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  1. Sperm pH
  2. WHat helps keep uterus in place
  3. What happens to vaginal mucus afer puberty
    becomes relatively resistant to infection
  4. What causes the synthesis of milk production
  5. how long do mentrual cycles tend to last
    2-8 days
  6. what does FSH do when secreted in increasing amounts?
    ovarian folicle starts to develop and grow

    • increase estrogen
    • stage ends with ovulation & sharp increase of LH
  7. what does sharp increase of LH do cause
    • rupture of ovarian membrane
    • increase amount of progesterone secretion
  8. How long does mensturation last?

    Average length
    23-35 days

    28 days
  9. what are LH and FSH needed for

    sperm production (Spermatogenesis)
  10. what do the seminol vesicles do

    secrete alkiline  to enhance sperm mobility

    fructose to nurish sperm
  11. what does alkiline substance do
    ensurethat sperm can live in the acidic environment of the vagina
  12. what does menopause's decreased estrogen  cause
    bonematrix loss and increase risk for osteoporosis and fractures

    • Increasedrisk for vaginal infections-
    • decreased secreations-drying of mucosa
  13. how long should pregnancy last
    ~40 weeks
  14. for women what should you assess first
    • •Breast feeding history
    • •Knowledge of breast exam education
    • •Any breast discomfort or changes, any lumps/thickening/nipple discharge
    • •Menstrual history
    • •“Menarche”- start of menstrual cycle- age
    • •Age of menopause
    • •LMP--Length of cycles, are there any changes or difficulties
    • •Any “dysmenorrheal”- pain, clotting
  15. Obstetrical history assesment
    • •Number of pregnancies, outcomes, viable births
    • •History of miscarriage( can also be called abortion)/abortion
    • •Gender of the births
    • •GPA
    • •any surgeries or treatments for fertility•Medications
  16. What does GPA stand for
    •Gravida = pregnancies•Para= births (live and stillborn)Abortions = spontaneous or therapeutic
  17. other female Hx assessment
    • •Height and weight (can interfere with reproduction)
    • •Sexual history (one partner? for how long?)
    • •Any STD’s
    • •Birth control- what form
    • •Assess family history
    • Social history
  18. why are Breast Assessment palpations doen
    • •To confirm the presence of lumps
    • •To confirm any changes from the month prior
    • •Location of tender areas•Educate MAMOGRAMS EARLY AND YEARLY!!!•Self exam- once monthly at least
  19. what kind of breast edu should be done how often?
    • •Self exam- once monthly at least
    •    ---so familiar w/ feel
  20. when should do breast self exams

    what do you look/monitor for?
    • •One week after the beginning of the menstrual period- b/c the breasts are more “lumpy” and lumps would be easier to detect
    • •Without a period?- any time during the month- once monthly

    • •Look for puckering or dimpling of the skin and assymetrical movement
    • •Monitor for differences in the location of the nipples
    • •Also check the axilla 
    • •Check for enlarged nodes in the breasts and axilla area
  21. how can breasts be examined
    •Breasts can be examined in a circular motion as well as in a linear fashion
  22. Diagnostic Breast Testing
    • •US can check the density of the tissue and map breast structures via sound waves
    • •Used to detect fluid filled cysts or solid tumors
    • •Can be used as a guide for needle bx. •Mammogram- radiographic examination
  23. mammogram
    • •Spreads and flattens the tissue to show benign and malignant growths
    • •2 views of each breast
  24. For Mammogram
    • •Assess family history
    • •Before a mammogram- Bathe, DO NOT use lotion, deodorant, powders on the upper body (crystals and shadows)
    • •IF… any shadows are seen, you may be called back for a repeat view- DO NOT panic at this point
  25. By what age should exams be done
    • •20- life = Self exam
    • •20-39- self exam AND - add a breast exam by a professional every 3 years
    • •Age 40+ = Self exam, CBE by a doctor and and ADD- mammogram each year!
  26. Breast Thermography, Tomography, MRI
    • •Mapping the breast on photographic paper- records temp variations on the breast tissue
    • •Tomography- Precise pictures of the tissue- layer by layer
    • •This allows precise mapping of the tumor without possibility of flattening the tumor in a mammography and reduces the risk of displacing the tumor!

    MRI- to map breast tissue
  27. Breast Bx
    • Open- removal of tissue, cell, fluid samples using an open incision in a surgical environment
    • Needle- Aspiration of fluid or tissue by means of a large, hollow needle
    • Frozen section- After removal of tissue/cells- sample moistened/frozen/sent to lab- sliced very thinly and immediately examined under a microscope

    • •WHY?- gives immediate info 9that day)
    •    about tissue type and spares the client later surgery- can be removed then!
  28.  Female testing Hormonal Testing
  29. --To assess potential fertility
    • --To find reasons for abn. menses
    • -Assess for abnormal hormone-producing tumors
    • --Determination of hormonal treatment (effective or not)
  30. Female testing Pelvic Examination-
    •  •Inspection of vagina/cervix
    • •Allows for samples of cells and exudates Palpation
  31. Bimanual palpation
    • •One hand of the Dr. is placed on the abdomen
    • •The other gloved hand is placed inside the vagina
    • •The uterus and adnexa (ovaries and uterine tubes) are moved by both hands to detect shape, size, consistency and to check for abnormal growths
    • •*ADNEXA= tissue/structures next to…
  32. female Cytology
    • Study of cells taken after bx.
    • •PAP SMEAR- cell samples are scraped away from the surface of the cervical canal and smeared onto a slide for viewing
    • •“CONIZATION”- cone shaped sample from the cervical canal
    • “Punch bx.”- removes a small core of cells
    •  -can be done on emdometrium
    • •A “curet” can be placed into the cervix to remove samples of the endometrium
    •  -used to get vag discharge samples
    •  •Collection of vaginal discharge
  33. female Sonography
    • •For the detection of female organ abnormalities
    • •To decipher size and approximate age of a fetus
    • •To assess the HR of a fetus
    • •For locating “ectopic” pregnancies
    • •Used for the guidance of needle bx.
    • •May be done vaginally with a sheath covered transducer

