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NUR 141 > 2.10 Reproductive > Flashcards

2.10 Reproductive Flashcards

1
Q

Erectile Dysfunction aka Impotence

What is it?

A

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

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2
Q

Erectile Dysfunction-

NI

A

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.

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3
Q

Erectile Dysfunction-

med and treatment

A

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.

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4
Q

Penile Cancer

what is it

A

Rare occurrence
Cause unknown- HPV present in 50% of cases.

Penile cancer less common in men who have had circumcisions.

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5
Q

Penile Cancer
diagnosis
prognosis

A

Diagnosis:
Biopsy of lesion and suspicious lymph nodes
Prognosis:
Good if dx early & no lymph involvement.

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6
Q

Penile Cancer
s/s
treatment

A 
/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
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7
Q

Testicular CA-

what is it

A

Occurrence 1 in every 250 men
Common age 13-35
Cause unknown- correlation with undescended testicle at birth.

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8
Q

Testicular CA
s/s
treatment

A 
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.
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9
Q

Prostate CA- what is it

A

Common type of cancer 2nd leading cause of CA death in men in US.

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10
Q

Prostate CA

risk factors

A 
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
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11
Q

Prostate CA

s/s

A 
S/S
Early stage asymptomatic
Urgency, frequency, hesitancy, nocturia, dysuria, reduced stream. 
Hematuria common late sign.
Fatigue, weight loss.
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12
Q

Prostate CA

diagnostics

A

Diagnostics
Digital rectal exam=nodular prostate
PSA –can be elevated in CA of prostate
Biopsy= definitive diagnosis

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13
Q

Prostate CA Treatment

medication

A

Medication Treatment:
Androgen deprivation therapy.

Many tumors are androgen dependent.

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14
Q

Prostate CA

androgen deprivation meds

A

Androgen deprivation meds:
Leuprolide (Lupron)
Goserelin (Zoladex)
Radiation

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15
Q

Prostate CA

surgical

A

Surgical Treatment
Prostatectomy
Orchiectomy

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16
Q

Prostate CA

complications

A

Complications of Tx:
ED( with open radical prostatectomy)
Urinary incontinence
Diarrhea- radiation tx

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17
Q

Menopause

types

A

Types of Menopause:
Natural/biologic (average age 52)
Surgical
Chemical (chemotherapy/cytotoxic drugs)

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18
Q

Menopause

diagnosis

A

Diagnosis:
No menstruation x 1 full year
Estrogen decreases & FSH & LH remain elevated
Combination of above 2 is diagnostic for menopause.

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19
Q

Menopause

physical assessment

A

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

20
Q

Menopause
Perimenopausal Period (lasts several years):
S/S:

A 
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
21
Q

Menopause

psychogenic s/s

A 
Psychogenic S/S:
Moodiness
Nervousness/anxiety
Insomnia/frequent awakenings
HA
Irritability
Poor concentration/memory
Depression
22
Q

Menopause

effects of long term estrogen deprivation

A

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)

23
Q

Menopause

treatment

A

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)

24
Q

Menopaus

Teaching

A

each:
Dress in layers
Use vaginal lubricant
Screening: PAP, BSE, bone density testing, lipid profile, wt. control.

25
Q

Breast CA-

risk factors

A

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

26
Q

Breast CA-

s/s

A 
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
27
Q

Breast CA

diagnosis

A 
Diagnostics
Mammogram –detects tumors 2 years before palpable
Ultrasound
MRI or PET scan
Needle biopsy
Clinical Breast exam- CBE
Breast self exam - BSE
28
Q

Breast CA Treatment

radiation

A

Radiation
Typically after surgery (adjuvant), but can shrink large tumors pre-op
Can be palliative, treat bone mets
Daily, intraoperative hi dose, brachytherapy

29
Q

Breast CA Treatment

chemo

A

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

30
Q

Breast CA Treatment

hormone

A

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.

31
Q

Breast CA Treatment

surgical

A 
Surgical Intervention:
Aspiration biopsy
Excisional biopsy
Lumpectomy
Mastectomy
32
Q

Breast CA Treatment

surgical complications

A

Complications of surgery for breast cancer

Lymphedema
Pain
Infection/delayed healing
Grieving
Affects on sexual intimacy
Body image concerns: reconstruction or prosthesis
33
Q

Breast CA Treatment

Prophylactic Mastectomy

A

Prophylactic Mastectomy- in high risk patients

-women who carry a BRCA1 or BRCA2 gene mutation

34
Q

Nursing Care after Mastectomy

A

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

35
Q

Cervical Cancer

risk factors

A

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.

36
Q

Cervical Cancer

manifestations

A

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

37
Q

Cervical Cancer

treatment

A

Treatment
Chemotherapy
Radiation
Surgical intervention
Cold conization- removal of cone shaped portion of cervix
Cryosurgery- freezing cervix causing necrosis & sloughing
Hysterectomy

38
Q

Cervical Cancer

diagnostic

A

Diagnostic Tests
PAP smear
Colposcopy-magnifying device used when abnormal PAP results. Tissue samples can be taken.
Cervical biopsy

39
Q

Endometrial Cancer

what is it

A

Most frequent diagnosed reproductive cancer in women

cancer of the uterine lining.

40
Q

Endometrial Cancer

risk factors

A 
Risk Factors
Early menarche or late menopause
Use of estrogen after menopause
Use of birth control pills.
Obesity
DMII, polycystic ovarian syndrome.
Endometrial hyperplasia.
41
Q

Endometrial Cancer

s/s

A

S/S:
Abnormal painless vaginal bleeding in postmenopausal women.
Late: pelvic cramping, bleeding after sex, lower abdominal pressure, enlarged uterus.

42
Q

Endometrial Cancer

diagnosis

A

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!!!

43
Q

Ovarian Cancer

what is it

A

Tumors grow rapidly & spread quickly. Spread directly to nearby organs & through blood/lymph circulation.

44
Q

Ovarian Cancer

risk factors

A 
Risk factors:
Middle to older age.
BRCA1 or BRCA2 gene mutations.
Infertility/ difficulty getting pregnant.
Hx. of endometriosis.
45
Q

Ovarian Cancer

diagnosis

A

Diagnosis:
Bimanual pelvic exam performed
Biopsy/ CT scan/ Ultrasound
CA-125 – tumor marker highly specific to ovarian CA

46
Q

Ovarian Cancer

s/s

A

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)

47
Q

Ovarian Cancer –

treatment

A

Treatment:
TAH (Total abdominal hysterectomy) with BSO (bilateral salpingo-oophorectomy)
Radiation
Chemotherapy
Pts. Identified with BRCA1 & BRCA2 may opt for prophylactic BSO.

NUR 141 (48 decks)

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