Assessment of the Reproductive System Flashcards
Decreased efficiency in age
Graying and thinning of pubic hair
Decreased size of the labia majora and clitoris
Drying, smoothing, and thinning of the vaginal walls
Decreased size of the uterus
Atrophy of the endometrium
Decreased size and marked convolution of the ovaries
Loss of tone and elasticity of the pelvic ligaments and connective tissue
Increased flabbiness and fibrosis of the breasts, which hang lower on the chest wall; decreased erection of nipples
Female - Changes in the reproductive system related to aging
Decreased efficiency in age
Graying and thinning of pubic hair
Increased drooping of the scrotum and loss of rugae
Prostate enlargement, with an increased likelihood of urethral obstruction
Male - Changes in the reproductive system related to aging
Thorough history
Nutrition
Family history and genetic risk
Patient history - Assessment-history
Huge impact on diff types reproductive cancer
High/excessive alcohol intake increases risk of ovarian cancer
Diet high in fat and low in fruits and vegetables increases risk of reproductive cancers - Ex. Prostate cancer (specifically if saturated fats and red meats), ovarian cancer
Nutrition
Daughters of women given diethylstilbestrol (DES) to control bleeding during pregnancy are at increased risk for infertility and reproductive tract cancer - child woman who received that during pregnancy then increased risk
Specific BRCA1 and BRCA2 gene mutations increase overall risk for breast and/or ovarian cancer
Men with first-degree relatives (father, brother) -fam history- with prostate cancer are at greater risk
Family history and genetic risk
Focused assessment related to specific concerns and needs of the patient
Primary/chief complaint is
Physical assessment
Pain - diff times cancer
Bleeding - female areas = cancer; hematuria = prostate cancer
Discharge - unusual discharge out ordinary
Masses - cancer
Reproductive tract cancers for females not notice masses as much since internal
Current health problems - brings people into healthcare
Cytologic study effective in detecting precancerous and cancerous cells from the cervix
Annual Pap test starting at age 21; if negative after reproductive years can stretch out testing
Cervical cancer - want detect early so treat more effectively
Full pelvic exam; samples off cervix and test for diff cells; cytology test
Pap smear-F
Highly associated with cervical cancer; vaccine against HPV (causes genital warts)
Puts men at higher risk for other cancer
Used to identify many high-risk types of HPV associated with the development of cervical cancer
Cells are collected from the cervix at the same time a Pap test is completed
Human papilloma virus (HPV)-F
Big for STDs
Used to detect bacterial, viral, fungal, and parasitic disorders
Vaginal cultures-F
Elevated with ovarian cancer
Alpha fetoprotein (AFP)-F
Elevated/big with ovarian cancer; long-term monitoring with this; ovarian not caught early because not lot symptoms and symp vague (abd bloating, discomfort) so caught later stages
Cancer antigen 125 (CA 125)-F
Drawn lot on men; esp once older
Normally increase with age
BPH increase PSA and prostatitis; not specific so only screening
increases with age
Have prostate cancer - monitor over time; raised for lot diff things: BPH
Indicates prostate probs
Used as a screening lab for prostate cancer because other prostate problems can increase the level
Some variance on the PSA value and how it is affected by age
Prostate-specific antigen (PSA) test-M
Diagnostic for prostate cancer - do biopsy tell cancer
Elevations indicative of prostate cancer
EPCA-2 is very sensitive and can detect cancer early
Early prostate cancer antigen (EPCA-2) and Serum acid phosphatase-M
Elevations indicative of testicular cancer - hit younger people; looking for masses
Indicative of testicular cancer
Alpha-fetoprotein (AFP), Beta human chorionic gonadotropin (hCG), and Lactate dehydrogenase (LDH)-M
Evaluate for metastasis with different reproductive cancers
Evaluate for ovarian cancer
After diagnosed with reproductive cancer to check for metastasis
CT
Not tons; very high risk for breast cancer
Better pic
Evaluation for breast cancer for women with high risk factors
MRI
For diff types cancer
Get good pics
Transvaginal ultrasound-ovarian and endometrial cancer
Transrectal ultrasound-prostate cancer
Ultrasound-evaluate for testicular masses versus fluid; concerned about testicular cancer because differentiate if fluid mass or tumor
Also used for breast cancer evaluation
Ultrasonography