    Full bladder is often needed for some US testing
  34. Hysterosalpingogram
    • •- dye is injected into the uterus and comes out the ends of the fallopian tubes
    • •Useful
    • to detect any congenital abnormalities in the shape or size of the uterus
    • •Useful for the detection of fallopian tube blockage

    •Assess the “dye concerns”- (allergy to shellfish, iodine, dye)
  35. Endoscopic Exams
    • Fiberoptic light and lenses inserted through a small incision
    • Laparoscopy- to view the abdominal cavity (to check for endometriosis)
    • Salpingoscopy- to see the inside of the fallopian tubes
    • Hysteroscopy- to see the inside of the uterus
    • Colposcopy- to study the cervix
    • Culdoscopy- to see behind the uterus*
  36. What are endoscopic exams usually used for
    to test for endometriosis
  37. endoscopic exam nursing care
    • •Preop instructions and education for the client
    • •Baseline assessment
    • •General vs. local anesthesia
    • •Prepare client and family
    • •Postop comfort for the client
    • •Frequent VS
    • •Assessment of blood losses if any
  38. After any endoscopic procedures
    • •Educate that the client may have back, shoulder, and neck pain after CO2 pumping into the body compartment for visualization (insufflation)
    • •The remaining CO2 after examination travels to the highest point in the body before being absorbed

    Laying flat for a few hours after testing may be the best idea to decrease discomfort
  39. what kind of bleeding or discharge  should be reported after endoscopic procedure
  40. •Report any increase in bleeding,
    • •Report any bright red bleeding,
    • •Report any foul smelling discharge or bloody drainage ASAP!!!!!!
  41. Male Assessment- History
    • •Any problems obtaining or keeping an erection
    • •Any medication if there is a problem with erection
    • •Any problems with ejaculation
    • •Any pain with erection of ejaculation
    • •Any discoloration or foul discharge, any with erection
    • •Ask the same question- sexual activity, partners, etc…
    • •Family hx.
    • •Personal habits/social habits- smoking, etoh, drugs, steroids
    • •Bike riding
    • •Frequent use of hot tubs-heat
    • •Mental health history
    •      - stressors, fear, preformance
    • •Physical hx.- heart/kidney trouble etc…
    •   any physical prob can cause preformance issues
    • •GI history or problems
    • •Musculoskeletal history
    • •Urinary history (can help detect BPH)
    • •Neuro history
    • •DM?
  42. What arethe main causes of errectile dysfunction
    • HTN
    • DM
  43. male assessments ?'s undr and over 40
    Under age 40- does the client do regular testicular examinations

    • •Older than 40- When was  the last prostate examination
    • •Should be done yearly after 40, prostate cancer is easily treatable if detected early!- EDUCATE!

    •Unless a prostatectomy has been done, all male clients 40 and over should have a DRE done yearly
  44. Penis, scrotum and testes physical exam
    • •Penis should be positioned straight down if flaccid•Left testis usually hangs slightly lower than the right
    • •Are there any abonormalities in the skin around the penis or scrotum
    • •Is the urethra opening at the end of the shaft (it should be)If it is under theshaft- “hypospadias”
    • •Is the client circumcised?-difrnt cleaning technique
    • •Testes and scrotum are evaluated for lumps, tumors or cysts, warts
    • •If a fluid filled mass (hydrocele) is found- further eval. should be done
    • •“Transillumination”-
  45. Male physical exam
    • Examination for inguinal hernias
    • •DRE (digital rectal exam) for the presence of enlarged prostate (gland feels very hard or soft, contains lumps- will need bx.)
  46. Gynecomastia
    - excessive breast tissue may indicate increased female hormones
  47. Transillumination
    ”- non invasive test to determine if the mass is fluid filled or solid- Room lights are off- flashlight held behind scrotum- if the mass is fluid filled = glows red, if solid = appears opaque
  48. Penis, scrotum and testes physical exam
    • •Penis should be positioned straight down if flaccid
    • •Left testis usually hangs slightly lower than the right
    • •Are there any abonormalities in the skin around the penis or scrotum
    •   discolor, dimple, lesion, grwth, wart--often congenital
    • •Is the urethra opening at the end of the shaft (it should be)If it is under theshaft- “hypospadias”
    • •Is the client circumcised?-difrnt cleaning technique
    • •Testes and scrotum are evaluated for lumps, tumors or cysts, warts
    • •If a fluid filled mass (hydrocele) is found- further eval. should be done•“Transillumination”-
  49. “Varicocele”-
    • •spermatic cord feels like a bag of worms instead of thread like
    • •This is swelling of the veins and is common in male infertility
    • •common cause of infertility
  50. Types of male physical exams
    • Examination for inguinal hernias
    • •DRE (digital rectal exam) for the presence of enlarged prostate (gland feels very hard or soft, contains lumps- will need bx.)
  51. Examination for inguinal hernias
    •- pressing up through the scrotum into each of the inguinal rings while asking the client to cough or bear down- the herniation feels like a pulsation against the tips of the fingers
  52. DRE
    (digital rectal exam) for the presence of enlarged prostate (gland feels very hard or soft, contains lumps- will need bx.)

    done by one trained to do it-NP, DR, etc
  53. what can prostate swelling or pain can be indicative of
    • i&o
    • -kidney function
  55. male breast exams
    • •Rare for cancer in male breast tissue but NOT impossible
    • •Should be done monthly
    • •In the same fashion women do theirs

    •US done if found issue w/ breast exam
  56. Ultrasoundsfor the male patient
    • •Transrectal US to diagnose detected prostate cancer
    • •Rectal probe into the rectum and sound waves are monitored for visualizsation of the prostate gland
    • •Enemas may be ordered prior
    • •No aftercare
    • •Can be used to guide needle for bx.
  57. Cystourethrography
    • •To evaluate obstruction by an enlarged prostate
    • •Foley inserted- dye injected into the bladder
    • •Radiographs taken with dye in the bladder, while voiding, & after the cath is removed
    • •I/O monitored for 24 hours after testing
    • •Fluids encouraged

