Female Reproductive Challanges Flashcards
Infertility
-The inability to achieve pregnancy after at least 1 year of regular unprotected intercourse.
Infertility: etiology and patholophysiology
-Most frequent female cause is factors associated with ovulation, tubal obstruction, uterine or cervical factors.
Infertility: diagnostic studies
-Hormonal levels
-Ovulatory Studies
-Tubal latency studies
-Postcoital studies
Nursing and collaborative management: Infertility
-Depends on the cause
-Drug therapy
-Intrauterine inseminination (IUI) with partner or donor sperm
-Assistive reproductive technologies (ARTS)
-IVF; GIFT; ZIFT
-Ethical, legal, and social concerns
-Emotional suppourt
ABORTION
-Loss of terminal pregnancy before viability
-Spontaneous abortion (natural loss before 20 weeks gestation)
-Induced abortion (intentional or elective termination of pregnancy)
-Techniques depend on gestational age, woman’s condition and preference
-Menstrual evacuation, suction curttage, dialation and evacuation (D&E) drug therapy.
Problems related to menstriation
-Premenstrual Syndrome
-Dysmenorrhea
-Abnormal vaginal bleeding
-Ectopic Pregnancy
-Perimenopause and post menopause
-Conditions of the vulva, vagina, and cervix
Premenstrual syndrome
-Group of physical and psychological symptoms that occur a few days prior to menstruation
-Etiology and Pathophysiology
•Not well understood; serotonin is implicated
•Premenstrual dysphoric disorder
-Clinical Manifestations
•Breast discomfort, peripheral edema, abdominal bloating , weight gain, binge eating, migraine headache, mood swings
PMS; Collaborative Care
Diagnostic
-History and physical examination
-Symptom diary
-Diagnosis done via elimination of other causes
-Focused health history and physical exam
Collaborative Therapy
-Aerobic exercise
-Drug therapy
•Combined oral contraception
•Diuretics
•Prostaglandin inhibitors (ie Advil)
•Selective serotonin reuptake inhibitors (Zoloft)
-Nutritional Therapy
-Stress management and relaxation therapy
Dysmenorrhea
-Abdominal cramping associated with menstrual flow (Primary and Secondary)
Dysmenorrhea; etiology and pathophysiology
-Primary dysmenorrhea is not a disease; it is caused by excess prostaglandin
-Secondary dysmenorrhea is caused by endometriosis, pelvic inflammatory disease (PID), uterine fibroids
Dysmenorrhea; Clinical manifestations
-Starts 12-24 hours before period
-Lower abdominal pain (colicky), nausea, diarrhea, fatigue, loose stools, headache
-Special attention to menstrual and gynaecological history
-Treatment: heat, exercise, and drug therapy
-Teaching and supportive therapy
Dysmenorrhea; nursing management
-Primary role is client teaching
-Supportive therapy
•relief may be obtained by laying down for short periods
•drinking hot beverages such as herbal teas
•applying heat to abdomen or back
•Taking warm baths
•Taking NSAID’s for analgesia
Abnormal vaginal bleeding
Types of abnormal bleeding:
-Oligomenorrhea and amenorrhea
-Menorrhagia
-Metorrhagia
Diagnostic studies and collaborative care vary, depending on the cause
-Surgical therapy
Abnormal vaginal bleeding; nursing management
-Focus on Client teaching
-Toxic shock syndrome
-When there is excessive bleeding, the following should be assessed
•Amount
•Number of pads or tampons being saturated
•level of fatigue
•variations in pulse or blood preassure
Ectopic Pregnancy
-Implantation of fertilized ovum of the uterine cavity
-Majority occur in fallopian tube
-Life-Threatening
Ectopic Pregnancy; Etiology and Pathophysiology + CM
Clinical Mnaifestaitons
-Abdominal or pelvic pain
-Missed menses
-Irregular vaginal bleeding
-If rupture, pain is intense; referred shoulder pain
Diagnostic studies
-Pregnancy test
-Bhcg levels, Vaginal Ultrasound
Ectopic pregnancy; nursing and collaborative management
-Primary approach is surgery
-IM methotrexate
-Nurse alert to signs of rupture
-Vital signs monitored frequently
-Pre- and post operative care
-Emotional suppourt
Perimenopause and postmenopause
-Perimenopause begins with the first changes in menstruation
-Menopause is the physiological cessation of menses; it is complete after 1 year
-Postmenopuase is the time after menopause
-Age ranges from 44-55 years; average age is 51 years
-Ovarian changes begin events that result in menopause
Perimenopause and post-menopause; Clinical manifestations
Perimenopause: irregular menses, vasomotor instability, atrophy, stress/urge incontincence, breast tenderness, mood changes
Postmenopause: cessation of menses, occasional vasomotor symptoms, atrophy, stress and urge incontinence, osteoporosis
Perimenopause and post-menopause; collaborative care
-Diagnosis made on basis of exclusion
