Nursing Reproductive Flashcards
what does the female reproductive system consist of
paired ovaries paired fallopian tubes uterus vagina genitalia mammary glands- accessory
what is the function of ovaries
produce egg cells by process of meiosis (called oogenesis) which begins fetally and continues through puberty, and ends at menopause. follicles of ovary produce hormone estrogen and secrete progesterone
functions of vagina
receive sperm during intercourse
serve as exit for menstrual blood flow
serve as birth canal
resistant to infection (acidic pH)
what are the external genitalia structures (aka the vulva)
clitoris
mons pubis
labia majora and minora
Bartholin’s glands
what causes the production of milk after pregnancy
prolactin from the anterior pituitary
the menstrual cycle depends on what 2 hormones
FSH (follicle stimulating hormone)
LH (luteinizing hormone)
the ovarian cycle may be described in terms of 3 phases. what are they
menstrual phase
follicular phase
luteal phase
what happens during the menstrual phase in the ovarian cycle
loss of endometrium during menstruation. secretion of FSH is increasing. several ovarian follicles (potential ovum)
what happens during follicular phase of ovarian cycle
FSH stimulate growth of ovarian follicles. secretin of estrogen by the follicle cells. Promote growth and maturation of the ovum. estrogen stimulates the growth of blood vessels to regenerate endometrium. the phase ends with ovulation (sharp increase in LH causes rupture of a mature ovarian follicle and egg is released)
what happens during the luteal phase of ovarian cycle
LH causes rupture of follicle to become corpus luteum. progesterone stimulates further growth of blood vessels in the endometrium and promotes storage of nutrients.
Follicle-stimulating hormone in females: what is it secreted by and what function
anterior pituitary
initiates development of ovarian follicles. stimulates secretion of estrogen by follicle cells
Luteinizing hormone in females: what is it secreted by and what function
anterior pituitary
causes ovulation. converts ruptured ovarian follicle into corpus luteum
Estrogen in females: what is it secreted by and what function
ovary (follicle) and placenta
promotes maturation of ovarian follicles. promotes growth of blood vessels in endometrium. initiates development of secondary sex characteristics.
Progesterone in females: what is it secreted by and what function
ovary (corpus luteum) and placenta
promotes further growth of blood vessels in endometrium. inhibits contractions of the myometrium during pregnancy. promotes growth the secretory cells of mammary glands
Inhibin in females: what is it secreted by and what function
ovary (corpus luteum)
decreases secretion of FSH toward end of cycle
prolactin in females: what is it secreted by and what function
anterior pituitary
promotes production of milk after birth
oxytocin in females: what is it secreted by and what function
posterior pituitary
promotes release of milk and stimulates contraction of uterine muscle
the head of the sperm cell contains 23 ____, and has a acrosome of the tip that contains ____
chromosomes
enzymes to digest the membrane of the egg cell during fertilization
the paired seminal vesicles have an alkaline secretion. They contain fructose, prostaglandin, clotting proteins. what is the purpose of each
alkaline secretion: neutralizes urethra and acidic pH of vagina
fructose: used for ATP production
prostaglandins: enhance motility
clotting proteins: coagulate the semen after ejaculation
Follicle-stimulating hormone in males: what is it secreted by and what function
anterior pituitary
initiates production of sperm in the testes
Luteinizing hormone in males: what is it secreted by and what function
anterior pituitary
stimulates secretion of testosterone by the testes
Testosterone in males: what is it secreted by and what function
testes
promotes maturation of sperm
initiates development of male secondary sex characteristics
inhibin in males: what is it secreted by and what function
testes
decreases secretion of FSH t maintain a constant rate of spermatogenesis
Aging in the Reproductive System: What happens in women, what does it cause
decrease estrogen secretion.
ovulation and menstruation stop,
atrophy of vaginal epithelium
increased cholesterol level –> increased risk for CAD
atrophy of meatus and decreased urethral tone –> increased incontinence
increase in bone loss –> risk for osteoporosis and fractures
Aging in the Reproductive System: What happens in males and what does it cause
decreased testosterone secretion.