    •Careful monitoring of BUN/Creat before testing
  58. Male Lab tests
    • 1) PSA- Prostate specific antigen
    • 2) PAP- Prostatic Acid Phosphotase
    • 3) Infertility tests
  59. PSA
    • •Normals = <4 ng/L
    • •PSA is a glycoprotein produced by the prostate cells•Elevation indicates prostatic hypertrophy or cancer!
  60. PAP
    •  Prostatic Acid Phosphotase
    • •Normals = <3 ng/mL
    • •PAP is an enzyme that normally effects metabolism of prostate cancer cells Increased levels indicate prostate CA
  61. Male Infertility tests
    •Hormone levels- eval of LH and FSH, testosterone and adrenocorticotropic hormone

    •Semen analysis for sperm counts, motility and shape of the sperm
  62. Semen Analysis
    • •Before a semen analysis- client is instructed not to ejaculate for about 3 days prior
    • •Specimens are usually collected for 4 to 6 days on separate occasions
    • •Condoms and lubricants should be avoided
    • •Samples should be sent to the lab within one hour!
  63. Nursing Care- male/female
    • •Assess VS, physical assessment baseline
    • •Assess for bleeding at the site if any surg.
    • •Assess psychological condition of the client
    • •Be sure to educate every step of the way to reduce anxiety
    • •Consent signed prior to bx.
    • •Clients should empty bladder prior to pelvic examination
    • •Provide comfort and privacy
    • •Provide a sheet for the client to remain covered
    • Any cells or bx.’s removed from the client must be packaged appropriately and quickly for lab review- they die very quickly!
    • •educate that sampling can cause some discomfort and frequently spotting afterward
    • •Notify Dr. if the pain and bleeding increases or if there are any s/s of infection after testing
    • •Assess any allergies to dyes
    • •Sedatives may be give to the client if necessary for anxiety or discomfort
    • •Speculums (pap smears) come in different sizes- be courteous!
    • •For a female, small child- nasal specula can be used for pelvic examinations
    • •sexual/phys stuff is intertwined
  64. When to notify DR for male/female tests
    . if the pain and bleeding increases or if there are any s/s of infection after testing
  65. Breast D/O
    • Benign breast disorders
    • 1) Cystic breast disorders
    • 2) Fibrocystic Disease
    • 3) Mastitis

    • •US or mammogram may be in order to r/o any other pathophys
    • •Some breast cysts are more prone to cancer, so worth looking into
    • •Decreases in caffeine and caffeine containing food/fluids should be educated
  66. Cystic breast disorders
    • - usually due to hormone, menstr cycle
    • - Due to cyclical variations in hormone levels
    • - Can cause swelling, tenderness and “mastalgia”(breast pain) can be related to hormone mediated changes
    • - May need to treat by modifying hormone levels

    • most notice coming around menstrual cycle
    • caffine one of biggest causes
  67. Fibrocystic Disease
    • •not infect
    • • usual caused by-Ectasia”- overdevelopment of cells
    • •Blockage of ducts causes fluid to be trapped and cysts to develop
    • •Breasts will feel lumpy
    • •Are tender to palpation
    • No treatment- usually not cancerous

    less caffine=less discomfort
  68.  Mastitis
    • •Breast infection with inflammation
    • •Can be due to injury and introduction of bacteria onto the breast
    • •Common with breast feeding
    • •Breasts become swollen, red, tender, client may present with malaise and fever with flu-like symptoms•Breasts are often streaked
    • •Abscess may form
    • •Antibiotics are the treatment for mastitis
    • •May require an I&D
    • •Location and type of infection will determine whether or not the client can continue to breastfeed- but it is usually promoted to do so
  69. Breast D/O educate
    • •Educate with infection to wash hands well
    • •Wear a supportive bra
    • •Check with Dr. for OTC pain meds if breast feeding!
  70. Breast CA
    • May be due to:
    • •Increased age
    • •High fat diet
    • •Personal or family history of cancer and breast cancer
    • •Increased alcohol intake
    • •Estrogen treatments (especially if in combo. with progestins)
    • •Early menarche (start of menstrual cycle)
    • •Late menopause
    • •Late first pregnancy
    • •NO pregnancies
  71. Breast CA Prevention
  72. BreastCancer Staging (TNM)
  73. Breast CA Tumorsare classified
  74. Treatment-about 5 real options
  75. Radiation
  76. Chemo
  77. HormonalTherapy Breast CA treatment
  78. )Modification ofbiological response-
  79. 5)Surgery Breast CA treatment
  80. Breast CA surg Education
    • •Pre and post op teaching•Prepare the client before surgery of what to expect depending on what the surgery will involve•Prepare the client for chemo and radiation effects•Prepare the client for bulky dressings and the need for frequent VS after procedures•Monitoring dressings for bleeding
    • •Monitoring for s/s of infection•Frequent lab draws may be in order, esp. if the client has received chemo•Maintain an open line of communication•If the client has had a mastectomy or is undergoing chemo (especially)- there will be depression, changes in lifestyle, self-esteem issues
  81. Breast CA surg care
    •Monitor for coping ability and skills•Monitor for the need for intervention by ss, clergy, etc…•What is the client’s support system•If the client has had a mastectomy- may have JP drains = I/O and monitor the insertion site•For the first 24 hours- the client may have edema under the arm•Assess for movement, sensation, numbness and tingling of the arm and distal to the surgical site•NO BP OR VENIPUNCTURE IN THAT ARM ANY MORE!!!•Educate the client to pass on the information for future purposes!•Consult MD for any immunizations or vaccinations due to immunocompromised status

