Chapter 12
Care of the Patient with a
Reproductive Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and
Physiology
• Male repro system
 Testes and Sperm
 Ductal system
• Epididymis
• Ductus deferens (vas
deferens)
• Ejaculatory duct and
urethra
 Accessory glands
• Seminal vesicles
• Prostate gland
• Cowper’s glands
 Urethra and penis
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Slide 2
Figure 12-2
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell
(ovum) surrounded by sperm at time of fertilization (right).
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Slide 3
Overview of Anatomy and
Physiology
• Female reproductive
system






Ovaries
Fallopian tubes
Uterus
Vagina
External genitalia
Accessory glands
• Skene’s glands
• Bartholin’s glands
 Perineum
 Mammary glands
(breasts)
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Slide 4
Figure 12-4
Uterus
Breast
Ovary
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Slide 5
Figure 12-14
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)
A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast.
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Slide 6
Human Sexuality
• Sexual identity
 The sense of being feminine or masculine
• Influences on sexual health
 Overall wellness includes sexual health and sexuality
should be part of the health care program
• Illness and sexuality
 Illness may cause changes in a patient’s self-concept
and result in an inability to function sexually
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Slide 7
Laboratory and Diagnostic
Examinations
• Diagnostic tests for the female










Colposcopy; culdoscopy; laparoscopy
Papanicolaou (Pap) smear
Biopsies: Breast, cervical, endometrial
Conization; dilation and curettage
Cultures and smears
Schiller’s iodine test
Hysterograms
Mammography; pelvic ultrasonography
Tubal insufflation (Rubin’s test)
Human chorionic gonadotropin; serum CA-125
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Slide 8
Laboratory and Diagnostic
Examinations
• Diagnostic tests for the male






Testicular biopsy
Semen analysis
Prostatic smears
Cystoscopy
Rectal digital exam
Prostate specific antigen (PSA)
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Slide 9
The Reproductive Cycle
• Menarche






The beginning of menses
Follows breast development by 2 to 2½ years
Average age range is between 9 and 17 years
Cycle length ranges from 24 to 32 days
The average flow lasts 3 to 5 days
The average flow is 35 mL/cycle
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Slide 10
The Reproductive Cycle
• Amenorrhea
 Etiology/pathophysiology
• Absent or suppressed menstrual flow
 Clinical manifestations/assessment
• No menstrual flow for at least 3 months
 Medical management/nursing interventions
• Based on underlying cause
• Hormone replacement may be necessary
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Slide 11
Estrogens
Action and Uses

Used for hormone replacement therapy in menopause
and other conditions (ovarian failure); infertility workups; palliative breast cancer treatment
Adverse Reactions
Drug Interactions
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12
Progestins
Action
Uses

Contraception, control excessive uterine bleeding,
treatment of secondary amenorrhea, dysmenorrhea,
premenstrual tension, and control of pain in
endometriosis
Drug Interactions
Nursing Implications and Patient Teaching
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
13
Oral Contraceptives
Combination Drugs: Estrogen and Progestin

Table 21-11
Action

Prevent ovulation
Use

Contraception
Adverse Reactions

Estrogen excess, progestin excess, androgen excess,
estrogen deficiency, progestin deficiency
Contraindications for Oral Contraceptives
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
14
The Reproductive Cycle
• Dysmenorrhea
 Etiology/pathophysiology
• Uterine pain with menstruation
 Clinical manifestations/assessment
•
•
•
•
•
•
Breast tenderness; headache
Abdominal distention; nausea and vomiting
Vertigo
Palpitations
Excessive perspiration
Colicky, cyclic pain; dull pain in the lower pelvis
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Slide 15
The Reproductive Cycle
• Dysmenorrhea (continued)
 Medical management/nursing interventions
•
•
•
•
•
Exercise
Nutritious foods, high in fiber
Heat to pelvic area
Mild analgesics
Prostaglandin inhibitors