decreased spermatogenesis
graduale decrease in muscle size and strength
increase in bone loss –>risk for fractures
hypertrophy of prostate gland –>urine retention
When documenting obstetrical history what are the abbreviations and what do they mean
G = number of pregnancies P= number of births (alive or stillborn after 20 weeks) A= abortions (spontaneous or therapeutic)
hormone tests are commonly used to:
assess endocrine system function as it relates to reproduction
measure potential fertility
find reasons for abnormal menses
assess hormone producing tumors
determine if hormone treatment levels are effective
salpingoscopy
performed to see the inside of the fallopian tubes
hysteroscopy
used to see the inside of the uterus
colposcopy
binocular microscope used with an endoscope that is introduced into the vagina to study lesson of the cervix
culdoscopy
endoscope introduced into vagina and through a small incision in the vagina into the cud-de-sac of Douglas, cavity behind the uterus, observe for abnormalities in this region
insufflation
CO2 gas pumped into body compartment being examined. increases distance between structures so it is easier to visualize structures.
CO2 gas travels to highest level of body. woman may experience pain the the neck, shoulders, upper back. lying flat for few hours may decrease discomfort
gynecomastia
excess of female hormones in males. there is excess breast tissue
varicocele
spermatic cord feels like a bag of worms. swelling of the veins of the spermatic cord. one of the most common problems associated with male infertility.
which male reproductive duct carries sperm into the abdominal cavity
ductus deferens
which is the usual site for fertilization
fallopian tube
which procedure is most helpful in distinguishing a fluid filled mass from a solid mass of the breast
an ultrasound can identify fluid filled cysts
which of the following items should be set up in preparation for a pap smear: 50 mL syringe vaginal speculum lubricant clean gloves slides and fixative spray
speculum with lubricant for examination
gloves for examiner
sides and fixative spray to send sample to lab
what is a cystourethroscopy
used to evaluate the degree of obstruction by an enlarged prostate gland. foley catheter inserted, dye injected, radiographs taken with dye in bladder and while after removal of catheter.
what is most commonly diagnosed cancer in women
breast cancer
what is cause of fibrocystic breast disease
aka fibrocystic breast changes
over responsiveness of cell in breast to hormonal stimulation.
pathophysiology, etiology, and s/s of mastitis
breast infection with inflammation. result of injury and introduction of bacteria into breast commonly occurs while breastfeeding breast swollen, hot, red, painful can form abscess
treatment of mastitis
antibiotics or by I&D (incision and drainage)
NSAIDs, warm packs, breast supports
nursing care and pt education with mastitis
pt education on washing hands to not spread infection. if breastfeeding, continue to promote drainage of breast, mother-infant bonding, infant nutrition. infant is already colonized with bacteria
nursing tip to prevent mastitis in a breastfeeding mother
frequent changes in feeding position to empty all portions of the breast
good hygiene techniques when handling breasts
breast cancer can arise from:
milk producing glands
ductal system
fatty and connective tissue
factors for breast cancer
increasing age personal of family Hx of breast, ovarian, prostate high fat diet high alcohol intake treatment with estrogens early menarche late menopause first pregnancy after age 25
s/s of breast cancer
lump thickening of breast tissue change in shape or contour of breast dimpling of overlying skin retraction of the nipple clear or bloody nipple discharge swelling tenderness discoloration
prevention of breast cancer
moderation in fat and alcohol consumption
using non-hormonal methods for birth control/menopause symptoms
breastfeeding may reduce risk
early detection is important
diagnostic tests for breast cancer
BSE
clinical breast exams
mammograms later in life
characteristics of cancerous growths in breasts
harder, less mobile, less painful, more irregularly shaped, less clearly defined borders than benign growths
what are the five main treatment options for breast cancer
surgery radiation therapy chemotherapy hormone therapy targeted therapy
lumpectomy
removes just the tumor and a margin around it
mastectomy can be partial, simple, or radical. what is difference
partial: removing only part of the breast
simple: removing the breast tissue of one or both breast
radical: removing breast tissue, underlying muscle, and surrounding lymph nodes
radiation therapy for breast cancer
administered externally or internally
attack the rapidly dividing cells of tumor
radiation reduces incidence of side effects
usually used after surgery to reduce the risk of cancer recurrence or spread
when to get Pap smear
begin at age 21 or within 3 years of becoming sexually active. yearly until age 30. if negative, can do q 2-3 years. can be discontinued after hysterectomy or 65y
nursing actions for pap smear
ask client if they have douched in 24h, this may wash away abnormal cells.
