Slide 1 Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1 1 EFREN...

11

Slide 1Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1

EFREN N. AQUINO M.D.EFREN N. AQUINO M.D.

Sept. 29, 2009Sept. 29, 2009

Chapter 52Chapter 52

Care of the Patient with a Care of the Patient with a Reproductive Disorder Part 1Reproductive Disorder Part 1

Chapter 52Chapter 52

Care of the Patient with a Care of the Patient with a Reproductive Disorder Part 1Reproductive Disorder Part 1

22


LEARNING OBJECTIVESLEARNING OBJECTIVES

1.1. Know and understand the disorders Know and understand the disorders of the female reproductive systemof the female reproductive system

2.2. Know and understand how to care Know and understand how to care for female patients with for female patients with reproductive disorders.reproductive disorders.

3.3. Remember …Remember …

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Conception and birth are made Conception and birth are made possible through the dynamics of the possible through the dynamics of the normally functioning male and female normally functioning male and female reproductive systems. reproductive systems.

Reproduction of like individuals is Reproduction of like individuals is necessary for the continuation of the necessary for the continuation of the species. species.

The male and female sex glands The male and female sex glands (gonads) produce the gametes (sperm, (gonads) produce the gametes (sperm, ova) that unite to form a fertilized egg ova) that unite to form a fertilized egg (zygote), the beginning of a new life.(zygote), the beginning of a new life.

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55


Overview of Anatomy and Overview of Anatomy and PhysiologyPhysiology

Female reproductive systemFemale reproductive systemOvaries – almond size, contains the ovumOvaries – almond size, contains the ovumFallopian tubes – 10 cm., fimbriae, Fallopian tubes – 10 cm., fimbriae,

peristalsisperistalsisUterus – 2.5x3x5 cm, 3 layers, 3 partsUterus – 2.5x3x5 cm, 3 layers, 3 partsVagina – 3 cm, rugaeVagina – 3 cm, rugae

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Sectioned view of the uterus showing relationship to the ovaries and vagina.

77


Location of the female reproductive organs in the pelvis.

(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mosby.)

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Female Reproductive SystemFemale Reproductive System

The reproductive structures located The reproductive structures located outside the body are the external outside the body are the external genitalia, or vulva. These structures genitalia, or vulva. These structures include the mons pubis, labia majora, include the mons pubis, labia majora, labia minora, clitoris, and vestibulelabia minora, clitoris, and vestibuleAccessory glands Accessory glands – – secretes mucussecretes mucus

Skene’s glands - paraurethralSkene’s glands - paraurethralBartholin’s glands – para vaginalBartholin’s glands – para vaginal

Perineum – symphysis pubis to anusPerineum – symphysis pubis to anus Obstetrical or true perineum is Obstetrical or true perineum is

between between vagina and anusvagina and anusMammary glands (breasts)Mammary glands (breasts)

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1010


1111


The Menstrual CycleThe Menstrual Cycle

• Controlled by pituitary hormones regulated by hypothalamus

• Cyclic pattern• Regulated by hormonal feedback• Averages 28 days

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Beginning of the Cycle• Several follicles in the ovary begin to

develop but usually only one releases an ovum

• Increased production of estrogen• Thickens endometrium• Elongates glands that produce uterine

secretion • Negative feedback that inhibits release

of FSH• Stimulates pituitary to release LH

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Ovulation

• LH surge in blood • Causes ovulation – out goes the ovum• Transforms ruptured follicle into

corpus luteum that produces estrogen and mostly progesterone

• Endometrium thickens• Glands and blood vessels increase in size• FSH and LH are inhibited while the ovum

makes its journey in the oviduct

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1616


What are the two hormones produced in the ovaries?

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The Menstrual Phase

• If ovum is not fertilized, corpus luteum degenerates• Estrogen, progesterone levels

decrease• Endometrium degenerates, produces

menstrual flow where it bleeds and weeps

• Endometrium begins to repair itself• FSH released from anterior pituitary

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The Menstrual Phase – Month after month the process

goes on until the ovary grows tired and finally says enough.. no more production of estrogen.. no more ovulation.. no more progesterone, I’m not waiting for Mr. Right anymore … and the woman grows old.

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MenopauseMenopauseMenstruation ceases• Normal ovarian function declines

• Follicles stop ripening• No appreciable amounts of

estrogen produced• Uterus, oviducts, vagina, vulva

become somewhat atrophied• Vaginal mucosa becomes thinner,

dryer, more sensitive

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THE REPRODUCTIVE CYCLETHE REPRODUCTIVE CYCLEMenarche – first menstrual flowMenarche – first menstrual flow28 – day cycle28 – day cycle

Menstrual: 1-5 days – endometrial bleedingMenstrual: 1-5 days – endometrial bleedingPre ovulatory: 6-13 days – ovum maturesPre ovulatory: 6-13 days – ovum maturesOvulation: 14Ovulation: 14thth day – LH is released and day – LH is released and

Graafian follicle ruptures/expelled – C. Graafian follicle ruptures/expelled – C. luteumluteum

Post ovulatory: 15 – 28 days – C. Luteum to Post ovulatory: 15 – 28 days – C. Luteum to C. albicansC. albicans

