BN CH. 70/90/91 Female & Male Reproductive System Flashcards
What is the relationship between orchitis and mumps?
• Orchitis, inflammation of the testes, may result from infection or injury.
• It is common in clients who have epididymitis.
• Mumps after puberty may cause orchitis, resulting in sterility.
• Risk factors, diagnosis, and treatment are similar to epididymitis.
• Symptoms include pain and swelling in the scrotum and sometimes urethral irritation.
• A scrotal support is used.
• An ice bag applied to the scrotum is helpful.
• Heat is not used.
• Mumps, also called epidemic parotitis, is a viral disease that affects the salivary glands, especially the parotids. It is transmitted through direct and indirect contact and through salivary secretions. Children younger than 2 years and adults seldom contract mumps. However, adults who contract mumps may suffer serious aftereffects, including sterility in men. (Pg. 1205)
What is the Patient education on the contraceptives method?
Provide general overview of the various methods of contraception available.
Compare and contrast effectiveness, preparation and use, risks, and possible side effects of BC methods.
o Rationale: An overview provides the couple with necessary summary information from which to make an informed decision on a specific choice.
o Discussions of the varieties are proactive steps of preventative healthcare, e.g., first signs or symptoms of a blood clot.
Listen to couples’ concerns.
Discern existence of any physical, religious, or economic situations that may affect choice.
o Rationale: Listening to concerns and reviewing background information helps to enhance client’s learning and strengthen understanding.
o Long-term compliance and successful BC are more likely if couples understand personal and healthcare issues involved with choices.
Provide brochures, diagrams, charts, and pictures for couple to read at home.
Encourage individual research on the Internet and bring questions to the next appointment.
o Rationale: Individuals learn differently. Providing material in different forms enhances learning.
o Allowing the couple time to look over and process the information reinforces their ability to ask specific, individually based questions.
Using anatomical models, demonstrate and have couple return-demonstrate insertion technique of diaphragm and condom.
o Rationale: Return demonstration and discussions provide a means for evaluating the couple’s understanding.
o The method is only effective if it is used consistently and correctly.
Support couple’s decision.
Emphasize specific instructions regarding use of BCPs such as consistent and regular use of BCPs.
o Rationale: The client’s choice, not the nurse’s choice, will be the most effective choice.
Review with the couple the specific instructions about early danger signs and possible complications.
o Rationale: Knowledge of potential complications, danger signs, and necessary follow-up helps to minimize the risks associated with the method chosen.
Schedule necessary follow-up appointments, e.g., yearly pelvic examinations, and routine screening.
o Rationale: Assisting with follow-up promotes compliance and helps to determine the couple’s satisfaction with the method chosen.
What are the success rate of the various contraceptive methods
Continuous abstinence
o Continual abstinence is the only 100% effective method of BC and protection against STIs.
o The individual does not have intimate physical con contact or intercourse with any partner.
o The advantages of continual abstinence include the knowledge that no STIs can be transmitted, and no pregnancies will result.
o However, it may be difficult to abstain from sex for long periods of time.
Withdrawal
o When the best techniques are used, this method has about an 80%– 90% protection against pregnancy, which is increased to nearly 100% when a condom is used.
o Withdrawal, technically known as coitus interruptus, is an ancient form of BC.
o The male must be aware of the approach of their climax (ejaculation) and withdraw from the vagina prior to it.
Fertility awareness method, natural family planning, partial abstinence (Workbook and Ch 70-3)
o The rhythm method is only about 75% to 99% effective.
o Fertility awareness methods (FAMs) can also be called the rhythm method or periodic abstinence. Sometimes this technique is called natural family planning.
o The rhythm method is a fertility awareness method that involves limiting sexual intercourse to the time during the client’s menstrual cycle when she is most likely to be infertile.
o It does require training and awareness of the days of ovulation
o FAMs involve determining when an egg is released from the ovary (ovulation) when a client is most likely to be fertile.
o Periodic abstinence may be useful for the couple who can avoid vaginal intercourse but may allow other types of sexual activity.
Fertility awareness methods are reliable only for female individuals who ovulate regularly.
Breastfeeding
o Breastfeeding can be a fairly reliable method of BC for the first 6 months after birth.
o Breastfeeding prevents ovulation.
o As a BC method, it is healthy, free, and does not require a prescription or supplemental BC device.
o To ensure effectiveness, the breastfeeding parent does not feed the infant anything besides breast milk, feeds the infant on a regular daily schedule, for example, every 4 hr during the day and every 6 hr at night, and has not had a period since giving birth.
o After 6 months, the client should start using another form of BCP.
o Breastfeeding does not provide any protection against HIV/ AIDS or STIs for the client but does provide antibodies and excellent nutrition for the infant.