    •Educate that the client may have decreased sensation in the affected arm- do NOT immerse in hot water, be careful placing the arm in a hot oven
  82. BREAST surgery (modifications)
    • 1) Mammoplasty
    • 2) Breast reduction and Mastopexy-
  83. Mammoplasty
    surgical modification of the breast —To restore shape after cancer surgery —Electively- to reduce or increase size —To improve the shape
  84. ) Breast reduction
    • - nipple is separated from the surrounding tissue—Large wedge of tissue is removed from bottom of breast
    • —Edges are sewn together and nipple is reimplanted in a higher position
    • —
  85. MASTOPEXY- removal of skin and fat with resuturing of the breast tissue to be held higher on the chest to correct sagging
    MASTOPEXY- removal of skin and fat with resuturing of the breast tissue to be held higher on the chest to correct sagging
  86. Augmentation
    • -—To increase size-—Saline or silicone is implanted into a portion of the client’s own tissue
    • —Positioned either under or over the pectoral muscles—
  87. reconstruction mammoplasty
    •  the clients own tissue is generally used for safety vs. implantation of artificial supplies
    • Grafting can be achieved by taking tissue from another part of the clients body (abdomen for example) if there is significant amounts of tissue needed
    • —If latissimus dorsi muscle or the rectus abdominus muscle is used for the site of tissue extraction, some muscle is detached from the usual attachment and replaced as breast tissue and surgically reconstructed
  88. Breast surgery complications
    • —Impaired healing process
    • —Infection—
    • Increased with silicone implants and can occur years later—
    • Can have hardening of the breast tissue and development of autoimmune disease later—
  89. Nurse care for breast surgery
    • —Watch and teach for identification of s/s of infection!
    • Teach about hand washing and dressing changes as ordered
    • —Educate for s/s of “poor attachment”
    • —Discolored or dusky colored skin or at the incision site
    • Swelling or drainage of the tissue at the incision site
    • —Gaping of the incisional lines
    • —Sloughing of the graft or at the edges of the site
  90. What do you monitor for after breast surgery
    • —Monitor for increase pain—
    • Monitor for red streaking, warm areas on the skin—
    • Monitor VS often after surgery—
    • Prophylactic abx. may be given after surgery—
    • May be given before surgery as well!
  91. Menstrual Disorders due to
    • Stress
    • —Hormonal imbalances—
    • Pregnancy—
    • Metabolic imbalances- excessive exercise, obesity, anorexia nervosa
    • —Tumors- benign and malignant—Infection
    • —Organ disease- kidney, liver, thyroid diseases—
    • Blood/bone marrow abnormalities
    • —Foreign body presence- (IUD)
    • —Birth control measures (oral, implanted) —

    Abnormalities can cause anemia, persistent fatigue, sexual discomfort and dysfunction
  92. Testing and Examinations for menstrual d/o
    • Medical history—
    • Physical examination, pelvic examinations
    • —Equipment = Vag speculum in different sizes, glove and lubricant—
    • Client should empty bladder
    • —Best time for a pelvic exam is b/t periods—
    • Should not douche before an exam—
    • Vaginal swabbing —PAP Smears
  93. PAP Smear Results
    • —Negative (90% cure rate cancer insitu)- cells are less than 1 cm. in diameter
    • —Class I- mild dyplasia
    • —Class II- moderate dysplasia
    • —Class III- Severe dysplasia to cancer
    • —Classes I, II, and III- need a complete evaluation
  94. other tests for female d/o
    • —Urine testing
    • —Pregnancy testing
    • —Blood screening for various disorders —
    • Hormone levels to be monitored
  95. Treatment for various disorders
    —May need to manipulate hormone levels—May require D&C (dilation and curettage)- dilation of the cervix with the introduction of a device to scrape the inside walls of the uterus- why? —Laser ablation of endometrial tissue- burns the endometrial tissue to form non-bleeding scar tissue —Hysterctomy- removal of uterus
  96. How to watch for bleeding after female surg treatment
    —Remember that after any of these treatment forms- watch for increased bleeding—This is done by “counting pads” or weighing them for a strict I&O of blood—Place the pad in a biohazard bag and weigh it, subtract from the actual dry weight of the pad and DOCUMENT
  97. Dysmenorrhea
    —Painful menstruation—Due to prostaglandin action resulting in painful cramping and uterine contractions (primary)—After normal menses without discomfort- the client will later c/o discomfort that may be caused by a pathological condition such as endometriosis, pelvic infection, retroversion of the uterus (backward tipping), or tumors (secondary)
  98. testing forDysmenorrhea
    —Hormonal testing—Lap exams—Biopsies—All to investigate for secondary causes of dysmennorhea
  99. Treatment and care for Dysmenorrhea
    —Drugs to inhibit prostoglandins (ASA and ASA-like drugs)—Prostaglandins mediate smooth muscle contraction (uterus) —Hormonal adjustment—D&C—Other surgical procedures depending on the cause of the secondary dysmennorhea

    —Other reasons for ASA- why?—Other reasons for NSAID’s- why?—Homeopathic treatment- biofeedback, yoga, massage—Knee to chest positioning for retroversion of the uterus
  100. Premenstrual Syndrome and symptoms (PMS)
    • —Due to the effects of ovarian hormones, aldosterone, neurotransmitters on the system
    • —Causes
    • - water retention
    • -—HA
    • -—Joint discomfort—
    • -Muscle pain
    • -—Breast tenderness—
    • -Change in affect
    • -—Decreased concentration and coordination
    • -—Sensory changes
  101. Tx for PMS
    • —OTC’s for pain can be used- NSAID’s, Tylenol, ASA 9but will increase bleeding)—Calcium supplements and magnesium supplements
    • —Vitamin E and B6 can help- but only by advice of Dr. due to increased amount = toxicity
    • —Application of heat to the abdominal area—
    • OTC PMS preparations- pamprin, etc
    • —Restriction of etoh, caffeine, nicotine, simple sugars—
    • Exercise moderately—
    • Stress management skill

    s—Education!!! for the family as well if the client has severe PMS
  102. Endometriosis
    • —Functioning endometrial tissue is on the outside of the uterus—
    • May be due to faulty differentiation of cells—
    • -Transport of endometrial cells via blood and lymph to other areas in the body
    • —Retrograde menstruation- backward blood and tissue leakage out through the fallopian tubes during the menstrual period—

    Mediated by ovarian hormones on a cyclical basis- these cells build up and slough like they would in the uterus, but sloughing and bleeding occurs in an enclosed abdominal cavity or into tissues they have invaded —

    Causes pain, swelling, can damage abdominal organs and structures
  103. endometriosis info
    • —Scar tissue can develop
    • —Infertility can be the demise
    • —Surgical intervention may be required —
    • The tight bands or webbing of the scar tissue can shut off blood supply to the bowel and the uterus!

