2.10 Reproductive Flashcards
Erectile Dysfunction aka Impotence
What is it?
Inability to attain or maintain an erection.
Age related changes in sexual function include:
Cellular & tissue changes of penis
Decreased sensory activity
Decreased testosterone levels
Effects of chronic illness & meds to treat the illnesses.
DM, HTN, renal failure are examples.
Skin sensation of penis declines causing increased time to achieve erection
Greying & thinning of pubic hair
Increased drooping of the scrotum & loss of rugae
Erectile Dysfunction-
NI
Nursing Considerations:
Obtain med history.
Teach: Do not take ED meds if on nitrate based meds can cause severe hypotension and cardiac s/e.
Assess for risk factors (new meds, new dx).
Detailed assessment of sexual practices.
Encourage discussion with partner.
Erectile Dysfunction-
med and treatment
Meds & Treatment:
Sildenafil (Viagra)
Tadalfil (Cialis)
Vacuum-assisted erection device
Surgery to re-vascularize (Vacuum device draws blood into the penis and an o ring is secured at the base of penis to keep blood there during intercourse)
Lifestyle changes – wt. loss, smoking cessation, exercise.
Penile implants
Penile injections- self-inject prostaglandin E1 into shaft of penis.
Wear condom to prevent infection during intercourse.
Penile Cancer
what is it
Rare occurrence
Cause unknown- HPV present in 50% of cases.
Penile cancer less common in men who have had circumcisions.
Penile Cancer
diagnosis
prognosis
Diagnosis:
Biopsy of lesion and suspicious lymph nodes
Prognosis:
Good if dx early & no lymph involvement.
Penile Cancer
s/s
treatment
/S Foul-smelling discharge Enlarged inguinal lymph nodes (occasionally) Treat: Prevent- HPV vaccine Penectomy (Man may have continent perineal urethrostomy but the man must void sitting down) Radiation Creams
Testicular CA-
what is it
Occurrence 1 in every 250 men
Common age 13-35
Cause unknown- correlation with undescended testicle at birth.
Testicular CA
s/s
treatment
S/S 1st sign- slight painless enlargement of one testicle. Abdominal ache Heaviness in one testicle Treatment: Chemo- up to 95% cure rate Radical orchiectomy –(testicle removal) Radiation Considered one of the most curable cancers.
Prostate CA- what is it
Common type of cancer 2nd leading cause of CA death in men in US.
Prostate CA
risk factors
Risk Factors: 85% dx after age 65 Family hx Vasectomy-believed r/t increased levels of free testosterone circulating Diet high in animal fat 95-100% cure rate
Prostate CA
s/s
S/S Early stage asymptomatic Urgency, frequency, hesitancy, nocturia, dysuria, reduced stream. Hematuria common late sign. Fatigue, weight loss.
Prostate CA
diagnostics
Diagnostics
Digital rectal exam=nodular prostate
PSA –can be elevated in CA of prostate
Biopsy= definitive diagnosis
Prostate CA Treatment
medication
Medication Treatment:
Androgen deprivation therapy.
Many tumors are androgen dependent.
Prostate CA
androgen deprivation meds
Androgen deprivation meds:
Leuprolide (Lupron)
Goserelin (Zoladex)
Radiation
Prostate CA
surgical
Surgical Treatment
Prostatectomy
Orchiectomy
Prostate CA
complications
Complications of Tx:
ED( with open radical prostatectomy)
Urinary incontinence
Diarrhea- radiation tx
Menopause
types
Types of Menopause:
Natural/biologic (average age 52)
Surgical
Chemical (chemotherapy/cytotoxic drugs)
Menopause
diagnosis
Diagnosis:
No menstruation x 1 full year
Estrogen decreases & FSH & LH remain elevated
Combination of above 2 is diagnostic for menopause.
Menopause
physical assessment
Decrease in breast tissue, body hair, skin elasticity, & sub q fat
Ovaries & uterus become smaller
Cervix & vagina decrease in size & become pale in color
Decreased size of labia majora and clitoris
Loss of elasticity of pelvic ligaments & connective tissue.
Greying & thinning of pubic hair
Menopause
Perimenopausal Period (lasts several years):
S/S:
Perimenopausal Period (lasts several years): S/S: Erratic menstrual cycles Vaginal PH rises increasing vaginal infection risk. Decreased vaginal lubrication Vasomotor instability Hot flashes & night sweats Palpitations, dizziness
Menopause
psychogenic s/s
Psychogenic S/S: Moodiness Nervousness/anxiety Insomnia/frequent awakenings HA Irritability Poor concentration/memory Depression
Menopause
effects of long term estrogen deprivation
Effects of long term estrogen deprivation:
Imbalance in bone remodeling (fracture risks)
Osteoporosis- Ca & Vit D supplements & weight bearing activities.
Increased Cardiovascular risks
Atherosclerosis development (r/t LDL:HDL ratio increase)
Menopause
treatment
Treatment:
HRT- controversial r/t ? Increased risk of breast & ovarian CA, stroke, MI, DVT. Informed consent.
Antidepressants- SSRI’s- promote use of serotonin to affect heat regulation in body. (off label use)
Menopaus
Teaching
each:
Dress in layers
Use vaginal lubricant
Screening: PAP, BSE, bone density testing, lipid profile, wt. control.