NSAIDS
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Slide 16
The Reproductive Cycle
• Abnormal uterine bleeding
 Menorrhagia
• Excessive bleeding during the regular menstrual flow
• Causes: Endocrine disorders; inflammatory
disturbances; uterine tumors
• May be placed on hormones to control bleeding
 Metrorrhagia
• Uterine bleeding between regular menstrual periods or
after menopause
• May indicate cancer or benign tumors of the uterus
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Slide 17
The Reproductive Cycle
• Premenstrual syndrome (PMS)
 Etiology/pathophysiology
• Believed to be related to the neuroendocrine events
occurring within the anterior pituitary gland
 Clinical manifestations/assessment
•
•
•
•
•
•
Irritability, lethargy, and fatigue
Sleep disturbances; depression
Headache; backache; breast tenderness
Vertigo
Abdominal distention
Acne
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Slide 18
The Reproductive Cycle
• Premenstrual syndrome (PMS) (continued)
 Medical management/nursing interventions
• Pharmacological management

Analgesics; diuretics; progesterone
• Dietary recommendations




High in complex carbohydrates
Moderate in protein
Low in refined sugar and sodium
Limit caffeine, chocolate, and alcohol
• Reduce or eliminate smoking
• Exercise; adequate rest, sleep, and relaxation
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Slide 19
The Reproductive Cycle
• Menopause
 Etiology/pathophysiology
• The normal decline of ovarian function resulting from
the aging process
• May be induced by irradiation of the ovaries or surgical
removal of both ovaries
• Not considered complete until 1 continuous year after
the last menstrual period
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Slide 20
The Reproductive Cycle
• Menopause
 Clinical manifestations/assessment
• Decrease in frequency, amount, and duration of the
normal menstrual flow
• Shrinkage of vulval structures; shortening of the vagina
• Dryness of the vaginal wall; pelvic relaxation
• Loss of skin turgor and elasticity
• Increased subcutaneous fat; decreased breast tissue;
thinning of hair
• Osteoporosis
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Slide 21
The Reproductive Cycle
• Menopause (continued)
 Medical management/nursing interventions
• Estrogen therapy


Premarin
Provera
• Calcium supplements
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Slide 22
The Reproductive Cycle
• Male climacteric
 Etiology/pathophysiology
• Gradual decrease of testosterone levels and seminal
fluid production; 55 to 70 years of age
 Clinical manifestations/assessment
• Decreased erections; decreased seminal fluid
• Enlarged prostate gland; decreased muscle tone
• Loss or thinning of hair
 Medical management/nursing interventions
• Emotional support; treatment for impotence
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Slide 23
Androgens
Actions

Development of secondary sex characteristics; tissue
building
Uses

Hypogonadism, hypopituitarism, dwarfism, eunuchism,
cryptorchidism, oligospermia, and male androgen
deficiency
Adverse Reactions

Edema due to sodium retention, acne, hirsutism, male
pattern baldness, cholestatic hepatitis with jaundice,
buccal irritation, nausea and vomiting, diarrhea
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
24
Androgens (cont.)
Drug Interactions



Increased effects – anticoagulants, antidiabetic agents,
and other drugs
Decreased effects – barbiturates
Concurrent use with corticosteroids increase edema
Nursing Implications

Assessment, diagnosis, planning, implementation, and
evaluation
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
25
The Reproductive Cycle
• Erectile dysfunction
 Etiology/pathophysiology
• Inability of an adult man to achieve penile erection
• Types



Functional
Anatomical
Atonic
 Medical management/nursing interventions
•
•
•
•
Remove cause if possible
Treat diseases
Viagra, Cialis – Cause vasodilation
Mechanical devices: penile prosthesis
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Slide 26
The Reproductive Cycle
• Infertility
 Etiology/pathophysiology
• Inability to conceive after 1 year of sexual intercourse
without birth control
 Medical management/nursing interventions
• Depends on the cause
• Hormone therapy


