Reproductive Flashcards
Identify changes in the reproductive system related to aging
Female:
— graying and thinning of pubic hair
— decreased size of labia majora and clitoris
—drying, smoothing, and thinning of vaginal walls
— decreased size of uterus
— loss of tone and elasticity of pelvic ligaments and connective tissues
— increased flabbiness and fibrosis of breasts; hang lower than chest wall; decreases erection of nipples
Male:
— graying and thinning of pubic hair
— increases drooping of scrotum
— prostate enlargement, increased likelihood of urethral obstruction
Nutritional history:
— high alcohol intake increases risk of ovarian cancer
— diet high in fat and low in fruits and vegetables increases risk of reproductive cancers
Family hx and genetic risk:
— daughters of women given DES to control bleeding during pregnancy are at increased risk for infertility and reproductive tract cancer
— specific BRCA1 and BRCA2 gene mutations increase overall risk for breast and ovarian cancer
— men with first degree relatives (father, brother) with prostate cancer are at greater risk
What are current health problems to assess?
— pain
— bleeding
— discharge
— masses
What is a Pap smear and at what age do women need to begin annual Pap smears?
Detects precancerous and cancerous cells from the cervix
Annual Pap test starting at age 21
What do vaginal cultures help detect?
Used to detect bacterial, viral, fungal, and parasitic disorders
What is alpha fetoprotein (AFP)
What is cancer antigen 125 (CA 125)
Elevated with ovarian cancer
Prostate specific antigen (PSA) test
Normal <2.5 for age <50 and increases with age
— used as screening lab for prostate cancer; other prostate problems can increase the level
What lab is an indicative for prostate cancer?
Early prostate cancer antigen (EPCA-2) and Serum acid phosphate
Describe the uses for CT, MRI, and ultrasonography
CT:
— evaluate for metastasis with different reproductive cancers
— evaluates for ovarian cancer
MRI:
— evaluation for breast cancer for women with high risk factors
Ultrasonography:
— transvaginal: ovarian and endometrial cancer
— transrectal: prostate cancer
— ultrasound: testicular masses; breast cancer evaluation
What is a hysterosalpingography?
X-ray that uses contrast dye to visualize the cervix, uterus, and Fallopian tubes
* uterine problems such as fibroids, tumors, fistulas
Pre: assess for contrast dye allergies
Post: pelvic and shoulder pain expected
What is a mammography?
X-ray of soft tissue of the breast
Annually for women 40+
Pre: no creams, lotions, powders, or deodorant on breast or under arms
*may experience discomfort during procedure
Post: reinforce continued self breast exams and clinical breast exams
What is a colposcopy?
Examines cervix and vagina using colposcope
Locates exact site of precancerous and malignant lesions for biopsy
What is a laparoscopy?
Direct examination of pelvic cavity through endocope
PERFORMED UNDER ANESTHESIA
Pre: NPO
Post: pelvic and shoulder pain; observe incision sites for infection
What is a hysteroscopy?
fibrotic camera inserted into the vagina
— examines cervix and uterus
— performed with regional nerve block
Post: pelvic and shoulder pain
Cervical biopsy study:
Cervical tissue removed for study
Early in menstrual cycle so less vascular
Pre: address anxiety; anesthesia
Post: monitor for bleeding and infections, nothing in vagina for 2 weeks, no heavy lifting
What is an endometrial biopsy?
Used to obtain cells directly from the lining of uterus to assess for cancer of endometrium
— assess menstrual disturbances infertility
Post:
— cramping
— monitor bleeding and infections
— spotting for 1-2 days
— nothing in vagina for 1-2 days
What is a breast biopsy study?
— tissue aspirated through large bore needle or small incision
— local anesthetic
— aspirated fluid from benign cysts may appear dark green-brown
— bloody fluid suggest cancer
Pre: address anxiety, anesthesia
Post:
— mild pain alleviated with analgesics, ice or heat
— monitor for bleeding and infection around incision
— numbness may occur around biopsy site
— wear supportive bra for 1 week
Prostate biopsy:
Diagnostic tool for prostate cancer
Pre: discuss positioning and discomfort; address anxiety
Post:
— educate regarding soreness and light rectal bleeding
— blood in urine and stool for a few days in addition to rust colored semen for several weeks
— monitor for excessive bleeding, infection, urinary retention
— post biopsy antibiotic
What are the CM of prostate cancer?
Early symptoms:
— urinary retention
— bladder infections
— difficulty starting urination
Advanced:
— hematuria
— swollen lymph nodes in groin
— pain
— unexpected weight loss
What are labs to evaluate prostate cancer?
Prostate specific agent (PSA)
— normal <2.5 with age <50 and increases with age
— used as screening lab; other prostate problems can increase level
Early prostate cancer antigen (EPCA-2)
— detects changes in prostate gland early
What are interventions for prostate cancer?