vaginal medication or intercourse can alter test
have pt empty bladder
lithotomy position and drape
explain procedure
equipment ready (light source, scraping tools, glass slides, fixative, perineal pad, gloves, speculum)
what is a cone biopsy
an extensive cervical biopsy that excises a cone shaped sample of tissue. can remove potentially harmful cells don’t if a cervical lesion is visible
client education post procedure of cone biopsy, endometiral biopsy, colposcopy, or cervical biopsy
abstain from intercourse and avoid douche, vaginal cream, tampons until all discharge has stopped. about 2 weeks
notify provider if heavy vaginal bleeding, fever, severe pain, or foul discharge is present
when should mammograms be done
q 1-2 years beginning at 40.
If family Hx, should be done earlier
nursing actions for pre procedure mammogram
instruct client to avoid deodorant, perfume, lotions, powders prior to exam
caffeine may increase discomfort, avoid
A nurse is preparing a sexually-active adolescent for her first(Pap) test. Which of the
following information should the nurse reinforce to the client?
A. You will not feel any discomfort.
B. You will need to hold your breath during the procedure.
C. You may experience some bleeding after the procedure.
D. You should urinate immediately after the procedure.
C. You may experience some bleeding after the procedure.
It is normal and expected for a small amount of bleeding to occur after the procedure secondary to the scraping of the cervix. It is unnecessary for the client to urinate
immediately after the procedure. Some discomfort can be felt when the speculum is introduced and the cervical scraping is done. The client should breath normally or take a few deep breaths during the procedure.
which layer of the uterus will become the maternal portion of the placenta
endometrium
strong contractions of the smooth muscle of the uterus for labor and delivery are brought about by which hormone
oxytocin
a nurse is assisting with collecting gonorrhea bacteria for culture. which of the following supplies will be required?
- clear swab
- chlamydia kit
- charcoal swab
- viral collection swab
charcoal swab
menorrhagia
excessive bleeding in amount and duration possibly with clots and for longer than 7 days
metrorrhagia
bleeding between menstrual periods more frequently than every 21 days
what is PMDD and how is it treated
premenstrual dysphoric disorder
similar to premenstrual syndrome
symptoms occur for at least 2 consecutive cycles
so severe they interfere with woman’s ability to function
symptoms: depression, irritability, changes in appetite, abd blooding, fatigue, emotional liability, fluid retention
Treatment: decrease sugar, salt, alcohol intake. increase exercise. antidepressants
endometriosis is characterized by:
an over growth of endometrial tissue that extends outside the uterus into the fallopian tubes, onto the ovaries, and into the pelvis. blockage of the fallopian tubes is a common cause of infertility
leuprolide (Lupron)
synthetic luteinizing hormone
suppresses estrogen and testosterone production in the body
effective treatment for endometriosis
promotes atrophy of ectopic tissue
causes birth defects, use reliable contraceptive
may cause decrease libido
increased risk of osteoporosis
menopause symptoms
hot flashes, irregular menses, atrophic vaginitis, vaginal dryness, incontinence, mood swings, change in sleep, decreased REM seep, decreased bone density, decreased HDL and increased LDL, decreased skin elasticity, loss of hair on head and pubic area, breast tissue change
alternative therapy to treat menopause
dong quai and block cohosh
phytoestrogens: dandelion greens, alfalfa sprouts, black beans, soy beans
Vitamin E decrease hot flashes in some women
