Reproductive Flashcards
What are tests used to identify and diagnose sexual and reproductive problems
Transrectal Ultrasound
PSA
Digital Rectal
Endometrial Biopsy
Hysterosalpingography
Mammography
What is BPH (Benign prostatic hyperplasia?
Enlargement or hypertrophy of prostate gland
What are some causes of BPH?
-Elevated estrogen levels
-Smoking
-Reduced activity level
-Western diet
What are manifestations of BPH?
-Increased urinary frequency
-Urinary urgency
-Nocturia
-Weak urinary stream
-Dribbling
-Straining
How to manage BPH
Catheterization
Cystostomy
Medication
-Alpha-adrenergic blockers
-antiandrogen agents
-herbal: Saw Palmetto
What are surgical management options for BPH?
-Transurethral microwave heat treatment
-TUNA (TRansurethral needle ablation)
-TURP (transurethral resection of the prostate
-Open prostatectomy
What are nursing interventions for BPH?
-Help reduce anxiety
-Relieve discomfort
-Provide instruction
-Maintain fluid balance
What are home care guidelines for a pt with BPH?
-Urinary control
-Avoid valsalva maneuver (straining heavy)
-Avoid bladder discomfort (spicy foods, alcohol, and coffee)
-Increase fluids
What is TURP?
Transurethral Resection of the prostate
-most common prcedure used to treat BPH
-Surgical and optical instrument goes through urethra to remove glandular
Pre-Op management for TURP
-Inform about procedure and expectations
-discuss complications
-incontinence or dribbling up to one year after surgery
-retrograde ejaculation
-bowel preparation is given
-optimal cardiac, respiratory and circulatory status should be achieved
-Prophylactic antibiotics are ordered
Post-op Management for TURP
-Urinary drainage maintained (observe for signs of hemorrhage)
-maintain patency of catheter
-Avoid overdistention of bladder
-Administer anti-cholinergic (reduce bladder spasms)
-best rest for 24 hours, then movement
-wound care
-administer pain meds
-Promote comfort
-Stool softeners
-reduce anxiety
-open discussion of anxiety and fear
-Educate
What are symptoms of prostate cancer
-may or may not have symptoms early on
-blood in urine
-need to pee at night
-weak or interrupted urine flow
-pain or burring while peeing
-inability to urinate
-regular pain in lower back, pelvis, or upper thighs
How to we find prostate cancer
-check PSA (prostate-specific antigen)
*know that other things can cause elevated PSA, but it is a good way how to screen
-DRE (Digital rectal exam)
*feeling for bumps, hard spots, and any other abnormalities
What are things that can elevate PSA level?
-Prostate cancer
-BPH (benign prostatic hyperplasia
-Age
-Prostatitis (infection of prostate gland - from stds, etc)
-Ejaculation (for short duration)
**man should not ejaculate for 2 days before taking the exam!
What is Cystocele (Bladder prolapse) ?
Bladder moves from its normal position and presses against the front wall of the vagina?
What causes Cystocele?
-Muscles and tissues that hold bladder in place are weak or damaged
*pregnancy / childbirth
*obesity
*frequency constipation
What are symptoms of cystocele?
-Urinary incontinence
-frequent voiding or urge to pass urine
-not feeling relief after voiding
-frequent UTI
-Pain in vagina, pelvis, lower abdomen, groin or lower back
-heaviness or pressure
-dyspareunia
-tissue sticking out of vagina (tender and/or bleeding)
How to manage cystocele?
No treatment if
-not causing any problems
-not blocking urine flow
Behavior therapy
-kegal exercises
-pelvic floor physical therapy
-Pessary (vaginal support device)
Medication
-Estrogen replacement therapy
What are surgical management options for cystocele?
-open surgery (incision made through abdomen)
-Minimally invasive surgery
-Laparoscopic
-Robot-assisted laparoscopic
What is Rectocele?
A bulge of tissue into the vagina (similar to hernia)
*also called posterior vaginal prolapse
Symptoms of Rectocele
-sometimes asymptomatic
-soft bulge of tissue that might come through opening of vagina
-trouble having bowl movements
-feeling pressure or fullness in rectum
-feeling rectum has not fully empties
-sexual concerns, embarrassed
Prevention of rectocele
-Perform kegal
-treat and prevent constipation
-avoid heavily lifting and lift correctly
-control coughing
-avoid weight gain
treatment options for rectocele
-Observation
-Pelvic floor pt
-pessary
-Surgery
What is uterine prolapse?
Part of uterus descends into vagina
What are symptoms of uterine prolapse?
-Feeling tissue bulge
-heaviness or pulling in the pelvis
-feeling like bladder is not empty all the way
-incontinence (leakage)
-trouble with BM
-feeling like sitting on a ball
-vaginal tissue rubbing on clothing
-pressure or discomfort in pelvis or lower back
-sexual concerns, too loose
What are causes of uterine prolapse?
weakened or damaged muscles and connective tissues such as ligaments allow the uterus to drop into the vagina.
Common causes: pregnancy, childbirth, hormonal changes after menopause, obesity, severe coughing and straining on the toilet.
What are risk factors that increase risk of uterine prolapse?
-Having vaginal birth
-being older when you have first birth
-large baby
-aging
-obesity
-prior pelvic surgery
-chronic constipation or often straying during bm
-family history
-being Hispanic or white
-chronic coughing, from smoking
What are treatment options for uterine prolapse?
Pessary
Surgery
-Hysterectomy
-Repair
-Mesh
What is a hysterectomy?
Surgical removal or the uterus
Why would a woman need a hysterectormy?
-Cervical / Uterine cancer
-Endometriosis
-Uterine fibroids
-Extensive hemorrhage
-Rupture of uterus
-Intractable pelvic infection
What are the different types of hysterectomys?