Clomid
Testosterone
• Repair occlusion
• Intrauterine insemination
• In vitro fertilization
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Slide 27
Infections of the Female
Reproductive Tract
• Simple vaginitis
 Etiology/pathophysiology
• Common vaginal infection
• Causative organisms: E. coli; staphylococcal;
streptococcal; T. vaginalis; C. albicans; Gardnerella
 Clinical manifestations/assessment
• Inflammation of the vagina
• Yellow, white, or grayish white, curd-like discharge
• Pruritus and vaginal burning
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Slide 28
Infections of the Female
Reproductive Tract
• Simple vaginitis (continued)
 Medical management/nursing interventions
• Douching
• Vaginal suppositories, ointments, and creams

Organism-specific (antibiotic, antifungal, antiprotozoal)
• Sitz baths
• Abstain from sexual intercourse during treatment
• Treat partner if necessary
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Slide 29
Infections of the Female
Reproductive Tract
• Cervicitis
 Etiology/pathophysiology
• Infection of the cervix
 Clinical manifestations/assessment
• Backache
• Whitish exudate
• Menstrual irregularities
 Medical management/nursing interventions
• Vaginal suppositories, ointments, and creams;
organism-specific
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Slide 30
Infections of the Female
Reproductive Tract
• Pelvic inflammatory disease (PID)
 Etiology/pathophysiology
• Any acute, subacute, recurrent, or chronic infection of
the cervix, uterus, fallopian tubes, and ovaries that has
extended to the connective tissues
• Most common causative organisms

Gonorrhea; streptococcus; staphylococcus; Chlamydia;
tubercle bacilli
• High risk: Surgical and examination procedures; sexual
intercourse (especially with multiple partners);
pregnancy
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Slide 31
Infections of the Female
Reproductive Tract
• Pelvic inflammatory disease (PID) (continued)
 Clinical manifestations/assessment
•
•
•
•
•
Fever and chills
Severe abdominal pain
Malaise
Nausea and vomiting
Malodorous purulent vaginal exudate
 Medical management/nursing interventions
• Antibiotics; analgesics
• Bed rest
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Slide 32
Infections of the Female
Reproductive Tract
• Toxic shock syndrome
 Etiology/pathophysiology
• Acute bacterial infection caused by Staphylococcus
aureus
• Usually occurs in women who are menstruating and
using tampons
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Slide 33
Infections of the Female
Reproductive Tract
• Toxic shock syndrome (continued)
 Clinical manifestations/assessment
• Usually occurs between days 2 and 4 of the menstrual
period
• Flu-like symptoms; sore throat; headache
• Red macular palmar or diffuse rash
• Decreased urinary output; BUN elevated
• Pulmonary edema
• Can be fatal
 Medical management/nursing interventions
• Antibiotics; IV fluid therapy; oxygen
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Slide 34
Disorders of the Female
Reproductive System
• Endometriosis
 Etiology/pathophysiology
• Endometrial tissue appears outside the uterus
• The tissue responds to the normal stimulation of the
ovaries; bleeds each month
 Clinical manifestations/assessment
• Lower abdominal and pelvic pain
• May radiate to lower back, legs, and groin
 Medical management/nursing interventions
• Antiovulatory medications; pregnancy
• Laparoscopy; total hysterectomy
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Slide 35
Figure 12-9
Common sites of endometriosis.
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Slide 36
Disorders of the Female
Reproductive System
• Vaginal fistula
 Etiology/pathophysiology
• Abnormal opening between the vagina and another
organ
 Clinical manifestations/assessment
• Urine and/or feces being expelled from vagina
 Medical management/nursing interventions
• Oral or parenteral antibiotics
• Diet: high protein; increase vitamin C
• Surgery: Repair fistula; urinary or fecal diversion
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Slide 37
Figure 12-10
(From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3rd ed.]. St. Louis: Mosby.)
Types of fistulas that may develop in the vagina and uterus.
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Slide 38
Disorders of the Female
Reproductive System
• Displaced uterus
 Etiology/pathophysiology
• Congenital
• Childbirth
• Backward displacement