what is a cystocele and how is it treated
protrusion of the posterior bladder through the posterior vaginal wall. caused by weakened pelvic muscles and/or structures
treatment- estrogen therapy, Kegel exercises, vaginal pessary, or surgery
subjective data:
Urinary frequency and/or urgency
■■ Stress incontinence
■■ Report of frequent UTIs
■■ Sense of vaginal fullness
what is a rectocele and what is treatment
protrusion of the anterior rectal wall through the posterior vaginal wall. caused by defect of he pelvic structures, a difficult delivery, forceps delivery
treatment: posterior colporrhaphy or anterior posterior repair
subjective date:
Constipation and/or the need to place fingers in the vagina to elevate the
rectocele to complete evacuation of feces
■■ Sensation of a mass in the vagina
■■ Pelvic pressure or pain
■■ Pain with intercourse
■■ Pain in the back or pelvis
risk factors for cystocele
obesity advanced age (loss of estrogen) chronic constipation family Hx childbearing hysterectomy
risk factors for rectocele
Pelvic structure defects Obesity Aging Family history Difficult childbirth necessitating repair of a tear Forceps delivery Previous hysterectomy
vaginal pessary
removable rubber, plastic, or silicone device inserted into the vagina to provide support and block protrusion of other organs into the vagina
risk factors for ovarian cancer
Over 40 years of age
Nulliparity or first pregnancy after 30 years of age
Family history of ovarian, breast, or colon cancer
History of dysmenorrhea or heavy bleeding
Endometriosis
High-fat diet (possible risk)
Hormone replacement therapy
Use of infertility medications
Older adult clients following surgery for cancer.
subjective data for ovarian cancer
Abdominal pain or swelling Abdominal discomfort (dyspepsia, indigestion, gas, distention) Abdominal mass Urinary frequency
diagnositc procedures for ovarian cancer
Bimanual examination may reveal an enlarged ovary.
A vaginal ultrasound may also be helpful in determining the pre surgical size and location of tumors
Staging of ovarian cancer is determined at the time of the hysterectomy or exploratory laparotomy when the tumor is removed and examined by the pathologist
is chemotherapy used for ovarian cancer?
chemotherapy is always given for ovarian cancer, even if surgery was performed. Cisplatin and carboplatin are most common
what does TAH with BSO mean
total abdominal hysterectomy with bilateral salpingectomy and oophorectomy
the usual treatment for ovarian cancer
A nurse is caring for a client who has breast cancer and is to undergo hormone therapy. Identify two agents used for this type of treatment and their intended effect
Leuprolide (Lupron) is a gonadotropin-releasing hormone (GnRH) that inhibits estrogen synthesis. Tamoxifen (Nolvadex) and raloxifene (Evista) are selective estrogen receptor modulators that suppress the growth of remaining cancer cells post postmastectomy or lumpectomy.
most common type of cancer in men
prostate cancer
what is PSA and what does it measure
The PSA measures the amount of a protein produced by the prostate gland in the bloodstream.
◯◯ The PSA is done on a sample of blood, and its value is reported.
◯◯ Clients who have an elevated PSA should undergo a DRE by a provider to validate the
findings
When to get PSA and DRE
Many providers recommend an annual PSA and DRE on men over 50 to better ensure
early detection of prostate cancer. African-American men and men who have a family
history of prostate cancer should begin screening at an earlier age.
interpretation of PSA and DRE
An increase in PSA may indicate that a client has prostatic cancer. The expected reference range for the PSA is from 2 to 4 ng/mL. A PSA is considered elevated if its value is above 4 to 10 ng/mL.