Graafian follicle – Graafian follicle – structure that nurtures structure that nurtures the the ovum during development and maturityovum during development and maturity

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The REPRODUCTIVE CYCLEThe REPRODUCTIVE CYCLE Menarche: the beginning of mensesMenarche: the beginning of menses

Occurs from 9-17 (12 ½)Occurs from 9-17 (12 ½) Regular menstrual flow occurs in 24 – 32 days Regular menstrual flow occurs in 24 – 32 days

( Ave=28 day)( Ave=28 day)Flow = 1-8 days (ave=3-5 days)Flow = 1-8 days (ave=3-5 days)Amount of flow = 10-75 mL (ave=35 mL)Amount of flow = 10-75 mL (ave=35 mL)Aging and the REPRODUCTIVE CYCLEAging and the REPRODUCTIVE CYCLE

Menopause – Cessation of menstrual flow and Menopause – Cessation of menstrual flow and hormones decrease, at about 35 – 65 y/o hormones decrease, at about 35 – 65 y/o Hot flushes – low estrogenHot flushes – low estrogenVagina – inelasticVagina – inelasticBreast and vulva – loss of turgorBreast and vulva – loss of turgor

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Human SexualityHuman SexualitySexual identitySexual identity

The sense of being feminineThe sense of being feminine Influences on sexual healthInfluences on sexual health

Overall wellness includes sexual health, Overall wellness includes sexual health, and sexuality should be part of the health and sexuality should be part of the health care programcare program

Illness and sexualityIllness and sexualityIllness may cause changes in a patient’s Illness may cause changes in a patient’s

self-concept and result in an inability to self-concept and result in an inability to function sexuallyfunction sexually

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SEXUAL IDENTITYSEXUAL IDENTITYBiologic identity, or the differences Biologic identity, or the differences

between men and women, is between men and women, is established at conception and further established at conception and further influenced at puberty by the effects of influenced at puberty by the effects of hormones. hormones.

Gender identity is the sense of being Gender identity is the sense of being feminine or masculine. feminine or masculine. Gender role is the manner in which Gender role is the manner in which

a person acts as a woman or man.a person acts as a woman or man.

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SEXUAL IDENTITYSEXUAL IDENTITYBiologic identityBiologic identityGender identityGender identityTranssexuals - the inward sense of Transsexuals - the inward sense of

sexual identity does not match the sexual identity does not match the biologic body. biologic body.

A transvestite is most often a A transvestite is most often a heterosexual man who periodically heterosexual man who periodically dresses like a woman. dresses like a woman.

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Laboratory and Diagnostic Laboratory and Diagnostic ExaminationsExaminations

Diagnostic tests for the femaleDiagnostic tests for the femaleColposcopy; culdoscopy; laparoscopy: Colposcopy; culdoscopy; laparoscopy:

visualization of structures using scopesvisualization of structures using scopesPapanicolaou (Pap) smear: 18 y/o (ACS)Papanicolaou (Pap) smear: 18 y/o (ACS)Biopsies: breast, cervical, endometrial: Biopsies: breast, cervical, endometrial:

benign or malignantbenign or malignantConization: removal of eroded areasConization: removal of eroded areasDilation and curettage (D & C): scraping Dilation and curettage (D & C): scraping

of materials from uterusof materials from uterus

2828


Diagnostic tests for the femaleDiagnostic tests for the femaleCultures and smears: Identify infectious Cultures and smears: Identify infectious

microorganismsmicroorganismsSchiller’s iodine test: Iodine stain is used Schiller’s iodine test: Iodine stain is used

but has been found to be not so reliable.but has been found to be not so reliable.Hysterograms: contrast mediaHysterograms: contrast mediaMammography: Breast examination Mammography: Breast examination Pelvic ultrasonography: safe, non invasivePelvic ultrasonography: safe, non invasiveTubal insufflation (Rubin’s test): CO2 Tubal insufflation (Rubin’s test): CO2 Pregnancy test: Human chorionic Pregnancy test: Human chorionic

gonadotropingonadotropinSerum CA-125: Follow up of ovarian Serum CA-125: Follow up of ovarian

cancer recurrence.cancer recurrence.

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Pap Test Interpretation Classifications and Action

InterpretationNumerical

SystemDysplasia Cytologic

Classification

Cervical Intraepithelial

Neoplasia (CIN)

Classification

BethesdaSystem

Action

Negative (Normal)

Class I Negative squamous metaplasia

No designation Negative (Normal)

Repeat annually

Probably negative, may indicate infection

Class II Atypical squamous cells

No designation InfectionAtypical squamous cellsReactive changes

Treat infection, repeat Pap

Suspicious, but not conclusive for malignancy

Class III Mild dysplasiaModerate

CIN ICIN II

Low-grade squamous intraepithelial lesion

Treat infection, repeat Pap in 8-12 weeks; colposcopy

More suspicious, strongly suggestive of malignancy

Class IV Severe dysplasiaCarcinomaIn situ

CIN III High-grade squamous intraepithelial lesion.