Retroversion
Retroflexion
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Slide 39
Disorders of the Female
Reproductive System
• Displaced uterus (continued)
 Clinical manifestations/assessment
•
•
•
•
Backache
Muscle strain
Leukorrheal discharge
Heaviness in the pelvic area
 Medical management/nursing interventions
• Pessary
• Uterine suspension
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Slide 40
Disorders of the Female
Reproductive System
• Uterine prolapse
 Etiology/pathophysiology
• Prolapse of the uterus through the pelvic floor and
vaginal opening
 Clinical manifestations/assessment
•
•
•
•
Fullness in vaginal area
Backache
Bowel or bladder problems
Protrusion of cervix and vaginal walls in perineal area
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Slide 41
Figure 12-11
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)
Uterine prolapse.
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Slide 42
Disorders of the Female
Reproductive System
• Uterine prolapse (continued)
 Medical management/nursing interventions
• Pessary
• Surgery


Vaginal hysterectomy
Anteroposterior colporrhaphy
The Donut vaginal pessary is for 3rd degree prolapse
as well as cystocele and rectocele. The Donut vaginal
Pessary can be compressed for easy insertion. 10
pessaries sizes available.
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Slide 43
Disorders of the Female
Reproductive System
• Cystocele and rectocele
 Etiology/pathophysiology
• Cystocele (A)

Displacement of the
bladder into the vagina
• Rectocele (B)

Rectum moves toward
posterior vaginal wall
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Slide 44
Disorders of the Female
Reproductive System
• Cystocele and rectocele (continued)
 Clinical manifestations/assessment
• Cystocele

Urinary urgency, frequency, and incontinence; pelvic
pressure
• Rectocele

Constipation; rectal pressure; hemorrhoids
 Medical management/nursing interventions
• Surgical repair

Anteroposterior colporrhaphy; bladder suspension
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Slide 45
Disorders of the Female
Reproductive System
• Leiomyomas of the uterus (fibroids, myomas)
 Etiology/pathophysiology
• Arise from the muscle tissue of the uterus
• Stimulated by ovarian hormones
 Clinical manifestations/assessment
• Pelvic pressure; pain; backache
• Dysmenorrhea; menorrhagia
• Constipation; urinary symptoms
 Medical management/nursing interventions
• Surgery: Myomectomy; hysterectomy
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Slide 46
Figure 12-13
(Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak’s gynecologic and obstetric pathology.
[6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the
biologic basis for disease in adults and children. [4th ed.]. St. Louis: Mosby.)
Leiomyomas.
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Slide 47
Disorders of the Female
Reproductive System
• Ovarian cysts
 Etiology/pathophysiology
• Benign tumors that arise from dermoid cells of the ovary
 Clinical manifestations/assessment
•
•
•
•
May be no symptoms
Palpable on examination
Disturbance of menstruation
Pelvic heaviness; pain
 Medical management/nursing interventions
• Ovarian cystectomy
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Slide 48
Cancer of the Female
Reproductive Tract
• Cancer of the cervix
 Etiology/pathophysiology
• Squamous cell carcinoma
• Carcinoma in situ
• If untreated, invades the vagina, pelvic wall, bladder,
rectum, and regional lymph nodes
• High risk




Sexually active during teens
Multiple sexual partners
Multiple births
Chronic cervical infections
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Slide 49
Cancer of the Female
Reproductive Tract
• Cancer of the cervix (continued)
 Clinical manifestations/assessment
•
•
•
•
Few symptoms in early stages
Leukorrhea
Irregular vaginal bleeding; spotting
Advanced

Pain in the back, upper thighs, and legs
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Slide 50
Cancer of the Female
Reproductive Tract
• Cancer of the cervix (continued)
 Medical management/nursing interventions
• Carcinoma in situ

