Chapter 72: Assessment of the Reproductive System Flashcards
Vaginal pH
Normal flora called doderlein bacilli help maintain a pH of 3.5 to 5. This acidity helps prevent infection
climacteric
The phase of a womens life from the initial decline in the amount of estrogen produced by the ovaries to the end of symptoms. This phase is called the change of life. Menopause is only one sign of climacteric. High levels of FSH and LH confirm the presence of climacteric
Most common symptom is a hot flash which may be from vasodilation and increased heat production due to the elevations in FSH and LH
Artificial menopause
May occurre because of an oophorectomy or radiation to the ovaries. Premenopausal women who experience this may need estrogen and progesterone therapy.
Changes in the reproductive system for an older woman.
Greying and thinning of the pubic hair.
Drawing, smoothing, and any of the vaginal walls.
Decrease size of the uterus.
Atrophy of the endometrium.
Decrease size of the ovaries.
Loss of tone and elasticity of the pelvic ligaments and connective tissue. I
ncrease flabbiness and fibrosis of the breasts.
Changes in the reproductive system for an older man
Thinning and graying of the pubic hair.
Increased drooping of the scrotum and loss of rugae.
Prostate enlargement with in with increased likelihood of urethral obstruction.
Nutrition effects on the reproductive system
Fatigue and low libido from poor diet and anemia. Obesity increases risk for uterine cancer. High-fat diet increase the risk for breast, ovary, prostate cancer. Decrease body fat results in insufficient estrogen levels. Women on oral contraceptives need to increase their folic acid, B6, B12, and C vitamins. Women who have had heavy menstrual bleeding may need iron. All women need calcium.
Indications for a pelvic exam
Pregnancy, infertility, menstrual irregularity, unexplained abdominal or vaginal pain, vaginal discharge, itching, sores, infection, rape trauma, or pelvic injury, physical changes in the vagina, cervix, and uterus. Do not douche for at least 24 hours prior to exam.
Pap smear
papanicolaou test
An annual Pap test is recommended within three years of becoming sexually active or by 21 years of age. Annual screening is recommended to 30 years of age. After age 30 and three or more negative tests, they may be performed every 2 to 3 years until 70 years old. At 70 if there has been normal results for 10 years they may be discontinued.
It can detect precancerous or cancerous cells, viral, fungal, and parasitic disorders, and function of steroid hormones. Should be scheduled in between periods. No medications or intercourse for 24 hours prior. Follow up test is cells are atypical.
DNA Human papillomavirus
Identifies 13 high risk types of HPV that are associated with cervical cancer. Is done at the same time as a Pap test for women older than 30 and for women who have an abnormal Pap test.
Serologic studies
Detect antigen/antibody reactions that occur in response to foreign organisms. It’s only helpful after an infection has become established. It can be used to evaluate syphilis, rubella, herpes simplex virus type II. Results are read as nonreactive, weakly reactive, or reactive.
Conditions that can give a false positive syphilis test include TB, infectious mononucleosis, recent smallpox vaccine, rheumatoid arthritis, systemic lupus erythematosus, subacute bacterial endocarditis, hepatitis, and ingestion of alcohol. If the test is positive it must be confirmed by more specific test for triponeum pallidum such as the fluorescent antibody absorption test.
Other Lab tests
see page 1653
HIV for 19 to 64 years and adolescents who are sexually active. PSA above 10 is associated with prostate cancer. All men, especially African have a higher normal PSA as they age. Combined with a digital rectal exam, 90% of prostate cancer can be detected. Patient should not ejaculate for 24 hours before the test. Also draw the blood before the digital rectal exam.
Imaging
KUB kidney ureter and bladder xray
Bone scans, chest xrays for metastatic cancers
CT abdomen and pevis
Hysterosalpingogram: x-ray of the cervix, uterus, and Fallopian tubes performed after injection of contrast. Used to evaluate tubal anatomy and patency, uterine problems such as fibroids, tumors, and fistulas. At least six weeks after an abortion, delivery, or D&C. Contraindications include reproductive tract infection and uterine bleeding. Scheduled 2 to 5 days after the end of period to avoid flushing the ovum or fertilized egg and fetus. The patient takes a laxative followed by an enema or rectal suppository prior. Ask about iodine or shellfish allergy. Consent form is signed. Premedicate with analgesics. Patient may have nausea and vomiting, abdominal cramping, faintness. Patient is placed in the lithotomy position, speculum is inserted to view the cervix, dye is injected through the cervix and then the x-ray is taken. The patient may have pelvic pain or referred pain into the shoulder. Provide a path after to avoid stating common and advised to report is bleeding after four days for signs of infection.
MRI are expensive but may be used to detect breast cancer if at risk.
Mammography
X-ray of the soft tissue of the breast. It can detect 80 to 90% of cancers that are not palpable. Some cancers may not appear on a mammogram. Anyone screening is recommended for women older than 40. Pregnancy is a contraindication. The breast is compressed between two plates and takes about 15 minutes.
Ultrasound
Used to assess uterine fibroids, ovarian cysts, pelvic masses, tumors, very cells, scrotal abnormalities, problems of ejaculatory ducts in seminal vesicles. Women should have a full bladder. Maybe performed transvaginal or transrectally.
Colposcopy
3d illumination of the cervical, vagina, or vulvar epithelium with suspected disease. It can locate the exact site of precancerous and malignant lesions for biopsy. Lithotomy position, same instructions as a pelvic exam. Have materials ready for a biopsy.
Acetic acid is used to draw moisture from the tissue for bettter visibility.
