Nursing care of clients with specific health problems related to reproduction and sexuality Flashcards
A urethral defect in which the urethral opening is not at the end of the penis but on the ventral (lower) aspect of the penis.
Hypospadias
Denotes a urethral opening on the superior or dorsal (i.e., upper) surface.
Epispadias
Urethral defect occurring in approximately 1 in 300 male newborns.
Hypospadias
Urethral defect occurring in approximately 1 in 100,000 male newborns.
Epispadias
Many newborns with hypospadias have an accompanying short
_______ : a fibrous band that causes the penis to curve
downward (often called a cobra-head appearance).
chordee
The opening of the urethra is located somewhere near the head of the penis.
Subcoronal Hypospadias
The opening of the urethra is located along the shaft of the penis.
Midshaft Hypospadias
The opening of the urethra is located where the penis and scrotum meet.
Penoscrotal Hypospadias
Hypospadias
Therapeutic Management
Should not be ___________ :
Circumcised Surgeon may wish to use a portion of the foreskin during repair.
A procedure in which the urethra is extended to a usual position—to establish better urinary function.
Meatotomy
When the child is older (___ to ___ months), adherent chordee can be released. If the repair will be extensive, all surgery may be delayed until the child is __ to __ years of age. Must be corrected before _______ age if at all possible so the child looks and feels like other males.
12 to 18 months
3 to 4 years of age
school age
The child may notice painful bladder spasms as long as the catheter is in place (__ to __ days), so an analgesic such as acetaminophen (Tylenol) and an ____________ medication such as oxybutynin (Ditropan) may be prescribed for pain relief.
3 to 7 days
anticholinergic
Meatal opening at an inferior penile site may interfere with
________ because it does not allow sperm to be deposited close to
the female cervix during coitus.
fertility
A most common benign tumor of the breast in women of all
ages.
Fibrocystic disease of the breast
Fluctuating hormone levels during the menstrual cycle can cause
breast discomfort and areas of lumpy breast tissue that feel
tender, sore and swollen.
Fibrocystic disease of the breast
Most common in older adolescents. Can occur as early as puberty, when estrogen rises to adult levels.
Fibrocystic disease of the breast
List the how you can Diagnosis Fibrocystic disease of the breast
Mammogram and ultrasound.
BSE (breat self examination)
-Should be performed at monthly intervals, preferably 1 week
after menses.
BSE (breat self examination)
-Should be performed at monthly intervals, preferably __ week/s
after menses.
1 week
Fibrocystic disease of the breast
Assessment:
Breast tenderness
Round, fluid-filled, and freely movable cysts form in the
connective breast tissue.
3 patterns in conducting BSE
Lines
Circles
Wedges
Fibrocystic disease of the breast
Medical Management:
-Breast tenderness: Acetaminophen (Tylenol), an NSAID, or warm compresses, avoidance of trauma, and firm bra support.
-Annual breast ultrasound or magnetic resonance imaging (MRI) to efficiently locate and identify that the cysts are benign.
Fibrocystic disease
of the breast
Surgical Management:
Aspiration: Reduces the size of
the cyst but also provides fluid
for biopsy.(FNAB)
FNAB
Fine needle aspiration biopsy
The client frequently finds lumps in her breasts, esp. around
her period. Which info should the nurse teach the client re:
breast self care?
1. This is a benign process that does not need follow up.
2. Eliminate chocolate and caffeine from diet.
3. Practice breast self exam monthly.
4. This is how breast cancer starts and she needs surgery
- Practice breast self exam monthly.
-Benign tumors that consist of both fibrotic and glandular
components that occur in response to estrogen stimulation .
-They may increase in size during adolescence, during pregnancy and lactation, or when a woman takes an estrogen source such as an oral contraceptive.
Fibroadenoma
Fibroadenoma
-They may increase in size during adolescence, during pregnancy and lactation, or when a woman takes an _________ source such as an oral contraceptive.
estrogen
Where do fibroadenoma usually occur in the breast?
a. fat
b. muscle
c. lobule
d. milk duct
C. Lobule
Fibroadenoma
Assessment:
-Feels _______ and well delineated, are ________ and freely
movable.