Common imaging used to eval reproductive tract in woman
X-ray that uses an injection of a contrast medium to visualize the cervix, uterus, and fallopian tubes
Used to evaluate tubal anatomy and patency and uterine problems such as fibroids, tumors, and fistulas
Do early on in cycle so risk pregnancy lower; first ½ menstrual cycle
Inject dye and tubes patent - dye goes into peritoneal space - good result
Not resulted
Pre: Assess for allergies to contrast dye
Post: Some pelvic and referred shoulder pain - irritate phrenic nerve during procedure
Hysterosalpingography
Big one for breast cancer
x-ray of the soft tissue of the breast
Now have 3-D mammograms that allow better visualization of the layers of breast tissue
Annually for women ages 40 and older
Some research recommend every other year over 40 and annually over 50 if no risk factors; lot research recommends annually 40+
Pre: no creams, lotions, powders or deodorant on breast or under arms - interferes with pic
May experience discomfort during procedure - smush breast tissue to get good pic
Post: reinforce continued self breast exams and clinical breast exams (very extensive)
Catch breast cancer early so treat them and better outcomes; less mortality with breast cancer; better survival rate if caught early
Mammography
Examination of the cervix and vagina using a colposcope
Allows three-dimensional magnification and intense illumination of epithelium with suspected disease
Locate exact site of precancerous and possible malignant lesions for biopsy
Better pic of lesion/area think cancerous
Colposcopy
Direct examination of the pelvic cavity through a endoscope
Performed under anesthesia typ
Pre: NPO prior
Post:
Some pelvic and referred shoulder pain - irritate phrenic nerve
Observe incision sites for infection - redness, swelling, temp; tiny incisions
Can also used during surgical procedures/instead of procedures; less invasive - make little incisions
Laparoscopy
Fibroptic camera that is inserted into the vagina
Examines the cervix and uterus
Performed with regional nerve block - numbness post-op and safety is issue
Post: Some pelvic and referred shoulder pain
Hysteroscopy
Biopsy gives
definitive diagnosis for cancers regardless of area
Cervical tissue is removed for cytologic study
Do Early in menstrual cycle so less vascular and less risk of bleeding
Pre:
Depends on anesthesia used - gen: NPO
Address anxiety - not top priority since safety always is but make sure address any concerns from psychosocial standpoint
Post:
Monitor for bleeding and infections - inform about s/s: temp, increased bleeding, increased pain
Nothing in vagina for 2 weeks post biopsy
No heavy lifting
Cervical
Used to obtain cells directly from the lining of the uterus to assess for cancer of the endometrium
Biopsy endometrium of uterus
For cancers and check for menstrual abnormalities and if infertile
Assess menstrual disturbances and infertility - issues with fertility do endometrial biopsy
Post:
Some cramping may occur
Monitor for bleeding and infections
Some Spotting for 1-2 days
Nothing in vagina for 1-2 days or as long as have spotting/discharge
Endometrial
Tissue aspirated through a large bore needle or through small incision - 2 ways dones
local anesthetic
Aspirated fluid from benign cysts may appear clear to dark green-brown
Bloody fluid suggests cancer - suspicious of cancer
Pre:
Depends on anesthesia used
Address anxiety - psychosocial anxiety experiencing
Post:
Mild/min pain alleviated/managed with non-opioid analgesics, ice or heat
Monitor incision for bleeding and infection
Some Numbness may occur around biopsy site - tell pat about this
Wear a really supportive bra for at least 1 week - helps pain and discomfort
Breast
Definitive diagnostic tool for prostate cancer
2 ways
Transurethral biopsy
Insert a needle through the area of skin between the anus and scrotum
Transrectal biopsy
Passing the needle through the wall of the rectum to get to prostate
More common one
Typ in providers office
Pre:
Discuss positioning and some discomfort during procedure - side lying and knees toward them
Address anxiety - psychosocial issues related to diagnosis; helping through procedure and edu ahead of time
No anesthesia - no NPO
Post:
Educate regarding soreness and possible light rectal bleeding, possibily some blood in urine and stool for a few days since biopsied prostate in addition to rust colored semen for several weeks - let know this
Monitor for signs of excessive bleeding (report), infection and urinary retention - signs of any of these report
Post biopsy antibiotic - for infection prevention
Prostate