Colposcopy, biopsy, treatment

Conclusive for malignancy

Class V Invasive carcinoma

Invasive carcinoma

Invasive squamous cell carcinoma

Colposcopy, biopsy, treat with conization, hysterectomy

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Disorders of the Female Reproductive Disorders of the Female Reproductive SystemSystem

A.A. Disturbance of Menstrual cycleDisturbance of Menstrual cycle1. Amenorrhea1. Amenorrhea2. Dysmenorrhea2. Dysmenorrhea3. Menorrhagia3. Menorrhagia4. Metrorrhagia4. Metrorrhagia

B. Premenstrual SyndromeB. Premenstrual SyndromeC. InfertilityC. InfertilityD. InfectionsD. Infections

1. Simple Vaginitis1. Simple Vaginitis 3. Cervicitis3. Cervicitis2. Senile vaginitis 2. Senile vaginitis 4. PID4. PID 5. TSS5. TSS

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E. EndometriosisE. EndometriosisF. Vaginal FistulaF. Vaginal FistulaG. Relaxed pelvic musclesG. Relaxed pelvic muscles

1. Displaced uterus1. Displaced uterus2. Uterine prolapse – cystocele, rectocele2. Uterine prolapse – cystocele, rectocele

H. Leimyomas of the uterusH. Leimyomas of the uterusG. Ovarian CystG. Ovarian CystH. Cancer H. Cancer

1. Cervical cancer1. Cervical cancer 3. Ovarian cancer3. Ovarian cancer2. Endometrial cancer2. Endometrial cancer

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I. Surgical proceduresI. Surgical procedures1. Hysterectomy: TAH-BSO or also 1. Hysterectomy: TAH-BSO or also

called panhysterosalphingo-called panhysterosalphingo-oophorectomyoophorectomy

a. Vaginal hysterectomya. Vaginal hysterectomyb. Abdominal hysterectomyb. Abdominal hysterectomy

J. Disorders of the female breastJ. Disorders of the female breast1. Fibrocystic Breast condition1. Fibrocystic Breast condition2. Acute/Chronic mastitis2. Acute/Chronic mastitis3. Breast cancer3. Breast cancer

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K. Sexually Transmitted Diseases1. Genital Herpes2. Syphilis3. Gonorrhea4. Trichomoniasis5. Candidiasis6. Chlamydia7. HIV/AIDS

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Disturbance in Menstrual CycleDisturbance in Menstrual CycleAmenorrheaAmenorrhea

Etiology/pathophysiologyEtiology/pathophysiologyAbsent or suppressed menstrual flowAbsent or suppressed menstrual flow

Clinical manifestations/assessmentClinical manifestations/assessmentPrimary or secondaryPrimary or secondary

No menstrual flow for at least 3 No menstrual flow for at least 3 monthsmonths

Medical management/nursing Medical management/nursing interventionsinterventionsBased on underlying causeBased on underlying causeHormone replacement may be Hormone replacement may be

necessarynecessary

3535


Dysmenorrhea - Dysmenorrhea - Uterine pain with menstruation

• Etiology/pathophysiology• Primary or secondary: endometriosis/PID

• Clinical manifestations/assessment• Colicky, cyclic pain; dull pain in the lower

pelvis (menstrual cramps)• Breast tenderness; headache• Abdominal distention• Nausea and vomiting• Vertigo, Palpitations• Excessive perspiration

3636


Dysmenorrhea Dysmenorrhea (continued)(continued)Medical management/nursing Medical management/nursing

interventionsinterventionsProstaglandin inhibitorsProstaglandin inhibitorsMild analgesicsMild analgesicsOral contraceptivesOral contraceptivesExerciseExerciseNutritious foods, high in fiberNutritious foods, high in fiberHeat to pelvic areaHeat to pelvic area

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Abnormal uterine bleedingAbnormal uterine bleedingMenorrhagiaMenorrhagia

Excessive bleeding during the regular Excessive bleeding during the regular menstrual flowmenstrual flow

Causes: endocrine disorders; Causes: endocrine disorders; inflammatory disturbances; uterine inflammatory disturbances; uterine tumorstumors

MetrorrhagiaMetrorrhagiaUterine bleeding between regular Uterine bleeding between regular

menstrual periods or after menopausemenstrual periods or after menopauseMay indicate cancer or benign tumors May indicate cancer or benign tumors

of the uterusof the uterus

3838


Premenstrual syndrome (PMS)Premenstrual syndrome (PMS)Etiology/pathophysiologyEtiology/pathophysiology

Related to the neuroendocrine events Related to the neuroendocrine events occurring within the anterior pituitary occurring within the anterior pituitary glandgland

Genetic predispositionGenetic predispositionNutritional deficiency in pyridoxine (vit B6) Nutritional deficiency in pyridoxine (vit B6)

or magnesiumor magnesiumClinical manifestations/assessmentClinical manifestations/assessment

Behavioral: mood swings, irritability, Behavioral: mood swings, irritability, lethargy, fatigue sleep disturbances; lethargy, fatigue sleep disturbances; depressiondepression

Prementrual dysphoric disorders: severe Prementrual dysphoric disorders: severe mood disorder in addition to PMSmood disorder in addition to PMS

3939


Premenstrual syndrome (PMS)Premenstrual syndrome (PMS)Clinical manifestations/assessmentClinical manifestations/assessment