    • —Reduction of estrogen and the prevention of ovulation via medications or by surgical removal of the ovaries can be effective
    • --—This can cause early menopausal symptoms and infertility
    • Pain medications are usually required- OTC or narcotic- depending on the severity of the pain
  104. Menopause
    • -—Permanent cessation of the menstrual cycles because of decreased hormone production
    • -—Natural part of aging for women—

    • —-Atrophy of the urogenital tissues= marked decline of natural lubrication—
    • -pH shift to alkalinity = increased vaginal yeast infections
    • -Vasomotor instability = night sweating and hot flashes which are very uncomfortable and tend to disturb lifestyle—
    • - decrease in estrogen production-=is higher risk of osteoporosis and heart disease
    • —-Mental changes and mood swings may occur because of the hormonal and
    • -neurotransmitter changes and decline
    • —-May cause irritability, insomnia, anxiety, memory problems, mild depression
    the period of gradual decline of hormone production before the permanent end of menstruation—Can last months to years—May have erratic periods
  106. HRT
    (hormone replacement therapy) may be indicated but is controversial!

    —-Conjugated estrogen- Premarin, Provera —-Studies have shown that on a combo of conjugated estrogen and progestin- increased positive breast cancer incidences, increase in heart attack, stroke, Venous thromboembolism and cadiovascular disease , but a decrease In hip fracture and colorectal cancer!
  107. Menopause teaching
    • —*Teach about osteoporosis risks and prevention (should start early in life)
    • - especially high risk- fair skinned Caucasian women
    • *—Remember that if the client presents with bleeding after menopause- this may be cause for concern for other benign changes, such as polyps or malignant changes- further investigation should be done
    • *—Educate for the increase in calcium and Vitamin D from foods and weight bearing exercises to maximize bone mass
    • *—Educate the client who is perimenopausal to prepare- wear layers or dress in cooler clothing
    • *—Water soluble lubricants can be used if needed
    • *—Eat a healthy diet—
    • *MAY STILL BE fertile for several months after amenorrhea!
    • *May need birth control
    • —•Not necessarily sexually transmitted—
    • •Normal vaginal environment = pH less than 4.2 (acidic)—
    • •Protects against the growth of microorganisms

    • •—Candidiasis, bacterial vaginosis (overgrowth of bacteria), and cyctolytic vaginitis (inflammation) are all example of processes due to the overgrowth of normal, nonpathogenic microorganisms—
    • Trichomoniasis is also included as it can be contracted via toilet seats and on other fomites and sexually transmitted
    • **Poor nutrition (diets high in simple sugars), inconsistent blood glucose levels (DM), stress, pregnancy, hormonal fluctuations, pH changes, prolonged overheating of the genital area with little aeration, changes of vaginal normal flora such as with antibiotics and steroid treatment

    • —Immunocompromised clients such as those with HIV are more susceptible to vaginal disease—
    • Vaginosis or vaginitis can cause
    • inflammation and irritation to male partner as well- causing urethritis, balanitis, excoriation, sores to the penis—
    • He would need to be treated as well so as not to re-infect the female partner
  109. what can Vaginosis or vaginitis cause to male partner
    • •can cause inflammation and irritation to male partner as well- causing urethritis, balanitis, excoriation, sores to the penis—
    • •He would need to be treated as well so as not to re-infect the female partner
  110. PID
    • Pelvic Inflammatory Disease
    • —•Inflammation of the pelvis, goes outside the uterus
    • •Causes severe abdominal pain
    • -—Increased temp. —N/V—
    • -Vaginal discharge may be increased and foul smelling —
    • -May cause the pelvis to feel “heavy”

    —Antibiotics are ordered —Pain meds and heat to abdomen for pain control
  111. other female D/O
    • Salpingitis- infection of the fallopian tubes—Can lead to obstruction and ectopic pregnancy
    • Oophoritis- inflammation of the ovaries Pelvic peritonitis- inflammation of the pelvis or peritoneum 
    • *Pelvic Cellulitis-Inflammation extends outward from the uterus and involves tissue of the pelvis—Can be caused by any organism*Most commonly caused by Nisseria Ghonnorhea and Chlamydia
  112. Nursing care and education
    • —Educate on what to expect for a pelvic examination, testing
    • —Allow privacy
    • —Be aware that this may cause the client embarrasment —
    • May need local creams, suppositories
    • —May need to teach on how to use- do NOT assume the client is aware of what to do
  113. Toxic Shock Syndrome
    • —Can be deadly!—
    • Primarily associated with super-absorbant tampon use but can occur with nasal packing—
    • A severe SYSTEMIC infection often with strains of Staph Aureus- causes an epidural toxin—
    • The effect of this toxin on the kidneys, liver and circulatory system makes for life threatening conditions

    • —Streptococcal infection can cause similar symptoms—
    • Will need Blood cultures for identification and sensitivity
    • S/s
    • —May present with a sudden high fever—
    • Sore throat, HA, dizziness, confusion, redness of the palms of the hands and soles of the feet, skin blisters and rashes and petechiae followed by skin sloughing
  114. TSS nurse care & edu
    • —Report any S/S ASAP!! —
    • Educate to alternate tampons and pads periodically to reduce the risk of TSS —
    • Change tampons every 4 hours —
    • See the package insert/education/instructions