Abnormal findings during the DRE include an abnormally large and hard prostate with an irregular shape or lumps.
most common malignancy in men 15-35 years
testicular cancer
risk factors for testicular cancer
Undescended testis (cryptorchidism)
Genetic disposition
Metastases
Age 15 to 35 (but can occur at any age)
subjective data for testicular cancer
Lumps and/or swelling of testes
Feeling of heaviness in the testicles
Reports of back pain (evidence of metastasis)
objective data for testicular cancer
Enlarged testes without pain
Palpable lump
Swelling of lymph nodes in the groin
Abdominal mass, gynecomastia (evidence of metastasis)
orchiectomy
removal of the testis
treatment of choice for testicular cancer
performed using inguinal incision
gell filled prostheses are implanted after removal
lymph nodes can be removed at this time
risk factors for BPH
benign prostatic hypertrophy
age
family Hx
subjective data for BPH
Urinary hesitancy, frequency and nocturia
Recurrent bladder infections
Feeling of incomplete emptying of bladder
Painless hematuria
objective data for BPH
Small amounts of urine voided at one time with significant, residual weak stream, and posturination dribble
Hematuria and/or bacteruria
Elevated BUN and creatinine (indicates kidney damage)
diagnostic procedures for BPH
A digital rectal exam (DRE) will reveal an enlarged, smooth prostate.
Use uroflowmetry to measure rate and degree of bladder emptying
Client education on BPH
frequent ejaculation has been found to release prostatic
fluids, therefore, decreasing the size of the prostate.
avoid drinking large amounts of fluids at one time and urinate when the urge is initially felt.
avoid bladder stimulants, such as alcohol and caffeine.
avoid medications that cause decreased bladder tone, such as anticholinergics, decongestants, and antihistamines.
BPH may initially be treated conservatively with medication.
5-alpha reductase inhibitors – Finasteride (Proscar), dutasteride (Avodart)
what are they for and what do they do
Used to inhibit the enzyme – 5-alpha reductase from converting testosterone to dihydrotestosterone (DHT) and thus decrease the production of testosterone in the prostate gland.
Decreasing a male client’s DHT will often cause a decrease in the size of the prostate.
medication must be taken daily on a long term basis
impotence and decrease in libido are possible side effects
Clients taking dutasteride should not donate blood for 6 months after discontinuing the medication. Women who are pregnant or may become pregnant should use caution when handling the medication, and avoid exposure to semen of a partner taking these medications due to risk to male fetus.
Tamsulosin (Flomax)
Alpha-adrenergic receptor antagonists cause relaxation of the bladder outlet and prostate gland.
These agents cause less pressure to be placed on the urethra, therefore, reestablishing a stronger urine flow.
Postural hypotension may occur
changes in position must be made slowly
concurrent use with cimetidine (Tagamet) can potentiate hypotensive effect
TURP
performed using a resectoscope (similar to a cystoscope) that is inserted through the urethra and trims away excess prostatic tissue, enlarging the passageway of the urethra through the prostate gland
postop nursing actions for TURP
Provide routine postoperative care to prevent complications.
Manage continuous bladder irrigation through a large balloon (30 to 45 mL), indwelling urinary three-way catheter. The catheter tubing is taped tightly to the leg, creating traction so that the balloon will apply firm pressure to the prostatic fossa to prevent bleeding.
If the catheter becomes obstructed (bladder spasms, reduced irrigation outflow), turn off the CBI and irrigate with 50 mL of irrigation solution using a large piston syringe. Contact the provider if unable to dislodge the clot.
pt education following TURP
contact provider for difficulty or inability to void and/or persistent bleeding.
avoid heavy lifting, strenuous exercise, straining, and sexual intercourse for the prescribed length of time (usually 2 to 6 weeks).
consume 2 to 3 L/day of fluids from food and beverage sources.
avoid bladder stimulants, such as caffeine and alcohol.
if urine becomes bloody, stop activity, rest, and increase
fluid intake
risk factors for prostate cancer
Age greater than 65 years Family history African-American heritage High-fat diet BRCA2 mutation may be associated with an increased risk
subjective data for prostate cancer
Urinary hesitancy and weak stream Recurrent bladder infections Urinary retention Blood in urine and semen Painful ejaculation
radical prostatectomy
- Involves the removal of the entire prostate gland, along with the seminal vesicles, the cuff at the bladder neck, and the regional lymph nodes
- Procedure of choice for treatment of prostate cancer
- May be done using a suprapubic, perineal, or retropubic approach.