Birth control pill
o The effectiveness rate for BCPs is between 95% and 99%.
o Single hormone BCPs contain progestin, sometimes referred to as the mini pill.
o Other forms of BCPs contain estrogen and progestin.
o The pill works by preventing ovulation, which is needed for egg– sperm contact, and by making cervical mucus thicker, which inhibits sperm from reaching eggs.
o A client must take BCPs correctly and consistently to ensure effectiveness.
o Progestin-only BCPs must be taken at the same time every day because it helps to maintain the needed hormonal level.
Emergency contraception
o EC is also referred to as the “morning-after pill.” Emergency BC can be used up to 120 hr (5 days) after unprotected intercourse but is less effective 72 hr (3 days) after sex.
o Emergency contraception (EC) consists of two safe and effective methods of BC.
o Emergency contraception does not imply use of an abortifacient, a pill that initiates abortion.
o Most commonly, EC consists of the hormones levonorgestrel (Plan B One-Step) or ulipristal acetate (brand name Ella).
o Another type of EC is the insertion of the copper based ParaGard IUD.
o EC can be used to prevent pregnancy after unprotected sex when the male’s condom falls off or breaks, the male does not exit the vagina before ejaculation (withdrawal), or after forced unprotected sex.
Transdermal patch
o The patch is worn like an adhesive bandage and is changed once a week for 3 weeks, followed by 1 week in which no patch is worn.
o Transdermal patches with time-released hormones are convenient for a client to use.
o It may not be available in all communities as it is not being produced by some manufacturers.
o It is not effective against STIs.
o Birth control implant
o It is effective for up to 3 years.
o Similar to other hormonal methods, the BC implant releases progestin.
o Lack of progestin prohibits ovulation and increases cervical mucus.
o Known by the brand names of Implanon and Nexplanon, the implant is a cardboard matchstick-sized, thin, flexible plastic rod.
o It is inserted by a healthcare provider subcutaneously into the upper arm.
o Side effects mimic other hormonal BC methods.
o The client needs to monitor the insertion site for infection.
o It is not effective against STIs.
Medroxyprogesterone acetate (Depo-Provera)
o It is administered by a healthcare provider every 3 months by injection and is about 99% effective in preventing pregnancy.
o When the drug is discontinued, the return of fertility can take anywhere from 3 to 18 months.
o Medroxyprogesterone acetate (Depo-Provera) is a hormone similar to progesterone.
o Medroxyprogesterone acetate (Depo-Provera) works by preventing ovulation.
o Medroxyprogesterone acetate (Depo-Provera) is not effective against STIs.
o Vaginal ring Intrauterine device
o Vaginal Ring
o The ring is 98%– 99% effective in preventing pregnancy.
o Considered a safe and simple contraceptive device, the client inserts the ring once every 3 weeks; then, it is removed for 1 week when menses will occur.
o A vaginal ring, known by its brand name, NuvaRing, is a hormonal vaginal contraceptive ring.
o It slowly releases progestin and estrogen.
Intrauterine Devices
o It is 97%– 99% effective.
o An intrauterine device (IUD) is a small, T-shaped, flexible, plastic insert that a healthcare provider inserts into a client’s uterus.
o IUDs inhibit the sperm’s ability to reach the egg or prevent ovulation (hormonal IUDs).
o The IUD can prevent the fertilized ovum from implanting in the uterus.
o One benefit of the IUD is that it offers continuous protection without the need for a client to have to remember to insert it prior to sex.
o IUDs give no protection against STIs and may cause an increased, albeit uncommon, incidence of PID, tubal pregnancies, and infertility.
o The greatest danger is uterine or cervical perforation, although these situations occur rarely.
Mechanical barrier methods
o External condom
External condoms are thin latex or plastic sheaths designed in the shape of a penis.
An external condom is packaged as a flat disk that can be placed or rolled over the erect penis before sexual intercourse.
There are many brands of packaged external condoms, for example, dry, lubricated, colored, scented, spermicidal, which are designed for ease of use, sexual stimulation, or personal preference.
When used correctly, they are effective methods of BC.
Advantages of external condoms include their ability to protect against STIs when the penis is covered during vaginal, anal, or oral sex.
o Internal condom, cervical dap, diaphragm, Vaginal Sponge
As with an external condom, the internal condom is for one-time use, but the internal condom can be inserted up to 8 hr before sexual intercourse
An internal condom is worn inside the client’s vagina.
* It is a pouch made of thin latex attached to two flexible rings; one ring is inserted internally, and the other is left to open externally.
* The internal ring is inserted into the vagina, and the ring at the open end stays outside the vagina during intercourse.
* It can also be inserted into the anus.
* The condom protrudes from the vagina or anus, providing protection for the external genitalia.