    • —Wash hands thoroughly—
    • Do NOT leave female barrier contraceptives (diaphragms) in any longer than necessary—
    • NO tampons of female barriers for the first 12 weeks following giving birth
    • —Follow Dr’s. orders here
    • —Listen and educate- give written instructions
  115. Disorders of female development
    • —Congenital malformations—
    • +May be due to environmental or genetic factors
    • —+The uterus can be malformed or there can be a double uterus—
    • +Many malformations are evident in early age, but some are only identified after the client seeks treatment for dysmenorrhea —
    • +DYSPAREUNIA- pain with intercourse—
    • +Infertility—
    • +Repeated spontaneous abortion (miscarriages)
    • —+AGENESIS- not developed
    • —+HYPOPLASIA- underdeveloped portions of the reproductive tract—
    • +IMPERFORATE- expected openings that do NOT exist
  116. Testing & possible care for d/o of female dev
    • —US, CT, MRi can be used for dx.
    • —Hystero-salpingo-graphy
    • —Endoscpoic exams

    —May require surgery
  117. Displacement d/o
    • —^Pregnancy (esp. those with a large baby) and rapid or traumatic delivery can cause displacement, stretching or injury to supportive structures- ligaments, fascia, muscle
    • ^ —This can cause displacement of the uterus, vagina, bladder, bowel
    • ^—May be hereditary or congenital—
    • ^Scarring from sexually transmitted diseases can also cause displacement
    • ^ —Aging and gravity contribute to stretching —
    • ^Low estrogen levels weaken estrogen-dependent supportive tissues
    • ^ Chronic constipation, obesity, lack of exercise can contribute to the risk
  118. Teach for displacement d/o
    • —Teach for a healthy diet and exercise—
    • ^Kegel exercises to strengthen important muscle
    •   -s—Tightening the “pubococcygeal muscles to stop urination
    •   -—Squeeze the muscle for 10 seconds, relax and repeat 15 X daily—

    • ^Clients may require pessary rings for pelvic organ support- place in the proximal end of the  vagina—
    • ^Removed at bedtime and for cleaning—
    • ^Some can stay in place for several months
    • ^—Increased vaginal discharge is expected with a pessary ring b/c it is a foreign objec
    • ^ —Note s/s of foul odorous d/c or bleeding or s/s of infection—
    • ^May require frequent checks by a Dr. for placement
  119. Cystocele
    • —Bladder sags into the vaginal space due to poor support
    • —Pelvic pressure is felt
    • —Bladder incontinence is common

    • —Kegel’s and pessary rings may be prescribed —If ineffective- “colporrhaphy- surgical repair of the anterior portion of the vagina
    • —May require bladder suspension
  120. Rectocele
    • —^Portion of the rectum sags into the vagina
    • ^—Pelvic pressure +—Incontinence +, constipation—
    • ^Hemorrhoids
    • ^—Educate Kegel’s —
    • ^Maintain bowel regularity with a high fiber diet
    • ^—Surgery may be required
  121. Uterine Position Disorders
    • —Anteversion- uterus lies too far forward —Anteflexion- upper portion of the uterus bends forward —
    • Retroversion- uterus tips backward —
    • Retroflexion- upper portion of
    • the uterus bends backward
  122. What can uterine position disorder cause
    • —Painful menstruation and intercourse
    • ^—Infertility is common
    • ^ —Repeated spontaneous abortions at higher risk
    • ^—Pessary ring may be used
    • ^ —Surgery may be needed to correct the uterus positioning
  123. Uterine Prolapse-1st,2nd,& 3rd degree

    —Uterus sags into the vagina

    • —1st degree prolapse- less than half of the uterus sags into the vagina
    • —2nd degree- entire uterus sags
    • —3rd degree- uterus sags outside the body!

    • —Painful- pelvic pain—
    • Urinary incontinence, constipation, hemorrhoids
    • —May compromise circulation = tissue necrosis

    —Requires surgical repair and re-suspension
  124. Vaginal vault prolapse
    • may occur in the client who has had a hysterectomy
    • - vagina turns inside out and sags downward with similar s/s —
  125. Tx for Uterine prolapse
    • —Minor uterine displacements can be treated with a pessary
    • —Kegel exercises can be beneficial for the prevention of uterine prolapse
    • —Surgery may be needed
    • —---Uterus can be suspended by surgically shortening the muscles—
    • Hysterectomy is the more common treatment unless the client wishes to bear more children
  126. —Tumors of the Reproductive System
    • 1) Benign Growths
    • 2) Polyps
    • 4) Reproductive System Cysts
  127. Benign Growths of reproductive system
    • —Fibroids or Leiomyomas
    • —-Benign tumors comprised of endometrial cells that have implanted on the wall of the uterus or within the wall of the uterus
    • —Can be very large —Can be painful
  128. Tx of benign growths
    • —Estrogen suppression- why? ** b/c they thrive on hormones to grow!
    • —MYOMECTOMY- removal of the tumor
    • —May be done thru the abdomen or the vagina or via laser laproscope
    • —Hysterectomy may be needed for very large tumors that cause severe bleeding or severe pain
  129. Polyps of repro syst
    • —Usually benign—
    • Usually grow in the uterus or on the cervix
    • —May bleed in between menstrual cycles
    • —May bleed after intercourse
    • —Generally “teardrop” shaped attached by a “neck or stalk
    • ”—Develop most often after age 40
    • —PAP to be sure they are benign—
    • Removal can be done in the office in most cases
  130. Tx of repro syst polyps
    • —Removed vaginally or trans-cervically
    • —First the stalk is separated from the uterus —
    • Bleeding is stopped by use of chemical placement, electrical placement, or (laser) CAUTERY —
    • Transcervical removal requires cervical dilation and is probably done in patient with anesthesia
    • —Vaginally, polyps may be removed in the Dr.’s office
  131. Reproductive System Cysts
    • a)Ovarian Cysts
    • b) Polycystic Ovary Syndrome
    • c) Bartholin Cysts
    • d) Dermoid Cysts
  132. Ovarian Cysts
    • -—May develop due to incomplete ovulation
    • -—May be due to hypertrophy of the corpus luteum after ovulation
    • -—May be due to inflammation of the ovary
    • —Most will shrink on their own and cause mild discomfort for a short period of time

    • —“Chocolate cysts”- formed when endometrial cells bleed into an enclosed space (like with endometriosis)
    • —Theses are brownish in color because they are filled with OLD blood —