Physical: Physical: Headache; backache; breast Headache; backache; breast

tendernesstendernessAbdominal distentionAbdominal distentionAcne and paresthesiaAcne and paresthesiaHas no relation to ovulationHas no relation to ovulation

PMS occurs 7-10 days before PMS occurs 7-10 days before menstruation and subsides 3 days after menstruation and subsides 3 days after the onset of menstrual flowthe onset of menstrual flow

4040


Premenstrual syndrome (PMS) Premenstrual syndrome (PMS) (continued)(continued)Medical management/nursing interventionsMedical management/nursing interventions

Analgesics; diuretics; progesteroneAnalgesics; diuretics; progesteroneDiet Diet

High in complex carbohydratesHigh in complex carbohydratesModerate in proteinModerate in proteinLow in refined sugar and sodiumLow in refined sugar and sodiumLimit caffeine, chocolate, and alcoholLimit caffeine, chocolate, and alcohol

Reduce or eliminate smokingReduce or eliminate smokingExercise; adequate rest, sleep, and Exercise; adequate rest, sleep, and

relaxationrelaxationPMD-D: AntidepressantsPMD-D: Antidepressants

4141


Menopause:Menopause: cessation of menstrual flow cessation of menstrual flowEtiology/pathophysiologyEtiology/pathophysiology

The normal decline of ovarian function The normal decline of ovarian function resulting from the aging processresulting from the aging process

May be induced by irradiation of the May be induced by irradiation of the ovaries or surgical removal of both ovaries or surgical removal of both ovariesovaries

Not considered complete until 1 year Not considered complete until 1 year after the last menstrual periodafter the last menstrual period

Climacteric: Phase of the aging process of Climacteric: Phase of the aging process of women and men who are making a women and men who are making a transition from a reproductive phase to a transition from a reproductive phase to a nonreproductive stage of life nonreproductive stage of life

4242


MenopauseMenopauseClinical manifestations/assessmentClinical manifestations/assessment

Decrease in frequency, amount, and Decrease in frequency, amount, and duration of the normal menstrual flowduration of the normal menstrual flow

Shrinkage of vulval structures; Shrinkage of vulval structures; shortening of the vaginashortening of the vagina

Dryness of the vaginal wall; pelvic Dryness of the vaginal wall; pelvic relaxationrelaxation

Dyspareunia (painful intercourse) Dyspareunia (painful intercourse) Loss of skin turgor and elasticityLoss of skin turgor and elasticityIncreased subcutaneous fat; decreased Increased subcutaneous fat; decreased

breast tissue; thinning of hairbreast tissue; thinning of hairOsteoporosisOsteoporosis

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Menopause Menopause (continued)(continued)Medical management/nursing interventionsMedical management/nursing interventions

Hormonal Replacement Therapy (HRT) Hormonal Replacement Therapy (HRT) Estrogen therapyEstrogen therapy

PremarinPremarinProveraProveraADVERSE EFFECTS: risk for ischemic ADVERSE EFFECTS: risk for ischemic

stroke, CAD, breast cancer, ovarian stroke, CAD, breast cancer, ovarian cancer, thromboembolism, cognitive cancer, thromboembolism, cognitive declinedecline

Recommendation: short term low Recommendation: short term low dosagedosage

Calcium supplementsCalcium supplementsKegel ExerciseKegel Exercise

4444


InfertilityInfertilityEtiology/pathophysiologyEtiology/pathophysiology

Inability to conceive after 1 year of Inability to conceive after 1 year of sexual intercourse without birth controlsexual intercourse without birth control

Diagnostic procedures for both partnersDiagnostic procedures for both partnersR/O Systemic diseases, endocrine etc.R/O Systemic diseases, endocrine etc.

Medical management/nursing interventionsMedical management/nursing interventionsDepends on the causeDepends on the cause

Hormone therapyHormone therapyRepair occlusionRepair occlusionIntrauterine inseminationIntrauterine inseminationIn vitro fertilizationIn vitro fertilizationCall a friendCall a friend

4545


Infections of the Female Infections of the Female Reproductive TractReproductive Tract

Simple vaginitisSimple vaginitisEtiology/pathophysiologyEtiology/pathophysiology

Common vaginal infectionCommon vaginal infectionCausitive organisms: Causitive organisms: E. coliE. coli; ;

staphylococcal; streptococcal; staphylococcal; streptococcal; T. T. vaginalisvaginalis; ; C. albicansC. albicans; Gardnerella; Gardnerella

Clinical manifestations/assessmentClinical manifestations/assessmentInflammation of the vaginaInflammation of the vaginaYellow, white, or grayish white, curd-like Yellow, white, or grayish white, curd-like

dischargedischargePruritus and vaginal burningPruritus and vaginal burning

4646


Simple vaginitis Simple vaginitis (continued)(continued)Medical managementMedical management

DouchingDouchingVaginal suppositories, ointments, and Vaginal suppositories, ointments, and

creamscreamsOrganism-specificOrganism-specific

Sitz bathsSitz bathsAbstain from sexual intercourse during Abstain from sexual intercourse during

treatmenttreatmentTreat partner if necessary to prevent Treat partner if necessary to prevent

the ping-pong occurrence the ping-pong occurrence

4747


Simple vaginitis Simple vaginitis (continued)(continued)Nursing interventions - The nurse should Nursing interventions - The nurse should

advise the patient of the importance of advise the patient of the importance of handwashing before and after vaginal handwashing before and after vaginal applications. Applications of heat in the applications. Applications of heat in the form of douches, perineal irrigations, or form of douches, perineal irrigations, or sitz baths may be administered. Douching sitz baths may be administered. Douching too frequently can alter normal vaginal too frequently can alter normal vaginal flora.flora.