Active surveillance
*slow growing cancer
Surgery:
— laparoscopic radical prostatectomy (LRP): entire prostate removal
— open radical prostatectomy: entire prostate removal
— bilateral orchiectomy: removal of both testicles
Nonsurgical:
— radiation
— drug therapy: hormone, chemotherapy
What do you need to assess with prostatitis?
Inflammation of prostate gland
— occurs with urethritis or an infection of lower urinary tract
* organisms reach via bloodstream/urethra
CM:
— fever
— chills
— dysuria
— urethral discharge
— boggy and tender prostate
Chronic bacterial prostatitis:
— occurs in older men
— symptoms less dramatic
What are some interventions with prostatitis?
Tx:
— antibiotics
— hospitalization with aggressive IV antibiotics
Complications:
Inflammation of epididymis
Cystitis: inflammation of bladder
Testicular cancer assessments:
Rare cancer; affecting men 20-35 years of age
CM:
— painless
— hard swelling or enlargement of testicle
What are lab assessments with testicular cancer?
— alpha-fetoprotein AFP
— beta human chorionic gonadotropin (hCG)
— lactate dehydrogenase (LDH)
Ultrasounds to identify masses
CT + MRI to check for metastasis
Testicular cancer interventions:
Surgical management:
— radical unilateral orchiectomy
— radical retroperitoneal lymph node dissection
Nonsurgical:
— chemotherapy
— external beam radiation therapy
What is endometrial cancer? What are risk factors?
Cancer of the inner uterine lining
— grows slowly
— most common
Risk factors:
— prolonged exposure to estrogen without protective effect of progesterone
— women in reproductive years
— family hx
— DM
— HTN
— obesity
— smoking
What do you assess with patients with endometrial cancer?
Postmenopausal vag bleeding — main symptom
— watery, bloody vag discharge
— low back or abdominal pain
— low pelvic pain (enlarged uterus)
Endometrial cancer lab assessments:
CBC: anemia
Cancer antigen 125: elevated in ovarian cancer
Alpha fetoprotein: elevated
Human chorionic gonadotropin (hCG): elevated
Diagnostic assessment with endometrial cancer
Transvaginal ultrasounds
Endometrial biopsy
What are the stage 1 and stage 2 interventions with endometrial cancer?
Surgical management:
Stage 1:
— removal of uterus, Fallopian tubes, and ovaries TOTAL HYSTERCTOMY
Stage 2:
Radical hysterectomy; bilateral pelvic lymph node dissection and removal of upper third of vagina
Nonsurgical management of endometrial cancer:
Radiation therapy 1x to 2x a week
— bed rest during tx
— brachytherapy: internal radiation placed by radiologist; radioactive implant stays in place for several minutes
Drug therapy:
Chemotherapy
— coping mechanisms
What is cervical cancer and how would you treat it?
What are some health promotion tips?
Progressive cancer
— generally takes years for cervical cells to transform from normal to premalignant to invasive cancer
1. Normal cervical cells
2. Atypia (suspicious)
3. Cervical intraepithelial neoplasia
4. Carcinoma in situ
Health promotion:
Gardasil and Cervarix:
— given before sexual contract for girls and young women ages 9-26; also given to boys/men with genital warts + transmission of cancers
— protection against high risk HPV
— periodic pelvic exams; Pap smears age 21
TREATMENT:
Early surgical procedures:
— loop electro surgical excision procedure
— laser therapy
— cryotherapy
Surgical:
— hysterectomy
Nonsurgical:
— radiation therapy
— chemotherapy
What is ovarian cancer and what are some risk factors?
Epithelial tumors that grow on the surface of the ovaries
* tumors grow rapidly, spread quickly, often bilateral
LEADING CAUSE OF DEATH FROM FEMALE REPRODUCTIVE CANCERS
— survival rate is low; often not detected until late stages
*vague abdominal and GI symptoms
Risk factors:
— older than 40
— family hx of ovarian or breast cancer
— DM
— older than 30 at first pregnancy
— breast cancer
— infertility
— endometriosis
— obesity/high fat diet
— BRCA 1 or BRCA 2 gene mutations
What are CM and interventions for cervical cancer?
CM:
— mild symptoms for several months
— abdominal pain or swelling
— vague GI disturbances: dyspepsia + gas
— any enlarged ovary found after menopause should be evaluated as though if malignant
Interventions:
Diagnostic:
— CA-125 may be elevated
— transvaginal ultrasound, CXR, CT
Surgical:
— exploratory laparotomy (cancer is staged)
— total abdominal hysterectomy
— bilateral salpingo-oophorectomy
— pelvic and paraaortic lymph node dissection
— cytoreducation
Nonsurgical:
— chemo after surgery
ADVANCED
— palliative end of life care
— difficult cancer to dx before metastasis occurs