The Cervical Cap
* To protect against pregnancy, these devices are left in place for 6– 8 hr after having sex.
* The cap should not be left in for longer than 48 hr, and the diaphragm should not be left in for more than 24 hr.
* Brand name FemCap, is a thimble-shaped silicone cup that is inserted into the vagina to cover the cervical opening.
The diaphragm
* A silicone, dome-shaped shallow cup that covers the cervix.
* Urinary tract infections, vaginal irritation, or unusual discharge from the vagina may be related to the placement and use of a diaphragm.
* Some preexisting conditions may make the use of a diaphragm unwise.
* Examples of potential problems include a sensitivity to silicone or spermicide, recently giving birth, certain anatomical issues, and a history of infections such as toxic shock syndrome or urinary tract infections.
The vaginal sponge
* It is effective for as long as 24 hr.
* A combination method of BC using a barrier, made of polyurethane foam and a spermicide, nonoxynol-9.
* In the United States, the vaginal sponge is available as the Today Sponge.
* It is an OTC product, so it is important to advise the client to read and follow all instructions carefully before beginning sexual intimacy.
* It needs to remain in place for at least 6 hr after intercourse but be removed within 30 hr of insertion.
* A risk of toxic shock syndrome (TSS) exists if it is left in for more than 30 hr.
* TSS is a serious acute systemic disease caused by infection with strains of Staphylococcus aureus.
* The sponge does not protect against STIs or HIV/ AIDS, and the client can become sensitive to the spermicide, which can cause mucosal irritation.
o Chemical barrier methods for males and spermicides for females
o The spermicide must be inserted each time vaginal intercourse occurs and, to be most effective, the client needs to wait 10 min prior to having intercourse.
o After intercourse, spermicides remain effective for only about an hour.
o Chemical barriers involve the use of a spermicide.
o Spermicides are chemicals that immobilize or kill sperm and block the cervix to inhibit sperm from traveling to an egg.
o They are available in a variety of forms, including spermicidal creams, vaginal foams, film, gels, and suppositories.
o The most common side effect is skin irritation to the vagina or the penis; changing brands of spermicide may be a simple alternative if irritation results.
o Spermicides are not very effective if used as the only contraceptive method.
o They offer added contraceptive protection when used with barrier methods such as a male or female condom or with the withdrawal method.
o Spermicides do not prevent the risk of STIs, but when used with a condom the STI risk is decreased.
o A spermicide is used in combination with a diaphragm or a cervical cap.
o The spermicidal foams are most effective in preventing pregnancy when used with a diaphragm or condom.
o Sterilization
o Nonsurgical— hysteroscopic tube insertion
Chemical
* Chemical methods of tubal sterilization are commonly used for permanent BC.
* Specific chemicals can be introduced into the tubes to induce scarring of the inside of the fallopian tubes.
Hysteroscopic Tube Insertion
* Another nonsurgical method is the hysteroscopic insertion of a thin tube through the vagina and uterus and into each fallopian tube.
* As scar tissue forms, a natural mechanical barrier is created that prevents the egg from contact with sperm (i.e., prevents conception).
o Surgical— tubal ligation, hysterectomy, vasectomy
Tubal ligation
* is the most common and effective procedure for permanent sterilization in clients with female reproductive organs.
* The fallopian tubes are cut and tied (ligated), sealed by electric current, or closed with clips, clamps, or rings.
* The fallopian tubes transport the ova to the uterus. If the ova cannot travel through the fallopian tubes, the client will not become pregnant.
* Tubal ligation is usually done in a same-day surgery center under epidural, spinal, or general anesthesia via endoscope (laparoscopic tubal ligation).
* Each tube is usually ligated in two places, cut, and a portion removed.
Abortion
* An induced or therapeutic abortion may be performed to interrupt a pregnancy.
* Abortion is a controversial means of family planning and is discouraged by healthcare providers as a primary means of controlling pregnancy.
Hysterectomy
* A hysterectomy is the removal of the uterus.
* It is a significant surgery used to correct a variety of medical conditions and not usually done for BC.
* After a hysterectomy, the client ceases to have a menstrual period, but the individual will still have their ova and fallopian tubes.
Vasectomy
* A vasectomy is the most common surgical method for sterilization in clients with male reproductive organs.
* This procedure involves the ligation (tying off) and sometimes the removal of a small part of the vas deferens (ductus deferens).
* The vas deferens is part of the long tube that transports viable sperm in the testes to the outside of the client’s body.
* When it is cut, the sperm cannot reach the ova during intercourse, and pregnancy is prevented.
* The client who chooses to have a vasectomy should anticipate that they will remain sterile but will not be impotent (will be able to have an erection).
* Reversal (reattaching the vas deferens) of a vasectomy is not uncommon, but this revision procedure often is unsuccessful.