4848


SENILE OR ATROPHIC VAGINITISSENILE OR ATROPHIC VAGINITISThis condition occurs in women after This condition occurs in women after

menopause and upon aging. Low menopause and upon aging. Low estrogen levels cause the vulva and estrogen levels cause the vulva and vagina to atrophy and become vagina to atrophy and become susceptible to the invasion of bacteria. susceptible to the invasion of bacteria. The exudates causes pruritus, edema The exudates causes pruritus, edema and skin irritations.and skin irritations.

Medical management: Medical management: Estrogen, vaginal suppositories, and Estrogen, vaginal suppositories, and

ointments may be prescribed.ointments may be prescribed.

4949


Cervicitis:Cervicitis: Infection of the cervix Infection of the cervixEtiology/pathophysiologyEtiology/pathophysiology

Chlamydia trachomatis, gonorrhea, Chlamydia trachomatis, gonorrhea, Herpes 2 and trichomoniasisHerpes 2 and trichomoniasis

Clinical manifestations/assessmentClinical manifestations/assessmentBackacheBackacheWhitish exudateWhitish exudateMenstrual irregularitiesMenstrual irregularities

Medical management/nursing interventionsMedical management/nursing interventionsVaginal suppositories, ointments, and Vaginal suppositories, ointments, and

creams; organism-specificcreams; organism-specificPersonal hygiene and frequent warm tub Personal hygiene and frequent warm tub

baths can minimize odor and discomfort.baths can minimize odor and discomfort.

5050


Pelvic Inflammatory Disease (PID)Pelvic Inflammatory Disease (PID)Etiology/pathophysiologyEtiology/pathophysiology

Any acute, subacute, recurrent, or Any acute, subacute, recurrent, or chronic infection of the cervix chronic infection of the cervix (cervicitis), uterus (endometritis), (cervicitis), uterus (endometritis), fallopian tubes (salphingitis), and fallopian tubes (salphingitis), and ovaries (oophoritis) that has extended ovaries (oophoritis) that has extended to the connective tissues to the connective tissues

Most common causative organismsMost common causative organismsNeisseria gonorrhea; Neisseria gonorrhea; streptococcus; staphylococcus; streptococcus; staphylococcus; Chlamydia; Chlamydia; tubercle bacillitubercle bacilli

5151


Pelvic inflammatory disease (PID)Pelvic inflammatory disease (PID)Etiology/pathophysiologyEtiology/pathophysiology

CausesCausesBiopsy curette, irrigation catheter, Biopsy curette, irrigation catheter,

abortion, pelvic surgery, sexual abortion, pelvic surgery, sexual intercourse (especially with multiple intercourse (especially with multiple partners); or infection during partners); or infection during pregnancy.pregnancy.

5252


Pelvic inflammatory disease (PID) Pelvic inflammatory disease (PID) (continued)(continued)Clinical manifestations/assessmentClinical manifestations/assessment

Fever and chillsFever and chillsSevere abdominal painSevere abdominal painMalaiseMalaiseNausea and vomitingNausea and vomitingMalodorous purulent vaginal exudateMalodorous purulent vaginal exudate

Medical management/nursing interventionsMedical management/nursing interventionsAntibiotics; analgesicsAntibiotics; analgesicsBedrestBedrestUse universal precautions – goggles if Use universal precautions – goggles if

necessarynecessary

5353


Nursing Interventions and Patient TeachingNursing Interventions and Patient Teaching(1) follow the medical plan of treatment;(1) follow the medical plan of treatment;(2) monitor vital signs and progress of (2) monitor vital signs and progress of

treatmenttreatment(3) provide fluids to avoid dehydration; (3) provide fluids to avoid dehydration; (4) perform palliative measures for (4) perform palliative measures for

comfort in bathing, changing of perineal comfort in bathing, changing of perineal pads, personal hygiene, and warm pads, personal hygiene, and warm douchesdouches

(5) provide patient support with a positive, (5) provide patient support with a positive, nonjudgmental attitude; and nonjudgmental attitude; and

(6) position the patient in Fowler’s position (6) position the patient in Fowler’s position to facilitate drainage.to facilitate drainage.

5454


Toxic shock syndromeToxic shock syndromeEtiology/pathophysiologyEtiology/pathophysiology

Acute bacterial infection caused by Acute bacterial infection caused by Staphylococcus aureusStaphylococcus aureus

Usually occurs in women who are using Usually occurs in women who are using tampons during menstruationtampons during menstruation

If the tampon is left in place too long, If the tampon is left in place too long, the bacteria may proliferate and the bacteria may proliferate and release toxins into the bloodstream, release toxins into the bloodstream, causing TSS.causing TSS.