Removal of the affected area
• Early carcinoma


Hysterectomy
Intracavitary radiation
• Advanced carcinoma

Radical hysterectomy with pelvic lymph node dissection
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Slide 51
Cancer of the Female
Reproductive Tract
• Cancer of the endometrium
 Etiology/pathophysiology
• Adenocarcinoma of the uterus
 Clinical manifestations/assessment
• Postmenopausal bleeding (50% will have cancer)
• Abdominal pressure; pelvic fullness
 Medical management/nursing interventions
• Surgery: total abdominal hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO)
• Radiation; chemotherapy
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Slide 52
Cancer of the Female
Reproductive Tract
• Cancer of the ovary
 Etiology/pathophysiology
• Fourth most common cause of cancer death in women
• High risk: infertile; anovulatory; nulliparous; habitual
aborters; high-fat diet; exposure to industrial chemicals
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Slide 53
Cancer of the Female
Reproductive Tract
• Cancer of the ovary (continued)
 Clinical manifestations/assessment
• Early


Vague abdominal discomfort
Flatulence; mild gastric disturbance
• Advanced





Enlarged abdominal girth
Flatulence; constipation
Urinary frequency
Nausea and vomiting
Weight loss
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Slide 54
Cancer of the Female
Reproductive Tract
• Cancer of the ovary (continued)
 Medical management/nursing interventions
• Surgery

TAH-BSO and omentectomy
• Radiation and/or chemotherapy
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Slide 55
Hysterectomy
• Total hysterectomy
 Removal of the uterus including the cervix
• TAH-BSO
 Removal of the uterus, fallopian tubes, and ovaries
• Radical hysterectomy
 TAH-BSO with removal of the pelvic lymph nodes
• Vaginal hysterectomy
 The uterus is removed through the vagina
• Abdominal hysterectomy
 Abdominal incision is made to perform procedure
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Slide 56
Disorders of the Female Breast
• Fibrocystic breast condition
 Etiology/pathophysiology
• Hyperplasia and cystic formation in mammary ducts
 Clinical manifestations/assessment
• Cysts are soft, well-differentiated, tender, and freely
moveable; often bilateral and multiple
 Medical management/nursing interventions
• Eliminate methylxanthines
• Danazol (danocrine); vitamin E
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Slide 57
Disorders of the Female Breast
• Acute mastitis
 Etiology/pathophysiology
• Acute bacterial infection of the breast
 Clinical manifestations/assessment
• Breasts are tender, inflamed, and engorged
 Medical management/nursing interventions
•
•
•
•
Keep breasts clean
Application of warm packs
Support: Well-fitting bra
Systemic antibiotics
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Slide 58
Disorders of the Female Breast
• Chronic mastitis
 Etiology/pathophysiology
• Fibrosis and cysts in the breast
 Clinical manifestations/assessment
• Tender, painful, and palpable cysts
• Usually unilateral
 Medical management/nursing interventions
• Same as for acute mastitis
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Slide 59
Disorders of the Female Breast
• Breast cancer
 Etiology/pathophysiology
• Unknown cause; usually adenocarcinoma
 Clinical manifestations/assessment
• Small, solitary, irregular-shaped, firm, non-tender, and
non-mobile tumor
• Change in skin color
• Puckering or dimpling of tissue
• Nipple discharge; retraction of nipple
• Axillary tenderness
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Slide 60
Disorders of the Female Breast
• Breast cancer (continued)
 Medical management/nursing interventions
• Depends on the stage