* It may be performed in the healthcare provider’s office under local anesthesia.
* The client must be told that it may take up to 6 weeks after a vasectomy for the semen to be totally free of sperm because the body stores semen.
* A sperm count is usually taken 6 weeks– 2 months after the procedure.
* If the sperm count is zero, the vasectomy was most likely successful.
Characteristics of STIs (sex transmitted infect)
At least 25 types of STIs exist; etiologies include bacteria, parasites, and viruses
Individuals between ages of 15 and 24 years account for about one-half of STI cases
Increase chances of infection with HIV and other STIs
Significant side effects of minor symptoms such as irritation, discharge, or pain to significant permanent consequences such as PID, inability to reproduce, or death
Have few, inconsistent, confusing, or no symptoms
Cause significant side effects and/or death in newborns
Cause infections that lead to PID and/or infertility
Cause infections of the mouth, throat, respiratory tract, urethra, and reproductive organs
Cause infections that reoccur when re-exposed by partner who has not been diagnosed or had incomplete treatment
Can occur at any age, most common in sexually active young adults
Are less common in individuals who are tested for STIs and are in monogamous relationships
Treatment is difficult
Signs and symptoms, Diagnosis, Treatments and Nursing Interventions and Pat Education on HPV, Candidiasis, Bacterial Vaginosis, Trichomoniasis, and Gonorrhea
Genital Human Papillomavirus (HPV)
* Signs & Symptoms:
o HPV infections are very common but have very few signs or symptoms.
o Most of the time, warts appear and seem to disappear without any treatment.
o Genital warts appear as small bumps or group of bumps in the genital areas, which may be single or multiple soft, moist, pinkish growths.
o Sometimes the genital warts form a cauliflower-like shape appearing on and around the genital structures and the anus.
o Lesions may not appear for several weeks or 2–3 months after exposure.
o Additional clinical signs include pruritus (itching), dyspareunia, and chronic vaginal discharge.
* Diagnosis:
o Cancer of the cervix is the most often diagnosed problem associated with genital HPV.
o Cervical cancers are often discovered when a Pap smear shows abnormal cell changes that may or may not be HPV; that is to say, not all cervical cancers are caused by HPV.
o Follow-up is necessary as soon as possible if the Pap test is positive, and particularly if the virus is discovered.
o Cancer of the anus and penis are also possible with HPV.
* Treatment:
o The best form of treatment for HPV is prevention via HPV immunizations.
o The best treatments for cancer of the cervix are preventative HPV vaccinations and pelvic examinations to obtain a Pap smear, which typically detects precancerous, abnormal cervical cell changes
o Standard treatment should begin with self-inspection and observation of vaginal discharge or unusual pain.
o Routine examination by healthcare professionals is important because many individuals are asymptomatic and, thus, not aware that they are infected.
o With early detection, cervical cancer has a high cure rate.
- Nursing Interventions:
o Cleanliness and dryness are essential to promote healing.
o Cotton underwear is useful.
o Individuals with herpes should avoid unprotected sexual contact, especially when lesions or any symptoms are present.
o Client teaching includes instruction on use of standard precautions and restricting others from using items that come in contact with the lesions, such as a toothbrush.
o During active outbreaks, an infected person should not share food or engage in kissing.
o Meticulous handwashing is necessary to prevent the spread of the lesions to another part of the body. - Patient Education:
o Vaccinate for HPV prior to becoming sexually active.
o Avoid or abstain from oral, anal, or vaginal sex.
o Maintain a mutually monogamous sexual relationship.
o Limit sexual activity to individuals whose STI status is known.
o Use latex or polyurethane condoms every time sex occurs.
o Apply latex condoms appropriately.
o Use a barrier method (e.g., condom), which can prevent some, but not all, STI and HIV infections.
o Know the limits of the effectiveness of condoms.
o Be in a relationship with someone who has tested negative for STIs, including HIV.
o Have open and honest conversations with a sexual partner to ascertain if an untreated or partially treated STI exists; avoid sexual activity if concerns develop.
o Medicate or treat both partners simultaneously and avoid sex if one partner has an STI.
o Suggest mutual partner testing for STIs and HIV and wait for test results prior to having sex.
o Be alert for signs of STIs prior to having sex (e.g., a foul, fish-odor discharge, or unusual growths).
Candidiasis Vulvovaginal Candidiasis
* Signs & Symptoms:
o Symptoms include pruritus (intense itching), pain, swelling, and redness of the vulva, burning after urination, and a white, cottage cheese-like (curdy) vaginal discharge.
o A pelvic examination is done and samples of the vaginal discharge are obtained.
