Reproductive System

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Author:
Danette
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148252
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Reproductive System
Updated:
2012-04-17 20:18:35
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Exam Two
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Reproductive System
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  1. Femal Reproductive Gerontological Changes
    • Menopause
    • Lack of estrogen causes changes
    • Bone density a concern
    • Incontinence
    • Hot flashes - vasomotor instability
    • Emotionally labile - lack of REM sleep
  2. Amenorrhea
    Absence of mensus which can be caused by pregnancy, nutritional concerns, & meds such as antidepressants

    Primary - failure to start by age 16 - thyroid problem

    Secondary - exercise, pregnancy, BCP, eating disorder
  3. Salpingitis
    Inflammation of fallopian tubes. - Can be caused by infection such as STD.
  4. Dysmenorrhea
    Painful menstrual periods. Can be from STDs or endometriosis.
  5. Human Papillomavirus - HPV
    Determines 13 high risk types associated wiht development of cervical cancer
  6. Pap Smear
    Cytologic study to determine precancerous & cancerous cells from cervix
  7. Wet Smear
    Specimen obtained from vaginal wall, vulva area. Determines cervicitis.
  8. Cultures from vaginal vault & cx
    Done to check for STDs such as Neisseria Gonorrhoeae
  9. KUB
    Check for masses
  10. Hysterosalpingogram
    Inject contrast media & is used for infertility workup
  11. Colposcopy
    Inspects cervical, vaginal & vulvar epithelium. Can locate lesions for diagnostic purposes. Use acetic acid to accentuate features
  12. Laparoscopy
    Direct exam of pelvic cavity through an endoscope
  13. Hysteroscopy
    Visualizes interior of the uterus & cervical canal
  14. Cervical biopsy
    Done for follow-up positive Pap Smear
  15. Conization
    Removal of a cone-shaped sample of tissue
  16. Post procedure (biopsies, scopes)
    • Rest for 24 hours
    • No heavy lifting - 2 weeks
    • Report excessive bleeding
    • Change pad frequently
    • No tampons - 2 weeks
    • No intercourse - 2 weeks
  17. Endometrial biopsy
    Done for heavy bleeding & for infertility
  18. Endometriosis
    Benign problem of endometrial tissue implantation outside of the uterine cavity
  19. Treatment:
    Endometriosis
    • Exploratory laparotomy
    • 6 months HRT to decrease ovulation
    • NSAIDs
    • Hysterectomy
  20. Post Menopausal Bleeding
    • Vaginal bleeding occurring after a 12 month cessation of menses after the onset of menopause
    • Serious problem
    • 20-40% women have this
    • Most common cause - endometrial hyperplasia/tissue overgrowth
    • Precursor to endometrial cancer
    • TX: D&C & HRT
  21. Dysfunctional Uterine Bleeding
    Seen at end of reproductive years & is treated with D&C, hysteroscopy, hysterectomy
  22. Vaginitis
    Disturbance of balance of hormones & bacteria in the vagina
  23. Vulvitis
    Pruritis
  24. PMS
    • Etiology - ?
    • Affects 5% severly
    • Severity increases with age until menopause
    • Occurs during the luteal phase of menstrual cycle only (ovulation to menstration)
    • Assessment
    • Management
  25. Toxic Shock Syndrome
    • Caused by high absorbant tampons
    • Etiology - toxin produced by Staph aureus (can be MRSA)
    • Seldom seen until 1980 wint increased tampon use, diaphragms, vaginal sponges
    • Assessment - diffuse rash, temp 102 F or higher, peeling skin on palms & soles of feet, hypotension, multi-system involvement
    • Interventions - antibiotics, platelets, corticosteroids, treat hypotension
  26. STDs
    • Infectious organisms passed through intimate contact
    • Chlamydia - bacteria - is most common
    • Gonorrhea - gram negative bacteria
    • Trichomonas - protozoa
    • Can lead to PID
    • Reportable to Public Health Dept
  27. Pelvic Structure & Support Problems
    • Uterine prolapse - hysterectomy
    • Cystocele - protrusion of bladder thru vaginal wall making it difficult to urinate
    • TX: anterior colporrhapy which tightens pelvic muscles for better bladder support
    • Rectocele - protrusion of rectum thru weakened vaginal wall
    • TX: posterior colporrhapy
  28. Benign Neoplasms (Fibroids)
    • Uterine leiomyomas - benign slow growing solid tumors in uterus
    • Cause ?
    • Seen more in AA women & premenopausal women also at risk
    • Menorrhagia - increased menstrual bleeding
    • Metrorrhagia - bleeding between periods
  29. Treatment for Fibroids
    • Laser removal
    • Hysterectomy - abdominal & vaginal
  30. Female Malignancies
    • Ovarian carcinoma - leading cause of death from reproductive cancers
    • --Usually diagnosed at an advanced stage