-Drug therapy
-Nonhormonal therapy
-Nutritional therapy
Culturally competent care
-Nurses in key role to help women understand changes and to present options
-Teaching and reassurance
Pelvic inflammatory disease
Etiology and pathophysiology
-Infectious condition of the pelvic cavity
-Often result of untreated cervicitis
-Chlamydia and gonococcal infection most common
Clinical manifestations
-Lower abdominal pain
-Fever, chills, vaginal discharge
Complications
-Septic shock
-Fitz-Hugh-Curtis syndrome
-Ectopic pregnancy
-Infertility
-Chronic pelvic pain
Endometriosis
-Presence of normal endometrial tissue on sites outside of the endometrial cavity
-Etiology not well understood; many theories
-Wide range of clinical manifestations and severity
-Chocolate cysts
Collaborative care
-“Watch and wait” drug and surgical therapy
Endometriosis; diagnostic
-History and physical examination
-Laprascopy
-MRI
-Pelvic examination
-Pelvic ultra sonography
Endometriosis; drug therapy
-Danazol (cyclomen)
-GnRH agonists
-NSAIDs
-Oral contraceptives
Endometriosis; surgical therapy
-Laparotomy to remove implants and adhesions
-Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)
Benign tumours of the female reproductive system
-Leiomyomas
-Cervical polyps
-Benign ovarian tumours
•Polycystic ovary syndrome (PCOS)
Cervical Cancer
-Second most common female cancer in the world
-Noninvasive cancer four times more common than invasive
Cervical cancer; etiology and pathophysiology
-Progression from normal cervical cells to dysplasia, then to cervical cancer
-Progression occurs slowly over years
Cervical cancer; clinical manifestations
-Precancerous changes are asymptomatic
-Leukorrhea and intermenstrual bleeding
-Late symptoms; pain, weightloss, anemia, and cachexia
Cervical cancer; diagnostic studies
-Cervial cancer screening recommended for sexually actively women between the ages of 21 and 69
-Pap test recommended every 1-3 years
-Follow-up on positive Pap test
-Coloscopy, biopsy
Cervical cancer; collaborative care
-HPV vaccines
-Treatment of cancer is guided by the stage of the tumor, clients age, and health status
-Conization
-Laser treatment
-Cautery and cryosurgery
-Invasive cancer requires surgery, radiation
-Hysterectomy
Endometrial or uterine cancer
-Most common gynologucal malignancy
-Major risk factor is estrogen
-Most are adneocarcinomas
-First sign is abnormal bleeding, usually is postmenopausal women
-Diagnosed with endometrial biopsy
Endometrial or uterine cancer; collaborative care
-Surgery
-Radiation
-Progesterone therapy
-Chemotherapy’s
Ovarian cancer
-Malignant neoplasm of the ovaries
-Highest mortality rate of all gynaecological cancers
-At-risk women aged 55-65
-Cause is unknown
-Early-stage manifestations are vague; pain is not an early symptom
-No screening test exists
-Other cancer of the female reproductive system
•vaginal cancer
•vulvar cancer
Nursing assessment: reproductive system cancers
-Assess for leukorrhea
-Irregular vaginal bleeding
-Vaginal discharge
-Increase in abdominal pain and pressure
-Bowel and bladder dysfunction
-Vulvar itching and burning
Nursing diagnoses; reproductive system cancers
-Anxiety
-Acute pain
-Disturbed body image
-Ineffective sexuality patterns
-Greiving
Nurse Planning; cancers of the reproductive system
-Actively participate in treatment decisions
-Achieve satisfactory pain and symptom management
-Recognize and report problems promptly
-Maintain prefers lifestyle as long as possible
-continue to practice cancer detection strategies
Nursing implementation; cancers of the reproductive system
-Health promotion
Acute intervention related to surgery
-Hysterectomy
-Salpingectomy and oophorectomy
-Vulvectomy
-Pelvic exenteration
Acute intervention with radiation therapy
-External
-Internal (brachytherapy)
Problems with pelvic suppourt
Uterine prolapse
-Downward displacement of the uterus into the vaginal canal as a result of impaired pelvic suppourt
Cystocele
-Anterior wall prolapse; occurs when support between the vagina and the bladder is weakened
Rectocele
-Posterior wall prolapse; results from weakening between the vagina and the rectum
Fistula
-Abnormal opening between internal organs or between an organ and exterior of the body
-May develop between the vagina and the bladder, the urethra, the ureter, or the rectum
-excoriation and irritation of the vaginal and vulvar tissues occur and may lead to severe infections due to urine, flatus, or feces leaking into vagina
May heal spontaneously or require surgery
Nursing management; problems with pelvic suppourt
-Teach kegel exercises
-Pre- and postoperative vaginal surgery care
-Discharge teaching