Subtotal
total
total with bilateral salpingo-oophorectomy
vaginal hysterectomy or laparoscopically
total pelvis exenteration (TPS)
Menstruation
Average Age: 12.4 years old
Average Range: 9-17
Average days between cycles 28 days
average duration: 2-7 days
average amount of flow 30-80 ml
Normal color: dark red
normal odor: Marigolds…..????
What are the different stages of the menstrual cycle?
Proliferative Phase
Secretory Phase
Ischemic Phase
What is Dysmenorrhea?
-Painful menstruation
What is Menorrhagia ?
Heavy menstrual flow (>80ml)
WHat is metrorrhagia
Bleeding between menstrual periods
What is Menometrorrhagia?
Excessive and prolonged uterine bleeding occuring at irregular and/or frequent intervals
What is Mittelschmerz?
“Middle pain”
One-sided, lower abdominal pain associated with ovulation
What is endometriosis?
A condition in which cells similar to lining of uterus, or endometrium, grow outside of the uterus
What are S/S of Endometriosis
-painful periods (dysmenorrhea)
-pain with intercourse
-pain with bowel movements or urination
-excessive bleeding
-infertility
What are caused of endometriosis?
Retrograde menstruation
Transformation of peritoneal cells
embryonic cell transformation
surgical scar implantation
endometrial cell transport
immune system disorder
What are risk factors for endometriosis?
-Never giving birth
-starting period at young age
-menopause early
-short menstrual cycle
-heavy menstrual period
-higher levels of estrogen
-low BMI
-Family history
-Medical conditions that prevents passage of blood from body during periods
-disorders of reproductive tract
Complications from endometriosis
infertility
increases uterine cancer risk
What are treatment options for endometriosis
NSAIDS
Hormone Therapy
Surgery
-Conservative
-Hysterectomy
-Incl oophorectomy
What is menopause?
no longer menstruates (for at least 12 years)
What are symptoms of menopause?
-Vasomotor (hot flashes, night sweats)
-Problems sleeping
-Fatigue
-genito-urinary symptoms
-Vaginal dryness
-decreased libido
-joint pain
-weight gain and bloating
-migraine
When do symptoms level out during menopause?
around 2 years
What is perimenipause?
Can start as early as 35 years old
-steadily decreasing consistency of menstrual cycles
-often with some sx of menopause
What is premature menopause?
-menopause before age 40
How do we manage premenopause
OCP (birth control)
-can lead to thrombosos
-not used past age 50
HRT
-must have estrogen AND progesterone in uterur still
-without uterus, may have estrogen only
-Topical estrogen
-can increase thrombosis
-Slight increase in breast CA
-should stop after 5 years
What are other management options for symptoms of perimenopause?
Clonidine (reduces vasomotor Sx and help with sleep)
-st johns wort
-SSRI
-Gabapentin
-Testosterone
-Black Cohosh (herbal supplement)
-Evening primrose oil
-Vaginal moisturizer and lube
What is Fibrocystic breasts?
-thickening of breast tissue (fibrosis)
-fluid filled cysts
-affects >50% of women
Symptoms of fibrocystic breasts
-Pain or discomfort (breasts and/or under arms)
-lumps (can be painful and are movable)
-breast that feel full, swollen, or heavy
Management for fibrocysitc breasts?
-NSAIDS
-Heat / ice
-Sports bra for more support
-needle aspiration of cysts
-OCP (birth control)
-Reassurance
What is a BSE (breast self exam)
-Recommend it monthly
-start in front of mirror
-detects majority of breast abnormities
What to inspect during BSE
-Skin changes
-redness
-Visible bumps
-nipple crusting
-symmetry
-raise arms and watch for dimpling or retraction
-feel for lumps (marble in bag of rice)
What part of the hand should a woman use to inspect
use middle of fingers (not finger tips)
small circles
make sure to get the “tail” of breast *into armpit
try to express nipple discharge
What is a mammogram and when should they be done?
Smoosh the boobies to detect abnormalities
-start between age 40-50 *10 years prior to a first degree relative who received it
-once 50, every year
What is cervical cancer?
-most common in age 21-35
-Risk decreases after age 30
-Causes by HPV
Prevention in cervial cancer
-sexual abstinence
-HPV vaccine
-Regular pap
*every 3 years (age 21-30 if normal)
*every 5 years (30 and later if normal)
*stop screening at 65
How to treat cervical cancer
leep
loop
cone
cervicectomy (take the whole cervix out)
hystoectomy
radiation
chemo
When is Testicular cancer more common?
-Age 15-34
-most common form of cancer among young men
-cure rate over 98%
What do testicles do?
-produce sperm and testosterone
What does testosterone do?
-Body and facial hair
-low voice
-muscle development
-ability to have erection
-Libido
-Stamina
-mood and wellbeing
What are the risk factors for developing testicular cancer
-undescended testicle
-family history
-ethnicity
-height
-marijuana
What are MYTHS about causes of testicular cancer
-tight underwear
-other factors
-fertility
-injury
-Talc?
What are symptoms of testicular cancer
-lump within the testicle
-ache or dragging sensation in scrotum
-swelling of the testicle
less common:
-back pain
breast swelling or tenderness
What are treatment options for testicular cancer?
Orchidectomy (removal of testicle)
Surveillance
Chemo
What is survivorship rate of testicular cancer?
98% will make a full recovery (65+ deaths per year)
STIs
Syphilis Symptoms
-painless ulceration on genitals
-may have ulcerations on other parts of the body (hands and feet)
-can cause significant neurological damage (and can get to the brain)
Treatment for Syhilis
Penicillin