* Diagnosis:
o Diagnosis is made by putting a sample of the discharge on a microscopic slide. The healthcare provider typically requests a slide for a Gram stain and a “wet prep,” that is, a slide prepared with potassium hydroxide ( KOH ).
o A culture and sensitivity may be ordered also but, since Candida is known to normally be found in the vagina, a positive result may not be a helpful diagnostic indicator for this STI.
* Treatment:
o Treatment is available with prescription and nonprescription medications. OTC intravaginal creams include butoconazole 2% (Femstat 3) or miconazole 2% (Monistat).
o Prescription medications include nystatin 100,000-unit vaginal tablet or terconazole 0.4% (Terazol) creams.
o Creams are available in disposable applicators and are used for 1–7 days depending on product. Fluconazole (Diflucan), a single-dose pill, can also be used, especially in cases of reinfection.
* Nursing Interventions:
o Clients tend to self-treat this problem due to the availability of OTC medications.
o Some clients report relief from symptoms by swallowing acidophilus capsules, eating yogurt, or instilling yogurt directly into the vagina.
o Unnecessary or inappropriate use of OTC medications or self-care remedies can result in serious complications that do not respond well to short-term therapies.
* Patient Education:
o Client teaching should include the awareness that a healthcare provider should be seen for persistent problems.
o Recurrent problems, bad-smelling greenish discharge, and severe pain are not associated with Candida.
Trichomoniasis
* Signs & Symptoms:
o In female clients, signs and symptoms include itching and burning of the vulva accompanied by a copious, foul-smelling, greenish-yellow or gray, frothy or bubbly discharge.
o Red ulcerations may be seen on the vaginal wall or cervix.
o Both sexes may have frequent, painful, burning urination.
o Pain may be present in both sexes during sexual activity or when urinating, leading to urinary tract infections.
o Individuals may not have any symptoms, and, if untreated and nonsymptomatic, individuals can still infect or reinfect partners.
* Diagnosis:
o Diagnosis is confirmed by physical examination and laboratory testing.
* Treatment:
o Treatment consists of metronidazole (Flagyl), which is a highly effective antiprotozoal and antibacterial drug.
* Nursing Interventions:
o Trichomoniasis, also known as trichomonas or “trich,” is caused by the parasitic protozoan Trichomonas vaginalis.
o The parasite is common in young, sexually active female clients and, less frequently, in male clients.
o Transmission is by vaginal, anal, or oral sex with an infected individual and via any device (sex toy or douche tip) that has been exposed to the protozoa.
o Condoms help prevent cross-transmission.
* Patient Education:
o Factors that trigger growth of trichomoniasis include the following:
o Pregnancy
o Sexual activity
o Irritation of vaginal walls
o Trauma to the vaginal walls
o Systemic illness
o Menstruation
o Emotional upsets
Bacterial Vaginosis
* Signs & Symptoms:
o The client may have no symptoms or may complain of an odorous discharge.
o BV causes a “stale fish” vaginal odor with a vaginal discharge.
o The discharge is a thin, gray-white leukorrhea that may be mild or profuse.
o Without treatment, BV can result in PID and sterility.
o With many cases of BV, no itching or burning exists as is associated with candida or trichomonas infection.
* Diagnosis:
o A pelvic examination is done by the healthcare provider.
o Diagnosis is obtained by looking at a small smear of the vaginal secretion on a microscopic slide (at least two slides needed); a pH of the vaginal smear is also done.
o A Gram stain determines the relative quantity and type of bacteria that are present.
o The potassium hydroxide (KOH) test is done to ascertain a fishy odor associated with the vaginal samples of BV.
* Treatment:
o Treatment is generally successful with topical creams, metronidazole (Flagyl), or clindamycin (Cleocin T).
* Nursing Interventions:
* Patient Education:
o It is commonly found in sexually active women but can occur in women who have never had sex.
o Many things cause vaginitis (inflammation of the vagina), including personal hygiene products such as soap, laundry detergent, bath oil, frequent douching, spermicides, tampons, diaphragms, condoms, or sexual activity. Infections occur when normally healthy bacteria found in the vagina or alkaline semen from the male disturb the balance normally found within vaginal acidic tissues.
Gonorrhea
* Signs & Symptoms:
* Typical symptoms appear within the first 2 weeks after exposure, but it is possible not to have any symptoms; this is especially true for women.
* When initially infected, the client may have a burning sensation during urination and a yellowish-white discharge from the penis.
* Painful or swollen testicles are common.
* Prostatitis, infection of the seminal vesicles, and sterility may develop.
* Without treatment, the infection progresses to the epididymis.
* Gonorrhea can spread to bones, joints, or the bloodstream, resulting in arthritis, heart disease, liver damage, or central nervous system damage.
* Many women with gonorrhea are asymptomatic.
