
client dresses
• Prepare requisition &
slides
• Provide info
+ Pap smear 
• Colposcopy
• MRI
• CT-scan
Cervical Biopsy
• Before
– Explain
– Empty bladder
Cervical Biopsy
• After
– Cleanse area
– Perineal pad
– Minor bleeding and vaginal
discharge normal
– No tampon x 1 wk
– No sex until discharge cleared
– Notify MD if heavy bleeding, foulsmelling discharge, fever or
malaise
Tx: Cervical Cancer
• Surgery
• Radiation
• Chemotherapy
Nrs Dx: Cervical Cancer
FEAR
• Explain 90% survival rate
• Allow time to express concerns and ask
questions
• Refer to counselor or support group
Hysterectomy
• Removal of the
– Uterus
• Approaches
– Abdominal
– Vaginal + Laparoscopy
Vaginal vs. Abdominal
• Vaginal
– Faster recovery
• Abdominal
– Better access and
visualization of pelvic
cavity
RISK FACTOR
• increased the risk of
– DVT and PE.
• Encourage leg exercises
• Advise to stop smoking
• Promptly report S&S
Nursing Care post-op Hysterectomy
• Report
– Excessive bleeding
• Monitor for
complications
– Infection
– DVT
– PE
• Assess vaginal drainage
• Advise to restrict
activities for 4-6 weeks
– Heavy lifting
– Tampons
– Sex
• Report
–
–
–
–
–
Temp > 100oF
Vaginal bleeding
Urinary incontinence
Burning / Frequency
Severe pain
• Enc to express feelings
• Provide info about
hormone replacement
• Reinforce importance of
regular OB/GYN exams
Small Group Questions
1. What is the most common location for breast
cancer to form?
2. What might a women feel on a BSE that would
indicate a possibility of breast cancer?
3. What is the #1 cause of cervical cancer?
4. What screening is done for breast cancer and
cervical cancer?
5. Differentiate between abdominal and vaginal
hysterectomy. How might the nursing care
differ?
1. Your client had a hysterectomy 24 hours ago.
What would you teach her as part of her
discharge teaching?
2. A client had a mastectomy 24 hours ago. You
identify a nursing diagnosis of impaired body
image. Identify 3 nursing interventions for
this client.
Testes
• Testes produce
– Sperm
– Testosterone
• Testes are encased in
– scrotum
Ducts & semen
• Epididymis
– Houses sperm
• Vas deferens
• Seminal fluid
– Epididymis
– Prostate gland
– Cowper’s gland
• Sperm + Seminal fluid =
– Semen
Prostate Gland
• Encircles the urethra
• Just below the bladder
• Function
– Seminal fluid
– Aids in ejaculation
Penis
• Tip
– Glans
– Covered by
• Foreskin
• Removal of the foreskin
– Circumcision
Physical Assessment of Male
Reproductive System
• Inspect breasts
• Palpate inguinal area
and groin
– Bulges
Physical Assessment of Male
Reproductive System
• Penis
– Inspect
– Retract foreskin
– Inspect urinary meatus
• Scrotum
– Palpate each testes
Physical Assessment of Male
Reproductive System
• Digital Rectal Exam
– DRE
– Palpate
• prostate
Dx Test of Male Reproductive System
• Prostate-specific
antigen
– PSA
– Levels rise
• Benign prostate
hypertrophy
• Cancer of the prostate
Orchitis
• Inflammation of the
– Testes
• Caused by
– Trauma
– Infection
• Mumps
• Pneumonia
• TB
S&S orchitis
•
•
•
•
•
Pain
Swelling
*Fever
*Scrotal redness
Prognosis
– Infertility
– Sterility
Tx: Orchitis
• Swelling / pain
–
–
–
–
Elevate
Ice packs
Scrotal support
Bed rest
Rx: orchitis
• Analgesic
• Antipyretic
• If bacterial orchitis
– Antibiotics
Prostatitis
• Inflammation of the
prostate gland
• Caused by
– Bacterial agent
• Escherichia coli
– E-coli
– Non-bacterial agent
• Chlamydiae
• Viruses
S&S: Prostatitis
• Pain, burning on
urination
– Dysuria
• Frequency & urgency
• Chills & fever
• Low back, perineal or
genital pain
• Pain after ejaculation
• Obstructed urinary flow
Dx: Prostatitis
• Examination of
– Urine
– Prostatic secretions
• DRE
A client with prostatitis is being evaluated
by the MD. The MD performs a DRE. What
S&S would you expect to be noted?
A.
B.
C.
D.