Breast CA-
risk factors
Risk Factors:
Increased age is primary risk factor for men and women.
Family history
Menstruation before age 12 /menopause after age of 55 yrs.
Oral contraceptive use
No children or having after age 30
Long term use of HRT
Overweight (physical inactivity are higher risk of developing breast cancer)
Never breastfed
Breast CA-
s/s
S/S of Breast CA: Non-tender lump in breast Nipple discharge Rash around nipple Nipple retraction Dimpling of skin Nipple pain may occur Usually painless Some pts. report burning or stinging
Breast CA
diagnosis
Diagnostics Mammogram –detects tumors 2 years before palpable Ultrasound MRI or PET scan Needle biopsy Clinical Breast exam- CBE Breast self exam - BSE
Breast CA Treatment
radiation
Radiation
Typically after surgery (adjuvant), but can shrink large tumors pre-op
Can be palliative, treat bone mets
Daily, intraoperative hi dose, brachytherapy
Breast CA Treatment
chemo
Chemotherapy
If axillary nodes + most get chemo
Prolong life in metastatic disease
Neoadjuvant = pre-op to shrink large tumors
Adjuvant = widely used, chemo after surgery
Breast CA Treatment
hormone
Hormone Therapy
- Estrogen blockers- Tamoxifen (If take for 5 years following surgery it can reduce the risk of cancer reoccurrence by about 50%)
- Fareston (treat postmenopausal women with advanced cancers)
- Arimidex
Immunotherapy agents Herceptin) used to stop growth of tumors.
Breast CA Treatment
surgical
Surgical Intervention: Aspiration biopsy Excisional biopsy Lumpectomy Mastectomy
Breast CA Treatment
surgical complications
Complications of surgery for breast cancer
Lymphedema Pain Infection/delayed healing Grieving Affects on sexual intimacy Body image concerns: reconstruction or prosthesis
Breast CA Treatment
Prophylactic Mastectomy
Prophylactic Mastectomy- in high risk patients
-women who carry a BRCA1 or BRCA2 gene mutation
Nursing Care after Mastectomy
Wound and drain care
Pain management
Restore operative arm function – move affected arm
Prevent lymphedema- no b/p, lab draws affected arm
Provide psychosocial support- anxious, sad, body image disturbance
Counselor or support group
Cervical Cancer
risk factors
Risk factors
HPV infection- most important risk factor.
1st intercourse before age 16
Multiple sex partners, STI’s
Multiple pregnancies
Smoking
Family history
Overweight
Long-term use of oral contraceptives.
Cervical Cancer
manifestations
Manifestations:
Early: None
Late: watery vaginal discharge that becomes dark and foul-smelling, bleeding after intercourse, post-menopausal bleeding
Later: pressure on bowel and bladder, ureteral obstruction, heavy aching and abdominal /back pain, hematuria, anemia
Cervical Cancer
treatment
Treatment
Chemotherapy
Radiation
Surgical intervention
Cold conization- removal of cone shaped portion of cervix
Cryosurgery- freezing cervix causing necrosis & sloughing
Hysterectomy
Cervical Cancer
diagnostic
Diagnostic Tests
PAP smear
Colposcopy-magnifying device used when abnormal PAP results. Tissue samples can be taken.
Cervical biopsy
Endometrial Cancer
what is it
Most frequent diagnosed reproductive cancer in women
cancer of the uterine lining.
Endometrial Cancer
risk factors
Risk Factors Early menarche or late menopause Use of estrogen after menopause Use of birth control pills. Obesity DMII, polycystic ovarian syndrome. Endometrial hyperplasia.
Endometrial Cancer
s/s
S/S:
Abnormal painless vaginal bleeding in postmenopausal women.
Late: pelvic cramping, bleeding after sex, lower abdominal pressure, enlarged uterus.
Endometrial Cancer
diagnosis
Diagnosis:
Transvaginal ultrasound & Endometrial biopsy provides gold standard for definitive diagnosis.
CA-125- identifies markers
CT, MRI, PET scans
**Any post menopausal bleeding is abnormal and needs evaluation!!!
Ovarian Cancer
what is it
Tumors grow rapidly & spread quickly. Spread directly to nearby organs & through blood/lymph circulation.
Ovarian Cancer
risk factors
Risk factors: Middle to older age. BRCA1 or BRCA2 gene mutations. Infertility/ difficulty getting pregnant. Hx. of endometriosis.
Ovarian Cancer
diagnosis
Diagnosis:
Bimanual pelvic exam performed
Biopsy/ CT scan/ Ultrasound
CA-125 – tumor marker highly specific to ovarian CA
Ovarian Cancer
s/s
Formerly thought to be a “silent” disease where no s/s presented until late progression.
Evidence now shows common early s/s include:
- Bloating, urinary urgency/frequency
- Difficulty eating
- Feeling full
- Pelvic pain.
Caught early is treatable.
Bimanual palpation of mass may not be palpable until it reaches a size of 4-6 inches
Many do not seek care with the s/s because they are often associated with other things (menopause, constipation, weight gain)
Ovarian Cancer –
treatment
Treatment:
TAH (Total abdominal hysterectomy) with BSO (bilateral salpingo-oophorectomy)
Radiation
Chemotherapy
Pts. Identified with BRCA1 & BRCA2 may opt for prophylactic BSO.