Radiation
Chemotherapy
Surgery
o Lumpectomy
o Mastectomy—simple, radical
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Slide 61
Inflammatory Disorders of the Male
Reproductive System
• Prostatitis
 Etiology/pathophysiology
• Acute or chronic infection of the prostate gland
 Clinical manifestations/assessment
•
•
•
•
•
•
Chills and fever
Dysuria; urgency and frequency of urination
Cloudy urine
Perineal fullness; lower back pain
Arthralgia; myalgia
Tenderness, edema, and firmness of the prostate
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Slide 62
Inflammatory Disorders of the Male
Reproductive System
• Prostatitis (continued)
 Medical management/nursing interventions
•
•
•
•
Antibiotics – Floroquinolones - most frequent
Digital massage of the prostate
Sitz baths
Monitor I&O
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Slide 63
Inflammatory Disorders of the
Male Reproductive System
• Epididymitis
 Etiology/pathophysiology
• Infection of the epididymis
 Clinical manifestations/assessment
• Scrotal pain and edema
• Pyuria; chills and fever
 Medical management/nursing interventions
• Bed rest
• Elevate scrotum; cold compresses
• Antibiotics
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 64
Disorders of Male Genital Organs
• Phimosis
 Etiology/pathophysiology
• Prepuce is too small to allow retraction of the foreskin
over the glans
• Usually congenital; may be due to inflammation or
disease
 Clinical manifestations/assessment
• Infection of foreskin and glans penis
• Occasionally causes obstruction of urine flow
 Medical management/nursing interventions
• Circumcision
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 65
Disorders of the Male Genital
Organs
• Paraphimosis
 Etiology and pathophysiology
• An edematous condition of the retracted uncircumcised
foreskin preventing a normal return over the glans
 Medical management/nursing interventions
• Warm compresses
• Circumcision
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 66
Disorders of Male Genital Organs
• Hydrocele
 Etiology/pathophysiology
• Accumulation of fluid between the membranes of the
testes
 Clinical manifestations/assessment
• Enlargement of the scrotum; pain
 Medical management/nursing interventions
• Aspiration of fluid
• Surgical removal of testicular sac
• Bed rest; elevate scrotum; cold compresses
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 67
Disorders of Male Genital Organs
• Varicocele
 Etiology/pathophysiology
• Dilation of scrotal veins causing obstruction and
malfunction of circulation
 Clinical manifestations/assessment
• Engorgement and elongation of the scrotum
• Pulling sensation in scrotum; dull, aching pain
 Medical management/nursing interventions
• Surgery: Removal of obstruction
• Bed rest
• Elevate scrotum; cold compresses
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 68
Cancer of the Male Reproductive
Tract
• Cancer of the testis
 Etiology/pathophysiology
• Cause unknown
 Clinical manifestations/assessment
• Enlarged scrotum; feeling of heaviness
• Firm, painless, smooth mass
 Medical management/nursing interventions
• Radical inguinal orchiectomy
• Radiation and/or chemotherapy
• Teach testicular self-examination
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 69
Cancer of the Male Reproductive
Tract
• Cancer of the penis
 Etiology/pathophysiology
• Very rare
 Clinical manifestations/assessment
• Painless, wart-like growth or ulceration, usually on the
glans penis
 Medical management/nursing interventions
• Surgery



Removal of tissue
Partial or total amputation of the penis
Metastasis: Radical surgical procedures
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 70
Sexually Transmitted Diseases
• Genital herpes (HSV)
 Etiology/pathophysiology
• Infectious viral disease; usually acquired sexually
 Clinical manifestations/assessment
•
•
•
•
•
Fluid-filled vesicles
Eventually rupture and develop shallow, painful ulcers
Fever; malaise
Dysuria
Leukorrhea (female)
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 71
Figure 12-19
(From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)
Herpes simplex virus type II in a male and female patient.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 72
Sexually Transmitted Diseases
• Genital herpes (HSV) (continued)
 Medical management/nursing interventions
•
•
•
•
•
•
•
•
No cure; treat symptoms
Acyclovir (Zovirax)
Sitz baths
Local anesthetic; analgesics
Keep lesions clean and dry
GOOD handwashing
No sexual contact while lesions are present
Encourage use of condoms
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 73
Sexually Transmitted Diseases
• Syphilis
 Etiology/pathophysiology
• Treponema pallidum organism
• Transmission occurs primarily with sexual contact
 Clinical manifestations/assessment
• Incubation period

No symptoms
• Primary stage

Chancre; headaches; enlarged lymph nodes
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 74
Sexually Transmitted Diseases
• Syphilis (continued)
 Clinical manifestations/assessment
• Secondary stage


Rash on palms of hands and soles of feet
Generalized enlargement of lymph nodes
• Latent stage

No symptoms
• Tertiary or late stage

Lesions may affect many different systems; may be fatal
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 75
Sexually Transmitted Diseases
• Syphilis (continued)
 Medical management/nursing interventions
• Pharmacological management