    • Cervical carcinoma - classic symptom is painless, vaginal bleeding between periods, after intercourse, or douching
    • Preinvasive - limited to CX
    • Invasive - other pelvic structures

    • Preinvasive CX are termed:
    • --Cervical Intraepithelial Neoplasm
    • --CIN I Mild dysplasia
    • --CIN II Moderate dysplasia
    • --CIN III Severe dysplasia to Ca in situ

    Vulvar carcinoma - slow growing, metastasizes late

    • Endometrial carcinoma - most common reproductive cancer
    • --Good prognosis - 80-90%
    • --Onset - postmenopausal
    • --Intracavity radiation
  31. Treatment for female malignancies
    • Pap smear
    • Colposcopy - determine CIN
    • Laser
    • LEEP
    • Cryotherapy - freeze the tissue
    • Hysterectomy
    • Pelvic Exenteration - radical surgery; parts of colon & bladder may be removed
  32. Prostatitis
    • Abacterial - may occur after a virus or from sudden decrease in sexual activity
    • --Most common type

    • Bacterial - infection of lower urinary tract - organisms reach prostate via bloodstream or urethra
    • --E.coli, enterobacter, proteus
    • --Assessment - fever, chills, dysuria, discharge, tender prostate
    • --Management - AB (cipro), sitz bath, comfort measures, stool softeners, analgesics
  33. Benign Prostatic Hypertrophy (BPH)
    Cause suspected is a systemic hormonal alteration triggered by advancing age - 50% of men older than 50 have some degree of BPH

    Prostate frequent site of infection & chronic inflammation & increasingly with age, prostate undergoes hyperplasia which enlarges it (hypertrophy)

    Narrows urethral channel & obstructs urine flow
  34. BPH features / assessment
    S/S - urinary frequency, nocturia, urinary hesitancy, dribbling, bladder distension, diminished stream, possible renal insufficiency

    Complications - urinary retention, hydronephrosis, hydroureter, bladder irritability & hypertrophy

    Diagnostics - CBC, UA, BUN, Cr, KUB, IVP, cystourethroscopy
  35. BPH - Management
    • Non surgical
    • *Drug therapy - proscar to shrink prostate
    • *Prostate massage
    • *Dietary restrictions
    • *Avoid meds such as anticholingerics, antihistamines, decongestants

    • Surgical
    • *Prostatectomy
    • *Transurethral resection (most common) TURP
    • *Suprapubic
    • *Perineal
    • *Retropubic
  36. BPH - Nursing Interventions
    • Continuous bladder irrigation - check color & flow rate
    • AMicar for bleeding (prevents fibrin clots from forming)
    • Belladonna & opium suppository - for bladder spasms
  37. Cancer of Prostate
    • 95% adenocarcinoma
    • Slow growing
    • PSA - screens for prostate cancer. No ejaculation for 24 hours prior to test
    • CA - if suspected, a needle biopsy is done. It's done like a prostate exam under local anesthetic. Placed on prophylactic abx & infection can be a problem
    • TX: prostatectomy, radiation, hormone treatment & orchiectomy
    • Complications - sexual dysfunction, urinary incontinence
  38. Cancer of Testes
    • Rare but most common in men ages 15-35
    • Hx of trauma, infection, undescended testis
    • Treatment - unilateral orchiectomy, radiation, chemotherapy
    • Result - can cause sterility
    • Sperm Bank before treatment
  39. Erectile dysfunction
    • Organic - gradual deterioration of function
    • *Inflammation
    • *Smoking, ETOH
    • *HTN
    • *Pelvic Fx
    • *Neuropathy - vascular changes
    • *DM

    • Functional - psychological stress - happens suddenly
    • *Find out cause or DX testerone level
    • *Meds - causes relaxation of smooth muscles for blood flow to penis is increased ex Viagra
  40. Inflammatory Disease
    • Vaginitis
    • Candida
    • Trichomonas
    • Chlamydia
    • Endocervicitis
    • PID
  41. Diagnostics for Inflammatory DZ
    • Pap smear
    • Cervical intraepithelial neoplasia - CIN
    • D&C
    • Laparoscopy
    • Radiographic
    • Ultrasound
    • Culdocentesis

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