    CYSTOADENOMAS- benign growths, can sometimes become cancerous
  133. Ovarian Cyst info
    • —MOST cysts are not surgically removed BUT…
    • —Increased size—
    • Interference in fertility—
    • High potential for cancer
    • —May require needle drainage, bx., lap surgery, or laparotomy
    • —Painful cysts may be helped with heat to the abdomen or back
    • —ANY pelvic mass in a post menopausal woman has a high risk for malignancy and MUST be investigated and treated!
    • —
  134. What can Repro system cyst cause
    • Can cause menstrual disorders —
    • Can cause pressure to be placed on the bladder or bowel
    • - causing incontinence
    • —May cause necrosis b/c of the decreased blood supply to the surrounding tissues
    • —May interfere with fertility
  135. b) Polycystic Ovary Syndrome
    • —Multiple cysts on the ovaries may be present—
    • Family history and genetics tend to increase the risk
    • —Family history of women with too little hair, severe acne, DM, irregular menses, infertility increase the risk—

    • Many of the symptoms are a result of excessive levels of insulin in the blood due to insulin resistance
    • —Excessive insulin stimulates the secretion of androgens
  136. s/s & testing for polycystic ovary syndrome
    • —S/S = infertility, obesity, menstrual disturbances
    • —May have masculine features because of excessive androgen secretion—
    • Higher risk for DM, increase Bp, CAD, and endometrial cancer—

    Testing may include temperature mapping, progesterone levels during menses, ovulation testing, endometrial bx. to determine the levels of proliferation, serum levels for lipids and glucose tolerance
  137. Treatment for ovarian cysts
    • —May involve Bp meds, lipid control meds, and oral hypoglycemics
    • —Diet and exercise if the client is obese
    • —Oral contraceptives to normalize levels of hormones
    • —Ovulation inducing medications
    • --—Antiandrogen meds for the client with masculinazation problems
  138. c) Bartholin Cysts
    • often staph is present often from staph infection—
    • Infected/obstructed Bartholin glands
    • —--Found on either side of the vaginal opening
    • —Increased swelling causes pain with intercourse and sitting
    • —I&D is usually required- “Incision and Drainage”
  139. During the I&D and care after:
    • —“Marsupialization”- surg. formation of a pouch around an opening made into a gland for help with drainage
    • —Dressing changes (sterile of course)
    • —Sitz baths for comfort and cleaning and to decrease inflammation
    • —Antibiotic therapy (broad spectrum) until after a C&S can be obtained- then specific abx. based on the bug!
  140. d) Dermoid Cysts
    • —Develops from the germinal cell of the ovary —
    • Cell divides and differentiates into various tissue types such as teeth, bone, skin, hair and extremities and may be found within the cysts —

    • May grow quite large and can occur on both ovaries at the same time
    • —Tend to be filled with thick, yellowish, sebaceous material arising from skin lining

    • —75% are benign—
    • Client typically has increased abdominal girth, especially if the cyst is large—

    —This is basically a disordered group of cells identical to other cells in the body that do not form correctly—
  141. s/s of Dermoid Cysts


    if malignant
    • pelvic fullnes, abn mensturation, abn abd girth
    • May cause low back pain and pressure

    • These are removed via lap.—
    • Hormone levels are monitored if the gland is secreting hormones
    • May take some time to normalize hormone levels

    —If malignant- esp. in post menopausal women- bx. is done and treatment is done as necessary
  142. Malignant Disorders
    • ——Growths can be benign or malignant and benign tumors can become cancerous at a later time —
    • Some meds given to pregnant women to stave of premature delivery can cause malignant tumors (especially in the reproductive organs) in male and female children of these clients
    • start watching people w/ bening tumors
  143. Vulvar Cancer

    • —Not very common
    • often starts elswhere and moves there

    —Educate to report changes in the vulvar region early to r/o possible cancers

    • s/s
    • —Persistant itching—
    • White or red patches on the vulva—
    • Skin ulcers, warts, lesions —
    • Rough patches of skin
    • dimples/red/itchy/dry/scaly patches
  144. causes of vulvar CA

    • —STD’s can increase the risks of developing cancer—
    • Smoking, immune system depression, precancer or cancer of the anal region can increase the risk for cancer

    • Regular PAP smears are important
    • —Bx. of suspicious lesions
    • —If vulvar cancer is identified- may require chemo, removal of the lesion, removal of the vulva and skin grafting for repair
  145. Cervical Cancer

    risk factor
    —Changes in the cells in the cervix —

    • Risk factors include- Sexual activity beginning at an early age, multiple sexual partners, several pregnancies, smoking, infection with HSV II or human papillomavirus
    • —-Use of oral contraceptives for many years, especially if an STD has been contracted
  146. cervical CA s/s
    • —Many women are asymptomatic for long periods of time until the cancer is very widely spread
    • —Some women c/o serousanguenous drainage or bloody drainage —

    • PAP SMEARS are the best method of screening for cervical cancer
    • - —Detects cellular changes or dysplasia
  147. PAP Smear
    • —PAP SMEARS should be done beginning at age 18 or with the beginning of sexual activity
    • —Should be done yearly* unless required to do so more often by the physician—
    • If the client has had long periods of normal PAP’s, some professionals are suggesting less frequent PAP’s than yearly for those who are low risk!—
    • The ACS states that HPV “co-testing” should be done in women 30-65—
    • --This is the HPV and PAP done in one test and every 3 years is the new recommendation

    Results in categories that range from NO atypical cells to invasive cancer cells present (O-IV)

    • —SCHILLER’s TEST- done if the client has an abnormal PAP—-
    • -The cervix is painted with iodine- dysplastic cells will color differently than those that are normal
    • —-Bx. is then done of the abnormal cells—
  148. Tx for cervical CA
    • —Preinvasive neoplasia include
    • CRYOTHERAPY- freezing of the cells, laser therapy (burning), or surgical removal of the involved area
    • —All done through the vagina (transvaginally)in Dr office
    • —There should be no douching, tampons, or intercourse for at least 2 weeks after surgery
    • —Report any s/s of infection (what are they?)—