TSS can also occur in non-TSS can also occur in non-menstruating women.menstruating women.

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Toxic shock syndrome Toxic shock syndrome (continued)(continued)Clinical manifestations/assessmentClinical manifestations/assessment

Usually occurs between days 2 and 4 of Usually occurs between days 2 and 4 of the menstrual periodthe menstrual period

Flu-like symptoms; sore throat; Flu-like symptoms; sore throat; headacheheadache

Red macular palmar or diffuse rashRed macular palmar or diffuse rashDecreased urinary output; BUN elevatedDecreased urinary output; BUN elevatedPulmonary edemaPulmonary edema

Medical management/nursing interventionsMedical management/nursing interventionsAntibiotics; IV fluid therapy; oxygenAntibiotics; IV fluid therapy; oxygenSuperabsorbent tampons should not be Superabsorbent tampons should not be

used.used.

5656


Nursing Interventions and Patient Nursing Interventions and Patient TeachingTeaching

When the patient is hospitalized, bed When the patient is hospitalized, bed rest is prescribed and antibiotics are rest is prescribed and antibiotics are administered. administered.

Close monitoring of vital signs and Close monitoring of vital signs and fluid status is important. fluid status is important.

If there is respiratory distress, If there is respiratory distress, oxygen therapy is instituted.oxygen therapy is instituted.

5757


PrognosisPrognosisTSS is a rare and sometimes fatal TSS is a rare and sometimes fatal

disease. Prognosis depends on the disease. Prognosis depends on the severity of the disease and how severity of the disease and how quickly therapeutic measures to quickly therapeutic measures to combat shock and renal failure, if combat shock and renal failure, if present, are instituted.present, are instituted.

5858



EndometriosisEndometriosisEtiology/pathophysiologyEtiology/pathophysiology

Endometrial tissue appears outside the Endometrial tissue appears outside the uterusuterus

The tissue responds to the normal The tissue responds to the normal stimulation of the ovaries; bleeds each stimulation of the ovaries; bleeds each monthmonth

5959



EndometriosisEndometriosisClinical manifestations/assessmentClinical manifestations/assessment

Lower abdominal and pelvic painLower abdominal and pelvic painMay radiate to lower back, legs, and groinMay radiate to lower back, legs, and groin

Medical management/nursing interventionsMedical management/nursing interventionsAntiovulatory medications - Antiovulatory medications - Synthetic Synthetic

androgens such as danazol to arrest androgens such as danazol to arrest proliferation of the endometrium and prevent proliferation of the endometrium and prevent ovulationovulation

pregnancypregnancyLaparoscopy; total hysterectomyLaparoscopy; total hysterectomy

6060

Slide 60Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 60Common sites of endometriosis.

(From Herbst, A.L., et al. [1992]. Comprehensive gynecology. [2nd ed.]. St. Louis: Mosby.)

6161


Nursing Interventions and Patient TeachingNursing Interventions and Patient TeachingReinforce the physician’s explanation of Reinforce the physician’s explanation of

the expected results of treatment, the expected results of treatment, instruct the patient regarding the instruct the patient regarding the dosage, frequency, and side effects of dosage, frequency, and side effects of prescribed medications; and emphasize prescribed medications; and emphasize the importance of regular checkups and the importance of regular checkups and of reporting abnormal vaginal bleeding. of reporting abnormal vaginal bleeding.

Encourage patient to verbalize her Encourage patient to verbalize her concerns and assist the patient with concerns and assist the patient with comfort measures and help her with comfort measures and help her with adaptive responsesadaptive responses

6262


PrognosisPrognosisApproximately half of the women with Approximately half of the women with

endometriosis are infertile. If a young endometriosis are infertile. If a young woman has endometriosis, she is woman has endometriosis, she is usually advised to have a family early, usually advised to have a family early, because the fertility rate is low. because the fertility rate is low. Menopause stops the progress of Menopause stops the progress of endometriosis.endometriosis.

6363


Vaginal FistulaVaginal FistulaEtiology/pathophysiologyEtiology/pathophysiology

Abnormal opening between the vagina Abnormal opening between the vagina and another organand another organ

Clinical manifestations/assessmentClinical manifestations/assessmentUrine and/or feces being expelled from Urine and/or feces being expelled from

vaginavaginaMedical management/nursing Medical management/nursing

interventionsinterventionsOral or parenteral antibioticsOral or parenteral antibioticsDiet: high protein; increase vitamin CDiet: high protein; increase vitamin CSurgery: repair fistula; urinary or fecal Surgery: repair fistula; urinary or fecal

diversiondiversion

6464


Types of fistulas that may develop in the vagina and uterus.

6565


Nursing InterventionsNursing InterventionsSoiling from leakage of urine or stool Soiling from leakage of urine or stool

into the vagina is disturbing for the into the vagina is disturbing for the patient.patient.

Sitz baths, deodorizing douches, Sitz baths, deodorizing douches, perineal pads, and protective perineal pads, and protective undergarments are necessary. undergarments are necessary.

If the fistula is repaired surgically, a If the fistula is repaired surgically, a Foley catheter is inserted Foley catheter is inserted postoperatively to prevent strain on postoperatively to prevent strain on the suture line by a full bladder.the suture line by a full bladder.