* Clinical findings in women include cervical tenderness, dyspareunia, purulent anal discharge, dysuria, a yellow-green purulent discharge, or a change in vaginal discharge. PID with abdominal adhesions is common, and sterility may result.
* Douching, sexual intercourse, and menstruation may spread the infection to the ovaries and cause abscess. people.
* Diagnosis:
* A smear of the discharge is cultured and examined microscopically, obtaining a Gram stain of the gonorrhea bacterium, often referred to as a GC Gram stain.
* Some healthcare providers advocate obtaining urethral, vaginal, anal, and throat cultures.
* One treatment for gonorrhea is intramuscular injection of ceftriaxone (Rocephin) or cefixime (Suprax).
* Drug-resistant strains are problematic in many areas.
* Coinfection with chlamydia is very common.
* Treatment:
* Treatment consists of antibiotics that treat both infections.
* Individuals with gonorrhea should also be tested for other STIs, including HIV.
* All sexual partners also must be treated simultaneously to prevent reinfection.
* Nursing Interventions:
* With an advanced infection, the client needs bed rest and may require Sitz baths and massive doses of intravenous antibiotics.
* The individual is not considered infection-free until cultures have been negative for at least 7 days without antibiotics
* Patient Education:
* When the infection is active, teach the client about the use of Standard Precautions; that is, to wear gloves when coming into contact with their own body secretions.
* Frequent and careful handwashing is critical.
* Eyes are particularly susceptible to gonorrheal infection.
Relationship of HPV and Cancer
- The types of HPV that cause genital warts are not the same types of HPV that cause HPV-related cancers.
- Cancerous HPV is caused by specific viruses, and there is no way to differentiate between these varieties; individuals can have both types.
- In men, warts appear on the penis, scrotum, or around the anus.
- In women, some of the warts appear around the vulva, cervix, vagina, or anus.
- Oropharyngeal cancer can occur as growths in the throat, at the base of the tongue, and on the tonsils.
- Any sexually active person is at risk for genital HPV.
- Predisposing factors for genital warts include the following:
o Oral contraceptive use
o Frequent sexual intercourse
o Multiple sexual partners
o Cigarette smoking
o Presence of other STIs
o Sex without condom use
o Being immunocompromised
o Damaged or scratched skin
A&P of Male and Female Reproductive organs-functions
- Testes
o Paired testes or testicles produce spermatozoa - Scrotum
o Where 2 testes are enclosed - Penis
o The smooth cap of the penis is called the glans penis; it is covered by foreskin. - Ductal System
o Epididymis
Stores sperm cells
o Ductus Deferens (Vas Deferens)
Transport sperm from the epididymis to ejaculatory duct
o Ejaculatory ducts
They empty into the urethra.
o Ejaculatory fluid
Semen mixed with various secretions - Accessory Glands
o Seminal vesicles
Secretes a sticky, alkaline substance, called semen, which serves as a fluid medium for sperm
o Prostate gland
Glandular prostate tissue adds an alkaline secretion to semen, which increases sperm motility
o Bulbourethral Glands
Secrete alkaline mucus that coats urethra to neutralize the pH of urine residue and lubricates the penis
o Ovaries
Sometimes called uterine tubes, ovarian tubes, or fallopian tubes, the oviducts are the passageway for the ovum between the ovary and the uterus
Receives fertilized ovum and provides housing and nourishment for a fetus
The gonads (sex organs) in women are the ovaries , which produce female gametes or ova (singular: ovum) and secrete female sex hormones (estrogens).
o Vagina .
The vagina’s functions are to receive sperm, provide an exit for menstrual flow, and serve as the birth canal.
The mucus is acidic and retards microbial growth. (The alkaline semen can temporarily neutralize the vagina’s acidic environment.)
The hymen is a thin membrane over the vaginal opening
o Vulva
(External Genitalia)
Nursing Intervention and Patient Care during Bladder Irrigation
- Monitor for abdominal distention as that can indicate clogging in the catheter.
- Check to see if an order is in place for manual irrigation, if so irrigate tubing to check for blood clots.
- Monitor intake of solution along with total output especially in the postoperative period.
- Pay attention to the color of drainage urine, will start off bloody but should steadily decrease, document any sudden increase.
- Report to charge nurse immediately if drainage becomes bright red with gushes of fresh bleeding
Shut irrigation off if: - The client complains of bladder fullness, urinary urgency, or bladder or flank pain.
- Drainage from the TURP stops
Purpose and patient care with TURP
Transurethral resection of the prostate (TURP) *MOST COMMON PROCEDURE:
* Standard surgical treatment of obstructive benign prostatic hyperplasia (BPH).
* Removal of MOST of the prostate gland.
* The surgeon removes prostate tissue through the urethra by means of resectoscope, which has a cuddling edge of electric wire that slices the prostate away bit by bit, no incision is necessary since operation is done through the urethra.