Penicillin
Tetracycline or erythromycin, if allergic to penicillin
• May be treated in any stage; damage from previous
stages will not be reversed
• Treat all sexual contacts
• Reportable to CDC
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 76
Sexually Transmitted Diseases
• Gonorrhea
 Etiology/pathophysiology
• N. gonorrhoeae
• Transmitted by sexual contact
 Clinical manifestations/assessment
• Vaginal (female)



Urinary frequency and pain
Yellowish discharge
Nausea and vomiting
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 77
Sexually Transmitted Diseases
• Gonorrhea (continued)
 Clinical manifestations/assessment (continued)
• Urethra (male)



Urethral discomfort; dysuria
Yellowish discharge containing pus
Red and swollen meatus
• Rectal (male and female)

Perineal discomfort; purulent rectal discharge
• Pharyngitis (male and female)


Sore throat and swallowing discomfort
Edema of the throat
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 78
Sexually Transmitted Diseases
• Gonorrhea (continued)
 Medical management/nursing interventions
• Pharmacological management



Penicillin
Rocephin
Doxycycline or tetracycline
• Patient education
• TREAT ALL SEXUAL CONTACTS
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 79
Sexually Transmitted Diseases
• Trichomoniasis
 Etiology/pathophysiology
• T. vaginalis protozoan
• Usually sexually transmitted
 Clinical manifestations/assessment
• Most are asymptomatic
• Male: Urethritis, dysuria, urinary frequency, pruritus,
and purulent exudate
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 80
Sexually Transmitted Diseases
• Trichomoniasis (continued)
 Clinical manifestations/assessment (continued)
• Female






Frothy, gray, green, or yellow malodorous discharge
Pruritus
Edema
Tenderness of vagina
Dysuria and urinary frequency
Spotting; menorrhagia; dysmenorrhea
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 81
Sexually Transmitted Diseases
• Trichomoniasis (continued)
 Medical management/nursing interventions
• Pharmacological management

Metronidazole (Flagyl)
• Patient education
• TREAT ALL SEXUAL CONTACTS
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 82
Sexually Transmitted Diseases
• Candidiasis
 Etiology/pathophysiology
• C. albicans and C. tropicalis
 Clinical manifestations/assessment
• Mouth: Edema; white patches
• Nails: Edematous, darkened, erythematous nail base;
purulent exudate
• Vaginal: Cheesy, tenacious white discharge; pruritus;
inflammation of the vagina
• Penis: Purulent exudate
• Systemic: Chills; fever; general malaise
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 83
Sexually Transmitted Diseases
• Candidiasis (continued)
 Medical management/nursing interventions
• Pharmacological management



Nystatin (Mycostatin)
Diflucan
Topical amphotericin B
• Treat underlying condition
• Treat partner also; Using Nystatin vaginally and
concurrently having intercourse is NOT considered
treating the partner.
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 84
Sexually Transmitted Diseases
• Chlamydia
 Etiology/pathophysiology
• Chlamydia trachomatis
 Clinical manifestations/assessment
• Usually asymptomatic
• Male



Scanty white or clear exudate
Burning or pruritus
Urinary frequency; mild dysuria
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 85
Sexually Transmitted Diseases
• Chlamydia (continued)
 Clinical manifestations/assessment
• Female





Vaginal pruritus or burning
Dull pelvic pain
Low-grade fever
Vaginal discharge; irregular bleeding
Can lead to infertility
 Medical management/nursing interventions
• Pharmacological management

Tetracycline; doxycycline; Zithromax
• TREAT ALL SEXUAL CONTACTS
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 86
Nursing Process
• Nursing diagnoses






Anxiety
Body image, disturbed
Coping, ineffective
Fear
Fluid volume, deficient
Health maintenance,
ineffective
 Infection, risk for
 Knowledge, deficient
 Pain, acute and
chronic
 Self-esteem,
situational low
 Sexual dysfunction
 Skin integrity, impaired
 Tissue perfusion,
ineffective
 Urinary elimination,
impaired
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 87