Pain
Pain and swollen prostate
No pain, swollen prostate
No pain, soft prostate
Tx: Prostatitis
• Bacterial
– Antibiotics
• Non-bacterial
– Symptomatically
– Pain
• NSAIDs
• Stool softeners
– Voiding problems
• Anticholinergics
Nrs Care: Prostatitis
• h fluid intake
– 3 L/day
– Void often
• Sitz baths
• Finish antibiotics
Phimosis
• Constriction of the
foreskin
• Risk of
– Secondary infection
– Constriction of glans
• Tx
– Circumcision
Cryptorchidism
• Undescended testicle/s
Cryptorchidism
• The testes develop in the
abdominal cavity in early
fetal life. By 14 to 17
weeks of intrauterine life
they migrate to an
opening in the body wall
known as the inguinal
canal. After 28 weeks
they pass through the
canal and by 35 to 40
weeks reach the scrotum.
• Undescended testicles
are fairly common in
premature infants. They
occur in about 3 - 4% of
full-term infants. In
most cases the testicles
descend by the time the
child is 9 months old.
• Increased risk of
– Testicular cancer
– Infertility
Nrs Care:
• Teach men with HX to
be vigilant about
testicular self-exam
Testicular Cancer
• Most common cancer in
men between age 15-35
• One of the most curable
cancers
– 90%
• Cause
– Unknown
Testicular Cancer
• Risk Factors
– Age
• 15-40
– Cryptorchidism
– Family Hx
– Race / ethnicity
• USA
Testicular Cancer
• Pathophysiology
– Cancer in testicle 
replacing normal cells
– Affects one testicle
– Spreads rapidly, but only
locally
Testicular Cancer
• Stage 1
– Testicle only
• Stage 2
– Testicle
– Lymph node
• Stage 3
– Metastases
Testicular Cancer
• S&S
– Painless hard nodule
– Dull ache in pelvis or
scrotum
Dx: Testicular Cancer
• Ultrasound of testicle
• CT-scan
– Detect metastasis
• Biopsy
Tx: Testicular Cancer
• Orchiectomy
– Remove testicle
• Radical orchiectomy
– Testicle
– Spermatic cord
– Lymph nodes
• Prosthesis
Tx: Testicular Cancer
• Chemotherapy
• Radiation therapy
Prostate Cancer
•
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• TURP beginning of
surgery
Prostate Cancer
•
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• Turpsurgery
•
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Prostate Cancer
• Most common type of
cancer in men
Prostate cancer is the 2nd leading cause of
cancer death of men in North America.
What is the leading cause of cancer death
in men?
A.
B.
C.
D.
Stomach
Lung
Testicular
Brain
Prostate Cancer
• Risk factors
– Age
– African-American men
– Family hx
Prostate Cancer
• Prognosis
– Detected early 
• Curable
– If confined to prostate 
• 5+ year survival =
– 100%
– Slowly or aggressive
progression
Small Group Questions
1. Follow the path of sperm from formation to
ejaculation.
2. What is orchitis and what is its cause?
3. What are the symptoms of prostatitis?
4. How is prostatitis treated?
5. What are the S&S of testicular cancer?
6. What is the treatment for phimosis?
7. What is the complication associated with
Cryptorchidism?
Chlamydia
• Most common STD in
the USA
• Leading cause of PID
• Pathophysiology
– Bacteria that behaves
like a virus
S&S: Chlamydia
Female
• Asymptomatic
• * dysuria
• * discharge
• * vaginal bleeding
• * pelvic pain
• *Maybe
Male
• * Asymptomatic
• Dysuria
• White or clear urethral
discharge
• Testicular pain
Chlamydia
• Even though they are asymptomatic, they are
still potentially infectious.
Dx: Chlamydia
• The CDC recommends screening
asymptomatic women who are at high risk for
Chlamydia.
• Blood test
What is the causative agent for
Chlamydia?
A. Bacteria
B. Virus
C. Fungus
D. Yeast
E. Other
Rx: Chlamydia
• Doxycycline PO for 7
days
Complications: Chlamydia
Female
• PID
• Infertility
• Pelvic abscesses
• Spontaneous abortion
• Stillbirth
Neonate
• Conjunctivitis
• pneumonia
Male
• Urethritis
• Prostatitis
Gonorrhea
• AKA
– GC
– The Clap
• Most common
reportable STI in the US
Reporting STI’s
• All states require reporting of syphilis,
gonorrhea and HIV/AIDS to state and federal
agencies. Chlamydia is reportable in most
states. (California is a required reporting
state)
Mode of transmission
• Sex
• Delivery as the neonate
passes through the
birth canal
S&S Gonorrhea a
Female
• Asymptomatic
• *Vaginal discharge
• * Abnormal menses
• * Dysuria
Male
• Dysuria
• Frequency
• Purulent urethral discharge
Complications: Gonorrhea a
Female
• PID
• Sterility
• Ectopic Pg
• Abdominal adhesions
Male
• Prostatitis
• Urethritis
• Nephritis
• Epididymitis
• Sterility
Tx: Gonorrhea a
• Cephalosporins
– IM x 1
• Drug resistance is
becoming a problem!