* The client will return from the operating room with a bladder irrigation in place.
Complications: Hemorrhage, urinary retention, stress incontinence, and ED.
PostOp care :
● Anti Embolism stockings
● Early ambulation
● Encourage fluid intake
● Monitor I&O’s
● Encourage patient to use incentive spirometry
● Help clients with any psychological and emotional problems.
Managing TURP bladder irrigation:
● Shut off irrigation if drainage from the TURP tube stops.
● Record the amount of irrigating solution instilled into the bladder and total output.
● Carefully monitor TURP set up to make sure all the tubes are open and that they are not twisted or kincked.
● Make sure clients do not pull on the catheter or change rates of the flow of the solutions. Catheters must remain taped in place.
● Make sure traction is placed on penis when ordered, it is to be taped securely on the hip or abdomen and is not allowed to hang down.
● Irrigate manually if ordered, it helps irrigate obstructions and or clots.
● Take note if a patient complains of a feeling of fullness, urgency, or bladder flask pain. Can put clients at risk for hemorrhage.
Causes, Risk factors, complications signs and symptoms of ED, Priapism, BPH
Erectile Dysfunction (ED): Aka as impotence.
The inability to achieve or maintain an erection sufficient to complete sexual intercourse. Classified secondary and primary.
Primary: Never achieved sufficient erection.
Secondary: Has achieved erection and completed intercourse intercourse in the past.
● Causative Risk factors:
○ Tobacco, alcohol, hormones, diuretics, antihypertensive antidepressant, psychotropics, amphetamines, renal failure, heart failure, atherosclerosis, multiple sclerosis, diabetes mellitus, thyroid disorder, adrenal disorder, pituitary disorder, spinal cord injury ,cardiovascular disorders, prostatectomy surgery, ileostomy surgery, colostomy surgery.
Priapism: An abnormal and persistent penile erection without sexual stimulation.
● Causes:
○ Penile /spinal cord injury, cerebral spinal syphilis, Pelvic vascular thromboses, Prolong sexual activity leukemia sickle cell anemia infection such as prostatitis renal calculi, or side effect from antihypertensives anticoagulants or corticosteroids.
● Risk factors:
○ Complications: Extremely painful, can last up to several hours or even days. Can be difficult to treat, and sometimes treatment may be uncesseful.
● Signs & Symptoms:
○ The client has an erection that will not go away, along with penile pain and tenderness.
Benign Prostatic hyperplasia: Prostate gland enlargement.
● Risk factors: Enlarge as men age.
● Complications: Untreated BPH can occlude the flow of urine out of the bladder, resulting in a variety of renal problems.
● Signs & Symptoms: Urinary difficulties (nocturia, urinary frequency, difficult straining.
Prostatectomy and Vasectomy the nursing care and pat education.
- Prostatectomy:
- Surgical treatment for prostatic cancer and also BPH is removal of the excess or abnormal prostate tissue.
- Nursing care:
- Anti-Embolism stockings
- Early ambulation
- Encourage fluid intake
- Monitor I&O’s
- Encourage patient to use incentive spirometry
- Help clients with any psychological and emotional problems.
- Patient education:
o Review discharge instructions with the client.
o Have client demonstrate measures for catheter maintenance, including cleaning and changing of equipment per instructions.
o Explain bowel maintenance program, including use of stool softeners.
o Encourage ambulation.
o Encourage fluids.
o Demonstrate wound cleaning and dressing changes and have client return-demonstrate procedure using clean technique and sterile dressing as appropriate.
o Teach clients about bladder retraining and Kegel exercises.
o Assist clients with setting up necessary follow-up appointments, including postoperative appointments, appointments for evaluation and treatment of erectile dysfunction (ED), when necessary, and appointments for counseling, when necessary.
o Assist clients and their significant others to understand that depression is common.
o Often the client will benefit from psychological counseling because the reality of cancer, loss of sterility, loss of sexual function, and/or incontinence are very real and lifetime changes. - Vasectomy:
o Tying off and sometimes the removal of a small part of vas deferens (ductus deferens).
o It’s the most common surgical method for sterilization in clients with male reproductive organs.
o PREGNANCY PREVENTION - Nursing care:
o Sitz baths
o Ice packs
o Analgesics - Patient education:
- Remind the client to use birth control measures until their sperm count remains at zero for 6 weeks.
- Reasure the client that they will not lose their sexual potency or drive.