-Occasionally, they _______
and feel extremely hard.
round
painless
calcify
Fibroadenoma
Surgical management:
Breast mass excision (BME)
ADDENDUM: Breast Surgeries
– the surgeon removes:
• all of the breast tissue
• the skin of the breast
• the nipple and the areola (the
dark area around the nipple)
Simple mastectomy (also
called a total mastectomy)
Breast Surgeries
Surgery to remove the
whole breast, all of the
lymph nodes under the
arm, and the chest wall
muscles under the breast
Radical Mastectomy
/Halsted Radical
mastectomy
Breast Surgeries
The entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes, but the pectoralis major muscle is spared.
Modified radical
mastectomy
Breast Surgeries
Removes the cancer while leaving as much normal breast as possible.
Breast-conserving
surgery (BCS)
Inflammation of the breast
due to infection that may
occur as early as the 7th
postpartal day or not until the
baby is weeks or months old.
Mastitis
The organism causing the
infection usually enters
through cracked and fissured
nipples. (Bacterial Mastitis)
Mastitis
Assessment for Mastitis
Breast feels painful and
appears swollen and reddened.
Fever accompanies these first
symptoms within hours
Breast milk becomes scant.
Mastitis
Therapeutic Management:
-Antibiotic against penicillin-resistant staphylococci such as _________ or a _________.
dicloxacillin
cephalosporin
Provide Therapeutic Management for mastitis
- Antibiotic against penicillin-resistant staphylococci such as dicloxacillin or
a cephalosporin. - Breastfeeding should be continued if possible because keeping the breast
emptied of milk helps to prevent the growth of bacteria. - Express milk manually from the affected breast until their antibiotic has
taken effect and the mastitis has diminished (about 3 days). - Cold or ice compresses and a good supportive bra help with pain relief.
Mastitis
Measures to prevent nipples from cracking:
-Making certain the baby is positioned correctly and grasps the nipple properly, including both the nipple and areola
- Helping a baby release a grasp on the nipple before removing the baby from the breast
- Washing hands betweenhandling perineal pads and touching breasts
- Exposing nipples to air for at least part of every day
- Encouraging women to begin breastfeeding (when the infant sucks most forcefully) on an unaffected nipple (if a woman has one cracked nipple and one well nipple)
Prevention of breast engorgement
Regular breastfeeding
-Every 1 to 3 hours throughout the day and night. While you should let them breastfeed for as long as they want, aim for at least 20 minutes at each feeding (10 minutes each side)
Abnormal growth of extrauterine endometrial cells, often in the cul-desac of the peritoneal cavity or on the uterine ligaments or ovaries, and is one of the main causes of dysmenorrhea in adolescents.
Endometriosis
This abnormal tissue results from excessive endometrial production and a reflux of blood and tissue through the fallopian tubes during a menstrual flow
Endometriosis
Endometriosis
Assessment:
-Dyspareunia (painful coitus): Abnormal tissue in the pelvic cul-desac can cause pressure on the posterior vagina. -Pelvic examination: Uterine displacement due to tender, fixed, palpable nodules.
-Pelvic UTZ: Large endometrial tissues; Chocolate cysts (endometrioma)
Endometriosis
Complications:
Subfertility: Immobilized fallopian tubes blocked by tissue
implants or adhesions, preventing peristaltic motion and
transport of ova.
Adhesions
Endometriosis
Therapeutic Management:
__________/_________ ____ ________ may reduce the amount of extrusion into the peritoneal cavity because the tissue sloughs under the influence of the progesterone.
____________, a synthetic androgen, can be prescribed to
help shrink the abnormal tissue.
Administration of a GnRH agonist, such as __________ _______ (Lupron), can reduce hormone stimulation to help shrink the abnormal tissue.
-Estrogen/progesterone-based oral contraceptives
-Danazol (Danocrine)
-leuprolide acetate
Endometriosis
Surgical Management:
Laparoscopic surgery
A laparotomy with excision by
laser surgery is the most effective measure.