• Shortly after a neonate is delivered,
erythromycin is instilled into the neonate’s
eyes. This drug is given to prevent:
A. Ophthalmia neonatorum
B. Retrolental fibroplasias
C. Corneal keratitis
D. Acute uveitis
Syphilis
• Systemic STI if not
treated can lead to
–
–
–
–
Blindness
Paralysis
Mental illness
Death
S&S: Syphilis
• Primary
– Painless chancre at site
of exposure
– Lymphadenopathy
S&S: Syphilis
• Secondary
–
–
–
–
Skin rash
Oral mucous patches
Fever
Malaise
S&S: Syphilis
• Tertiary
– Tumors of the
• Skin
• Bone
• Liver
– Inflammation of the
aorta
– CNS degeneration
Tx: Syphilis
• Treatable – early
• Penicillin
– IM x1
Complications: Syphilis
• 1o & 2o
– Disease progression
• Tertiary
–
–
–
–
–
Heart failure
Blindness
Skin ulcers
Liver failure
Mental illness
Genital herpes
• Herpes simplex virus
– Usually type 2
S&S: Genital herpes
• “Single or multiple small
painful vesicles on an
erythematous base on
the genitals with
associated pruritus,
followed by painful
ulcers”
Complications: Genital Herpes
Female
• Herpes keratitis
• Cervical cancer
Neonates
• Herpes affection the
–
–
–
–
Eyes
Skin
Mucous membranes
CNS
Male
• Herpes keratitis
• Neuralgia
• Meningitis
• Urethral strictures
• Pus forming in lymph nodes
Rx: Genital Herpes
• NO CURE!
• Symptom relief
– Acyclovir
• PO
• 7-10 days
Nrs Dx:
Impaired skin integrity
• Keep perineal tissue
clean and dry
• Clean from to back
– After urinating
– After defecating
• Soap and water
• Cotton underwear
• No
• Avoid
–
–
–
–
Powders
Sprays
Tight fitting jeans
Pantyhose
Nrs. Dx
Risk for injury
• Take all Rx
• Abstain from sex until
client and partner are
cured
• Use a condom
• Teach S&S of infection
Nrs Dx
Anxiety
• Emphasize most STIs
can be effectively
treated
• C-section can prevent
transmission to baby
Nrs Dx
Situational Low Self-Esteem
• Create an environment
where the client feel
respect and safe
• Provide privacy and
confidentiality
• Communicate caring for
the client
Nrs Dx
Sexual Dysfunction
• Provide support,
nonjudgmental
environment to discuss
feelings and questions
• Offer information and
support groups
Nrs Dx
Impaired Social Interaction
• STI is a consequence of
sexual behavior, not a
punishment, and that it
can be avoided in the
future.
AIDS
• Causative agent
– Human
Immunodeficiency virus
– HIV
AIDS
• Mode of transmission
– Sexual contact
– Direct injection of
contaminated blood
– Mother to fetus
AIDS
• Causes destruction of Thelper cells 
• immunodeficiencies
Manifestations of HIV
• 3 stages:
– Primary infection
– Asymptomatic period
– AIDS & opportunistic
disorders
HIV: Primary infection
•
•
•
•
•
•
•
•
Fever
Sore throat
General malaise/fatigue
H/A
Rash
N&V
Night sweats
Wt loss
HIV: Asymptomatic period
• Chronic
– @ 10 years
HIV:
AIDS & Opportunistic disorders
• Respiratory
– Pneumocystis carinii
pneumonia
• Skin
– Kaposi’s sarcoma
• Gastrointestinal
– wasting syndrome
Kaposi’s Sarcoma
• -oma
– Cancer
• Most common cancer
assoc. with HIV
• Tumors on blood
vessels
• Reddish-purple lesions
on the skin and mucous
membrane
• Painless  painful
Wasting syndrome
• Unplanned weight loss
– >10%
• Chronic Diarrhea
• Fever
• Emaciated
Rx: HIV
• Antiretroviral
medication
– Combine 3-4 drugs
– HAART
– Highly Active
Antiretroviral Therapy
Small Group Questions
1. What is wasting syndrome in AIDS patients
2. What is the most common form of cancer
associated with HIV? What are its symptoms?
3. What are the S&S of Chlamydia, Gonarrhea,
Syphilis, and genital herpes? How are they each
cured?
4. What can one do to prevent from getting an STI?
5. What is Herpes keratitis and which STI can cause
it?