    INVASIVE cancers may require hysterectomy, radiation implants, or chemo, etc…
  149. Endometrial Cancer
    • —Most common uterine cancer —
    • Most develop due to excessive estrogen
    • —Abrupt changes in bleeding patterns, especially in postmenopausal women
    • —Estrogen levels should be monitored
    • —Perimenopausal women- estrogen tends to fluctuate widely
    • —Obesity can increase estrogen production —Estrogen therapy for postmenopausal women without progestin therapy can increase the risk of cancer
    • —?- etoh consumption may interfere with estrogen metabolism- (but they are not sure why exactly)

    • —MRI may evaluate involvement of lymph nodes
    • Treatment depends on the stage of cancer- hysterectomy, radiation, chemo, e
  150. Ovarian CA
    —Cellular changes of the ovaries are often asymptomatic until cancer is advanced —

    • Risks MAY include low fertility and several pregnancies , late menopause, family history of reproductive or colon cancer, diet rich in animal fats —
    • Yearly bimanual exams- so regular pelvic exams are important- EVEN if no longer sexually active and if the client has had a hysterectomy
  151. Test and Tx of ovarian CA
    • —Blood testing to identify tumor markers—
    • US/CT / —MRI / PET

    • —Treatment may be removal of the ovaries—
    • Removal may also be indicated in the client who has a high risk genetically or familial tendencies—
    • What implications might this create?—Radiation and chemo may be required
  152. s/e of chemo for female CA
    • bone marrow suppresion
    • n/v
    • cystis
    • stomatis
    • slopecia
    • renal toxicity
    • procriris
    • diarreha
  153. Nursing Care for radioactive impants
    • —
    • Some clients may have placed for 24-72 hours
    • —Avoiding long periods of contact with the client with implants is educated

    • —For cervical implants- stand at the head of the bed so you have much of the clients body b/t you and the implant—
    • Follow radiation protocol as per your institution
    • Foul vaginal discharge is expected in the client with implants
    • -- b/c of the tissue destruction, non ntv obj in body,  radiation
    • —Document amount, color, pad ct, etc… —

    Chemo can cause severe n/v and anorexia, sores in the mouth, vagina and rectum

    • —Do not care for the client with radioactive implants if you are pregnant
    • —
  154. Chemo combos
    • —Common chemotherapy combinations:
    • * Please look these up and become familiar with side effects and nursing of the patient on chemo!
    • Taxol-water insoluable
    • Bloomycin- all stage CA kill
    • very toxic to lungs
    • —Cytoxan-alkylating agent s/e-cysticis, gonadal suppression
    • —Methotrexate -antimetab s/e-diahrea, proctisis, hepatotox   solid tumors in breasts 
    • —5FU- Flurorucil-antimetab
    • —Adreamycin- antitumor antibiotic s/e-anorexia, cardiac toxicity
  155. Gynecological Surgeries
    • ENDOSCOPIC—Smaller incision = less bleeding tendencies—Recuperation is more rapid—Fewer complications—Traditional surgery may be required if the tissue removal is too large to fit through the canulla of the scope
    • —LAPROSCOPE- most commonly used for the female client for reproductive surgery

    • —CULDOSCOPIES- used to access the back of the uterus—
    • CULDOTOMY- incision into the posterior portion of the vagina—
    • CULDOCENTESIS- Removal of fluid from the cul de sac of Douglas—
    • May have a small amount of vaginal spotting—
    • —COLPOSCOPY- used to screen and diagnose and treat cervical problems —
    • HYSTEROSCOPY- used to treat problems in the uterus, removal of polyps and growths —
    • Heavy, purulent, foul odorous drainage may indicate infection
    • Endoscopes can also be used to enter the fallopian tubes
  156. Education/care- s/p procedure
    • —Postop —Excessive bleeding—
    • S/S of internal bleeding:
    • —VS—
    • Skin temp. and color
    • —Monitor for pain
    • —Remember that insufflation with carbon dioxide causes abdominal, back and shoulder pain
    • —Instruct the client to lay flat for several hours after surgery if insufflation was used
    • —Remember gas rises!
    • —Massage of the back and shoulders can help
    • —Administer pain meds as needed—
    • Give discharge teaching for the client with sutures, staples, the client being d/c’d on antibiotics/pain medications
    • --make sure pt understands tching
    • Surgical incision care per orders
  157. Hysterectomy
    • —Removal of the uterus
    • —For sterilization- tubal ligation has much fewer risks!—
    • Usually done via abdominal surgery, may be done vaginally—
    • Nerve routes are maintained in the vagina after a hysterectomy, bur lubrication is decreased, EDUCATE!
    • ——Removal of the ovaries is usually done for cancer, so estrogen replacement is not usually indicated—
    • Remember that some women consider this a loss of femininity!

    • TAH- uterus, ovaries, and fallopian tubes are removed—
    • Bilateral Salpingooophorectomy (TAH-BSO)- as above!-(radical)/Panhysterectomy-
  158. nurse care for hystorectoy
    • —Educate preop —Post-op = VS, oxygenation
    • —TCDBE—
    • Monitor for bleeding—
    • Monitor peri pads for amount of bleeding –I/O—-unless contraindiacted
    • Strict I&O requires weighing and measuring each pad!—
    • Monitor for any s/s of infection
    • Assess for wound healing

    • —Patient can have HOB elevated but should not be placed in high fowler after surgery to prevent pelvic congestion
    • —Assess urinary output- report if less than 30mL/hr or unable to void
    • —Check your policy- after surgery, usually need to void within 8 hours-
    • if NOT, call Dr.- may need to bladder scan and catheterize—

    • Usually started on C/L and then advanced as tolerated
    • Encourage increased fluids and high fiber diet
    • —Encourage early ambulation—
    • Remember that pain meds can cause decreased bowel sounds and up constipation
    • —Increase po fluid (H2O) intake
    • —Stool softeners/ laxatives—
    • Breast and abdominal surgeries = NO heavy lifting
    • —Follow Dr. orders—
    • ALWAYS keep follow up visits
    • —Take meds as directed
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2013-07-22 06:15:10
Femal male

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