- A laparoscopic approach may be an option for treatment of localized prostate cancer.
nursing interventions for diagnosis: anxiety related to uncertainty about diagnosis, prognosis, and treatments for mastectomy
assess vital signs observe verbal and nonverbal behavior assess pt knowledge of procedure assess level of anxiety support physician's explanations answer questions refer to knowledgeable sources
nursing interventions for diagnosis: risk for ineffective breathing pattern related to pain with chest movement after mastectomy
assess vitals, O2, pain level, lung sounds
medicate to relieve pain
encourage deep breathing and coughing qh
encourage use of inceptive spirometer qh while awake
nursing interventions for diagnosis: risk for ineffective tissue perfusion related to damage to blood and lymph vessels and tension at surgical incision site after mastectomy
monitor vitals, O2
avoid use of affected arm for BP, venipunctures, injections
assess incision for bleeding, amount and color f drainage, swelling
empty drain device PRN
measure circumference of arms daily and compare
elevate affected arm if swelling occurs
place items in easy reach
encourage post mastectomy exercises of the affected arm
teach postop self care and s/s of ineffective healing to report
nursing interventions for diagnosis: risk for ineffective coping related to cancer threat and body image disturbance after mastectomy
observe pt intrest in self care, ability to problem solve, level of family support
use therapeutic communication and listing skills
help pt remember previous successes in coping and strategies used
provide accurate information
refer to appropriate agencies for further support
mammoplasty
surgical modification of breast.
done to restore a normal shape after removal of cancerous tissues.
many undergo electively to reduce or increase the size or to improve shape of breasts
priority nursing diagnosis for breast cancer
anxiety
risk for ineffective breathing pattern
risk for ineffective tissue perfusion
risk for ineffective coping
mastopexy
involves removal of some skin and fat with subsequent resuturing so that the breast tissues are held higher on the chest to correct sagging breasts
causes of menstural abnormalities
stress pregnancy hormonal imbalance metabolic imbalance (obesity, anorexia) loss of too much body fat tumors infections organ diseases blood and bone marrow abnormalities foreign bodies
amenorrhea
menses absent for more than 6 months or 3 of previous cycles. called primary amenorrhea when menarche has not occurred by 17. called secondary amenorrhea when menses are absent after menarche
hypermenorrhea
menses lasting longer than 7 days
hypomenorrhea
less than the expected amount of menstrual bleeding
menometrorrhagia
aka metro-menorrhagia
overly long heavy and irregular menses
menorrhagia
passing more than 80 mL of blood per menses
oligomenorrhea
menstrual cycles of more than 35 days
polymenorrhea
aka metrorrhagia
menses more frequently than 21 day intervals
dysmenorrhea
painful menstruation
common problem (menstrual cramps) is primary
secondary- caused by a reproductive tract disorder
diagnostic test and therapeutic measures for dysmenorrhea
hormonal test. laparoscopic examination, biopsy, culture
aspirin, NSAIDS, hormonal adjustment (oral contraceptive, HRT), D&C
if related to uterine retroversion, knee to chest position helps
pathophys, etiology, s/s of PMS
exact cause not understood, ovarian hormones, aldosterone, neurotransmitters play a role
s/s water retention, headache, discomfort of joints, muscles, beats, changes in affect, concentration, coordination, sensory changes
therapeutic measures for PMS
drugs that affect prostaglandin production, hormonal balance, neurotransmitter production and reuptake (antidepressants), diuretics, supplements of calcium, magnesium vitamin E, vitamin B6
restriction of alcohol, caffeine, nicotine, salt, simple sugars. regular exercise, develop stress management skills