6666


Displaced UterusDisplaced UterusEtiology/pathophysiologyEtiology/pathophysiology

CongenitalCongenitalChildbirthChildbirthBackward displacementBackward displacement

RetroversionRetroversionRetroflexionRetroflexion

Forward displacementForward displacementAnteversionAnteversionAnteflexionAnteflexion

Relaxed Pelvic MusclesRelaxed Pelvic MusclesRelaxed Pelvic MusclesRelaxed Pelvic Muscles

6767


Displaced uterus Displaced uterus (continued)(continued)Clinical manifestations/assessmentClinical manifestations/assessment

BackacheBackacheMuscle strainMuscle strainLeukorrheal dischargeLeukorrheal dischargeHeaviness in the pelvic areaHeaviness in the pelvic areaPatient tires easilyPatient tires easily

Medical management/nursing Medical management/nursing interventionsinterventionsPessary – doughnut shaped ring placed Pessary – doughnut shaped ring placed

in the vaginain the vaginaUterine suspensionUterine suspension

6868


Etiology/pathophysiologyEtiology/pathophysiologyProlapse of the uterus through the Prolapse of the uterus through the

pelvic floor and vaginal openingpelvic floor and vaginal openingClinical manifestations/assessmentClinical manifestations/assessment

Fullness in vaginal area – something is Fullness in vaginal area – something is coming down (cystocele or rectocele)coming down (cystocele or rectocele)

BackacheBackacheBowel or bladder problemsBowel or bladder problemsProtrusion of cervix and vaginal walls Protrusion of cervix and vaginal walls

in perineal areain perineal area

Uterine ProlapseUterine ProlapseUterine ProlapseUterine Prolapse

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Prolapse of the uterusProlapse of the uterus through the through the pelvic pelvic floor and vaginal outlet:floor and vaginal outlet:First-degree (the cervix comes down to First-degree (the cervix comes down to

the introitus [an entrance to a cavity, as the introitus [an entrance to a cavity, as in the vaginal introitus]), in the vaginal introitus]),

Second-degree (the cervix protrudes Second-degree (the cervix protrudes through the introitus), or through the introitus), or

Third-degree prolapse – procidentia (the Third-degree prolapse – procidentia (the entire uterus protrudes through the entire uterus protrudes through the introitus) introitus)

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Uterine prolapse, A. Normal B. 1st degree prolapse C. 2nd degree D. 3rd degree (procidentia)

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Prolapse of the uterusProlapse of the uterus through the through the pelvic floor and vaginal outlet:pelvic floor and vaginal outlet:Medical management/nursing Medical management/nursing

interventionsinterventionsPessaryPessarySurgerySurgery

Vaginal hysterectomyVaginal hysterectomyAnteroposterior colporrhaphy - Anteroposterior colporrhaphy -

(suture of the vagina). (suture of the vagina).

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Etiology/pathophysiologyEtiology/pathophysiologyCystoceleCystocele

Displacement of the bladder Displacement of the bladder into the vaginainto the vagina

RectoceleRectoceleRectum moves toward posterior Rectum moves toward posterior vaginal wallvaginal wall

Cystocele and RectoceleCystocele and RectoceleCystocele and RectoceleCystocele and Rectocele

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Cystocele Rectocele

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Cystocele: another viewCystocele: another view

View from outsideView from outside what’s happening what’s happening insideinside

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RectoceleRectocele

View from outsideView from outside what’s happening insidewhat’s happening inside

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Clinical manifestations/assessment Clinical manifestations/assessment CystoceleCystocele

Urinary urgency, frequency, and Urinary urgency, frequency, and incontinence; pelvic pressure, cystitisincontinence; pelvic pressure, cystitis

RectoceleRectoceleConstipation; rectal pressure; heaviness Constipation; rectal pressure; heaviness

hemorrhoidshemorrhoidsMedical management/nursing Medical management/nursing

interventionsinterventionsSurgical repairSurgical repair

Anteroposterior colporrhaphy; bladder Anteroposterior colporrhaphy; bladder suspensionsuspension

Cystocele and rectocele Cystocele and rectocele (cont)(cont)Cystocele and rectocele Cystocele and rectocele (cont)(cont)

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COLPORRHAPY

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Nursing interventions and patient Nursing interventions and patient teaching.teaching.

Preoperative care for colporrhaphy is Preoperative care for colporrhaphy is especially important in ensuring as clean especially important in ensuring as clean an operative area as possible. an operative area as possible.

Patients may be given a cathartic Patients may be given a cathartic followed by enemas to be sure the bowel followed by enemas to be sure the bowel is completely empty. is completely empty.

A liquid diet for 48 hours before surgery A liquid diet for 48 hours before surgery will help keep the bowel empty. will help keep the bowel empty.

A cleansing vaginal douche is given the A cleansing vaginal douche is given the evening before and the morning of evening before and the morning of surgery. surgery.

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Nursing interventions and patient Nursing interventions and patient teaching. teaching.

Postoperative care includes checking Postoperative care includes checking vital signs and observing for vital signs and observing for hemorrhage. hemorrhage.