Adhesiolysis
Hysterectomy
Oophorocystectomy/Ovarian
cystectomy
Endometriosis
Nursing considerations:
Patient Education
Complications → Infertility/Subinfertility
Don’t postpone childbearing
Importance of treatment
Check hemoglobin level as ordered.
Annual pelvic exam
Evaluate disease progression
-Bladder prolapse (________) is a chronic condition during which a
bladder herniates to the anterior vaginal wall.
-Due to weakness of the pelvic floor muscles (Levator ani)
and the connective tissue surrounding the bladder and vagina.
Cystocele
Cystocele
Factors:
-Obesity
-Increasing age: Changes in pelvic anatomy.
-Multiparity
-Increased intra-abdominal pressure: Constipation, chronic cough, and obstructive pulmonary disease
-Family history of cystocele
-Following pelvic surgery: Damage to the endopelvic fascia and nerves.
Cystocele
Assessment:
Feeling of pressure or sensation that something is bulging or
about to come out of the vagina.
Incontinence: Overactive bladder
Dyspareunia
Cystocele
Diagnostics:
Vaginal examination
Perineal floor ultrasound
cystourethrogram
Cystocele
Medical and surgical management:
Pessaries: Plastic or silicone
devices that are inserted into the
apex of the vagina.
Kegel exercises (pelvic muscle
exercises) can be advised for
women with stage 1 or 2 prolapse
Anterior colporrhaphy (Cystocele Repair)
- Performed trans-vaginally to repair central vaginal wall defects and to lessen the size of the anterior vaginal wall.
Sacral Colpopexy
This procedure aims to place a permanent mesh to the
anterior and posterior walls of the vagina and then attach it to
the anterior longitudinal ligament below the sacral promontory.
• Benefit : Avoids vaginal incisions and scarring, which results in a
lower risk of vaginal shortening or dyspareunia.
Sacral Colpopexy
This procedure aims to place a permanent mesh to the
anterior and posterior walls of the vagina and then attach it to
the anterior longitudinal ligament below the sacral promontory.
• Benefit : Avoids vaginal incisions and scarring, which results in a
lower risk of vaginal shortening or dyspareunia.
Performed trans-vaginally to repair central vaginal wall defects and to lessen the size of the anterior vaginal wall.
Anterior colporrhaphy (Cystocele Repair)
Is a variety of pelvic organ prolapse (POP) that
involves the herniation of the rectum through the rectovaginal
septum into the posterior vaginal lumen.
Rectocele
The loss of integrity in the rectovaginal fascia would result in a herniation of the rectal tissue into the vaginal lumen leading to a vaginal bulge along the posterior vaginal wall on examination that would become more pronounced with the Valsalva maneuver.
Rectocele
Rectocele
Physical assessment:
Pelvic pain/pressure
Posterior vaginal bulge
Obstructive/Incomplete defecation
Constipation
Dyspareunia
Erosions and bleeding of mucosa if there is tissue exposure to
the outside environment
Rectocele
Diagnostic:
Vaginal/Rectal exam
Defecography: Contrast
medium is instilled in the
vagina, bladder, and rectum.
This test can be useful to
determine the size of the
rectocele.
Rectocele
Medical and Surgical Management:
High fiber diet and increased water intake to reduce constipation/defecatory symptoms.
Kegel exercises
Vaginal pessary: Stabilize the defects in the pelvic floor
Rectocele Repair aka Posterior colporrhaphy: Tightens the
muscles in the back wall that hold your rectum in place.
A type of fistula wherein there is a tunnel-like opening that develops between the vagina and rectum.
Rectovaginal fistula
Rectovaginal fistula
Factors:
Prolonged vaginal labors
Pressure from your baby pushing against your vaginal wall can
reduce blood flow, causing tissue death.
Vaginal tears
Inflammatory bowel diseases (IBD)
Colon infections like diverticulitis.
Radiation therapy to your pelvic region.
Rectovaginal fistula
Assessment
Foul-smelling vaginal discharge.
Gas, pus or stool that leaks out of the vagina.