Diagnosis, risk factors, pre and post nursing considerations for Cancer of prostate.
o Diagnosis:
o Almost always an adenocarcinoma, a gland cell cancer that is fairly common in men, especially African American men.
o Risk factors:
o Age
Incidences increase after the age of 40 years.
o Race
African American men are 60% more likely to develop prostate cancer than European or Hispanic men.
o Family history
Chances increase if an immediate blood relative has prostate cancer.
o Lifestyle
A diet high in animal fats, for example, saturated fats.
o Obesity
Obese men are more likely to have advanced prostate cancer.
o High testosterone levels:
Men who use testosterone therapy for other disorders have an increase in development of prostate cancer because testosterone stimulates the growth of the gland.
o Prostatic intraepithelial neoplasia (PIN)
Prostate gland cells look abnormal under the microscope, but the man may not have any symptoms until around age 50 years, when cancer may be diagnosed.
Pre-Op nursing considerations:
● Alert client on strong possibility of ED.
● Educate clients to consider baking sperm before surgery if there is a possibility, they want children.
● Discuss the possibility that the client will have a suprapubic cystoscopy catheter and some sort of continuous bladder irrigation for approximately 2-3 days after surgery.
● Before the prostatectomy, the client may have a catheter inserted for continuous urinary drainage to prevent accumulation of stagnant urine in the bladder.
● Give the client plenty of fluids, with proper diet and rest. Antibiotics are often given prophylactically.
Post-Op nursing considerations:
* Anti -Embolism stockings
* Early ambulation
* Encourage fluid intake
* Monitor I&O’s
* Encourage patient to use incentive spirometry
* Help clients with any psychological and emotional problems.
Difference between benign and malignant tumors
● Benign tumor:
○ Benign tumors, although generally not life threatening, can cause serious problems.
○ In cases where benign tumors push against normal tissues, they can threaten vital structures and functions ** slow growth
● Malignant tumor:
○ Tumors have different characteristics of growth; they also invade neighboring tissues. ** rapid growth
Testicular cancer- nursing care, risk factors and symptoms
- Testicular cancer:
o Occurs in the testicles aka testes (inside the scrotal sac)
o Metastasizes rapidly (spreads to other parts of the body)
o Often metastasizes before it is even diagnosed as primary diagnosis
o Two types of testicular tumors: Seminoma and Nonseminoma
Seminoma - Less aggressive
Nonseminoma - More aggressive, tumors develop at an earlier stage and spread quickly. There are several subtypes of Nonseminoma tumors
- Nursing care:
- Patient Education:
o Early detection is important. Clients can be encouraged to perform self-examination. Consult with PCP for any abnormal findings
o If detected and diagnosed early, surgery may be a suitable treatment option. With these surgeries it is possible that nerves that effect ejaculation can be damaged. (risk vs benefit)
o Radical inguinal orchiectomy
Total removal of testicle
o Retroperitoneal lymph nose dissection
Removal of lymph nodes
o Chemotherapy and Radiation may also be used in different combinations to treat more advanced stages.
o Chemotherapy and radiation therapy may cause sterility ( risk vs benefit), client should be informed of options such as preserving sperm prior to starting treatment. - Risk factors:
o Mostly affects European/American men aged 15-35, but can affect males of any age.
o Abnormal testicle development
o Men who have experienced Cryptorchidism (undescended testicle at birth) - Symptoms:
o Appear gradually
o Painless mass or lump may develop in testis
o As cancer grows, pain or dull ache may be felt in the now enlarged testis
o My also feel abdominal, groin, scrotum, and even breast area pain, tenderness, or enlargement
o In advanced stages affected person may experience backache, weight loss, weakness, more abdominal pain
Purpose, Preparation. and Patient education for Pelvic examination.
- Purpose:
o Procedure used to check the vulva, vagina, cervix, uterus, rectum, and pelvis for palpable (masses or lumps that can be felt) abnormalities such as benign or malignant tumors. - Prep:
o Procedure is performed in an examination room and takes only a few minutes
o Abdomen is palpated for ovarian or other masses.
o Speculum lubricated with water soluble lubricant is inserted, provider will then visually and physically examine the structures
o With gloved fingers the provider will insert fingers into vagina and palpate the uterus and ovaries.
o Also included rectovaginal examination, provider will digitally inspect the rectal area to palpate for any masses or abnormalities
o Supplies: speculum, water soluble lubricant, gloves (take note is client has latex allergy), privacy drape to be placed over client. - Patient Education:
o Encourage client to breathe deeply, which helps to relax all muscles and minimizes the discomfort associated with the examination.
o Client will lay in lithotomy position: Supine position with bottom toward end of exam table, legs up, spread outward, and feet resting on stirrups. Privacy drape wrapped over client.
o Pelvic examinations are recommended for clients past the age of puberty every 1-3 years. When there is family history of abnormalities should be done yearly.
o Pelvic exams may or may not include pap smear, depending on age, history, and family history
o Cervical biopsy, and cauterization, removal, or coagulation of a portion of cervix using laser or electric means can be performed during pelvic exam.