A retention catheter is usually inserted A retention catheter is usually inserted into the bladder to keep it empty and into the bladder to keep it empty and prevent pressure on sutures. prevent pressure on sutures.

It is important to keep the fecal residue It is important to keep the fecal residue as soft as possible; some physicians as soft as possible; some physicians order only liquids for several days, or order only liquids for several days, or they may order mineral oil to be given they may order mineral oil to be given every night. every night.

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Nursing interventions and patient Nursing interventions and patient teaching. teaching.

An oil retention enema maybe ordered, An oil retention enema maybe ordered, but cleansing enemas are not given. but cleansing enemas are not given.

The patient’s perineal area is cleansed The patient’s perineal area is cleansed carefully using surgical asepsis. carefully using surgical asepsis.

Early ambulation is also encouraged.Early ambulation is also encouraged.The patient should be advised against The patient should be advised against

standing for long periods or lifting standing for long periods or lifting heavy objects. heavy objects.

Coitus must be avoided until healing Coitus must be avoided until healing occurs, usually after about 6 weeks.occurs, usually after about 6 weeks.

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Description:Description:Leiomyomas (fibroids, myomas) are Leiomyomas (fibroids, myomas) are

the most common benign tumors of the most common benign tumors of the female genital tract. Fibroids are the female genital tract. Fibroids are benign tumors arising from the muscle benign tumors arising from the muscle tissue of the uterus. tissue of the uterus.

The size and number of leiomyomas The size and number of leiomyomas vary. Most are found in the body of vary. Most are found in the body of the uterus, but some occur in the the uterus, but some occur in the cervix or involve the broad ligaments.cervix or involve the broad ligaments.

Leiomyomas of the UterusLeiomyomas of the UterusLeiomyomas of the UterusLeiomyomas of the Uterus

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Etiology/pathophysiologyEtiology/pathophysiologyStimulated by ovarian hormonesStimulated by ovarian hormones

Clinical manifestations/assessmentClinical manifestations/assessmentPelvic pressure; pain; backachePelvic pressure; pain; backacheDysmenorrhea; menorrhagiaDysmenorrhea; menorrhagiaConstipation; urinary symptomsConstipation; urinary symptoms

Medical managementMedical managementSurgery: Surgery:

MyomectomyMyomectomyHysterectomyHysterectomy

Leiomyomas of the UterusLeiomyomas of the UterusLeiomyomas of the UterusLeiomyomas of the Uterus

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Leiomyomas

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Reinforce the physician’s explanation Reinforce the physician’s explanation of the treatment plan-either a total of the treatment plan-either a total hysterectomy or pelvic examination at hysterectomy or pelvic examination at regular intervals to monitor the status regular intervals to monitor the status of the fibroid tumor. of the fibroid tumor.

Instruct the patient about the dosage, Instruct the patient about the dosage, frequency, and possible side effects of frequency, and possible side effects of prescribed medications. prescribed medications.

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If with menorhagia patient should be If with menorhagia patient should be taught to include adequate iron in her taught to include adequate iron in her diet to prevent iron deficiency anemia diet to prevent iron deficiency anemia from the extra blood loss. from the extra blood loss.

Regular checkups to monitor the Regular checkups to monitor the status of the fibroid tumorstatus of the fibroid tumor

Encourage the patient to express her Encourage the patient to express her feelings and assist her with coping feelings and assist her with coping mechanisms.mechanisms.

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PrognosisPrognosisFibroid tumors of the uterus tend to Fibroid tumors of the uterus tend to

disappears spontaneously with disappears spontaneously with menopause.menopause.

They rarely become malignant. They rarely become malignant. Infertility may result from a myoma that Infertility may result from a myoma that

obstructs or distorts the uterus or obstructs or distorts the uterus or fallopian tubes. fallopian tubes.

Myomas in the body of the uterus may Myomas in the body of the uterus may cause spontaneous abortions; those cause spontaneous abortions; those near the cervical opening may make near the cervical opening may make the delivery of a fetus difficult and may the delivery of a fetus difficult and may contribute to postpartum hemorrhage.contribute to postpartum hemorrhage.

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Etiology/pathophysiologyEtiology/pathophysiologyBenign tumors that arise from dermoid Benign tumors that arise from dermoid

cells of the ovary cells of the ovary Clinical manifestations/assessmentClinical manifestations/assessment

May be no symptomsMay be no symptomsPalpable on examinationPalpable on examinationDisturbance of menstruationDisturbance of menstruationPelvic heaviness; painPelvic heaviness; pain

Medical management Medical management Ovarian cystectomyOvarian cystectomy

Ovarian CystsOvarian CystsOvarian CystsOvarian Cysts

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Ovarian CystsOvarian Cysts

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Nursing InterventionsNursing InterventionsNursing interventions are similar to Nursing interventions are similar to

those for the patient having an those for the patient having an abdominal hysterectomy.abdominal hysterectomy.

PrognosisPrognosisThe prognosis is good; ovarian cysts The prognosis is good; ovarian cysts

do not become malignant.do not become malignant.

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CANCER OF THE FEMALE CANCER OF THE FEMALE REPRODUCTIVE SYSTEM …REPRODUCTIVE SYSTEM …

WILL FOLLOW WILL FOLLOW

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