Dyspareunia
Recurrent urinary tract infections (UTIs) or vaginitis (vaginal
infections).
Rectal bleeding or vaginal bleeding.
Skin irritation in your vagina, vulva (entrance to the vagina) or
perineum.
Rectovaginal fistula
Diagnostic:
CBC and urinalysis to look for infections.
Fistulogram X-ray to determine the number and size of fistulas.
Pelvic MRI or CT scan to take images of your vagina and rectum.
Flexible sigmoidoscopy to view your rectum and the lower part of your large intestine (colon).
Colonoscopy to examine the inside of your rectum and all of your large intestine
Rectovaginal fistula
Medical/Surgical Managment:
Small rectovaginal fistulas may heal on their own over time. You
may need antibiotics for infections or medications for IBD.
(3 to 6 months after starting ttt.)
Fistulotomy/Fistulectomy
If the opening is large, Pt. may need a temporary colostomy. This procedure diverts poop (stool) away from the large intestine and rectum until the fistula heals.
Rectovaginal fistula
Nursing considerations for post-operative patients
Principles of catheter care post-op
No traction;No kinks
Increase fluid intake
Assess discharges
Mobilization
Abstinence for at least 3 months
CS for future pregnancies
The hymen is the
membranous ring of
tissue that partly
obstructs the vaginal
opening.
Imperforate hymen
Imperforate hymen
Assessment:
Lack of a first menstrual cycle
Palpation of the abdomen reveals a
lower abdominal mass.
On vaginal examination, an intact,
bulging hymen is evident.
Dysuria
Imperforate hymen
Surgical Managmenet:
Surgical incision (hymenotomy) or removal of the hymenal tissue.
The girl may have local pain after the incision, which can be
relieved by a mild analgesic and warm baths.
Because most girls of early menstrual age have scant knowledge of anatomy, pictures of the reproductive tract can help to explain that this is a local and minor problem. Once relieved, it will not interfere with sexual relations or future childbearing.
Imperforate hymen
Nursing Consideration:
Supportive environment: Adolescent patients may be highly embarrassed and may feel violated constantly examining and discussing their genitals. Nurse should be vigilant in supporting
the patient’s emotional needs
Adolescents with the syndrome begin to develop an increased
androgen (male hormone) level, which then prevents follicular
ovarian cysts from maturing. The androgen increase is usually
directly related to obesity and further exacerbates insulin
resistance.
Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS)
Most frequent cause of ovulation failure seen today.
Found in about _____ of women of childbearing age.
10%
Polycystic Ovary Syndrome (PCOS)
Typical symptoms:
Irregular or missed menstrual cycles
Acne
Excessive hair growth (hirsutism)
Overweight
Male pattern baldness
Type 2 diabetes
Absence of ovulation.
Polycystic Ovary Syndrome (PCOS)
Assessment:
Irregular periods or infrequent periods
Pelvic exam and ovarian UTZ to
determine the consistency and size of ovaries.
Serum androgen and glucose levels.
Polycystic Ovary Syndrome (PCOS)
Medical management:
Weight loss by increasing lean meat, fruits, and vegetables and
decreasing the amount of concentrated carbohydrates.
COC may be prescribed because this changes the ratio of estrogen and testosterone produced, leading to better regulated menstrual cycles.
Morbidly obese: Bariatric surgery.
Metformin (Glucophage) for to prevent type 2 diabetes from
developing
Clomiphene (Clomid) to stimulate ovulation.
In vitro fertilization (IVF)
Ovarian drilling: Reduces the size of the ovaries and limits the
amount of testosterone the ovaries are able to produce.
To decrease hair growth and reduce acne symptoms: Antiandrogens such as spironolactone (Aldactone) or finasteride (Propecia) can be tried.
Caution women that finasteride is teratogenic and so should not be used if they intend to become pregnant, and it should be discontinued during pregnancy
Polycystic Ovary Syndrome (PCOS)
Nursing Considerations:
Lifestyle modifications are considered the first line of treatment
for PCOS. Changes to diet or physical activity should be
recommended.
Supportive care: Health education
Post-operative care
