REPRODUCTIVE Flashcards
Erectile Dysfunction
Inability to attain or maintain an erect penis
Etiology and pathophysiology
Erectile Dysfunction
Results from physiological or psychological factors
Normal physiological age-related changes are associated with erectile function
Clinical manifestations and complications
Erectile Dysfunction
Self-report of problems associated with sexual function
Major complications: inability to perform sexually; personal issues
Diagnostic studies
Erectile Dysfunction
Thorough sexual, health, psychosocial history
-Erection Quality Scale
Physical examination
Further examination and testing based on findings
Collaborative care
Erectile Dysfunction
Oral drug therapy Vacuum constriction devices Intraurethral devices Penile implants Sexual counseling
Nursing Management
Erectile Dysfunction
Emotional support for both patient and partner
Confidentiality
Counselling and therapy for both patient and partner
Provide a support system and accurate information
Structural Abnormalities: Uterus
Normal position of uterus
Slightly anteverted and anteflexed
Cervix downward and posterior
Retroflexion of uterus Uterus tipped posteriorly May be excessively curved or bent Marked retroversion may cause back pain, dysmenorrhea, dyspareunia In some cases, infertility may occur.
Uterine displacement or prolapse
First-degree prolapse if cervix drops into the vagina
Second-degree prolapse if cervix lies at opening to the vagina
Body of uterus is in the vagina
Third-degree prolapse if uterus and cervix protrude through the vaginal orifice
Early stages of prolapse may be asymptomatic.
Advanced stages cause discomfort, infection, and decreased mobility.
Rectocele
Protrusion of the rectum into the posterior vagina
May cause constipation and pain
Cystocele
Protrusion of bladder into the anterior vagina
May cause UTIs
If severe, conditions are treated surgically to increase the support of the pelvic ligaments.
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Infertility
Inability to achieve conception despite 1 year of frequent, unprotected intercourse
Express concern and tactfulness with patient
Physical causes
Pretesticular, testicular, post-testicular
Cause may be a female condition, male condition, or a combination of both - 33% of cases involve male factors
Associated with hormonal imbalances Age of parents Structural abnormalities Infections Chemotherapy Workplace toxins Other environmental factors Idiopathic
Amenorrhea (absence of menstruation)
May be primary or secondary
Primary form may be genetic.
Secondary form usually hormonal imbalance
Dysmenorrhea
Painful menstruation caused by excessive release of prostaglandins as a result of endometrial ischemia
Usually begins a few days prior to menses & lasts a few days
NSAIDs offer relief.
Premenstrual syndrome
Approx 1 week prior to menses
Pathophysiology not completely known; may be several forms
Breast tenderness, weight gain, abdominal distension or bloating, irritability, emotional liability, sleep disturbances, depression, headache, fatigue
Treatment is individualized and may include exercise, limiting salt intake, use of oral contraceptives, diuretics, or antidepressant drugs.
Menorrhagia
Increased amount and duration of flow
Metrorrhagia
Bleeding between cycles
Polymenorrhea
Short cycles of less than 3 weeks
Oligomenorrhea
Long cycles of more than 6 weeks
Prostatitis
Infection or inflammation of the prostate gland
E. coli
Occurs in:
Prostatitis
Young men with UTIs Older men with prostatic hypertrophy In association with STDs With instrumentation such as catheterization Through bacteremia
Signs and symptoms
Prostatitis
Both acute and chronic forms manifested by dysuria, urinary frequency, and urgency Decreased urinary stream Acute form includes fever and chills Lower back pain Leukocytosis Abdominal discomfort Systemic signs include fever, malaise, Anorexia Muscle aches Acute Bacterial – Fever, chills, back pain, perineal pain, acute urinary symptoms
Diagnostic studies
Prostatitis
Urinalysis and urine culture are indicated
White blood cell count and blood cultures in presence of fever
PSA test to rule out prostate cancer; levels may be elevated with prostatic inflammation
Microscopic evaluation and culture of expressed prostate secretion
Nursing and Collaborative Management
Prostatitis
Antibiotics Pain management Treat acute urinary retention Prostatic massage High fluid intake Management of fever
Benign Prostatic Hyperplasia
Hyperplasia of prostatic tissue
Palpated on DRE
Occurs in up to 50% of men > 65 years
Most common urological problem in males
Etiology - not completely understood
Related to estrogen–testosterone imbalance
Compression of urethra and urinary obstruction
Does not predispose to prostatic carcinoma
Benign Prostatic Hyperplasia
S&S
Symptoms usually gradual in onset Early symptoms usually minimal because bladder can compensate Worsen as obstruction increases • Obstructed urinary flow • Hesitancy in starting flow • Dribbling • Decreased flow strength • Increased frequency and urgency • Nocturia • Dysuria occurs if infection is present.
Diagnostic studies
BPH
History and physical examination Digital rectal examination (DRE) Urinalysis with culture Prostate-specific antigen (PSA) level Serum creatinine Transrectal ultrasonography (TRUS) scan Uroflowmetry Cystourethroscopy
Collaborative care
BPH
Goals: • Restore bladder drainage • Relieve symptoms • Prevent and treat complications Watchful waiting Dietary changes Timed voiding schedule
Drug therapy:
BPH
Offers symptomatic relief of BPH
• slow enlargement dutasteride (Avodart)
• Smooth muscle relaxers tamsulosin (Flomax)
• Reduces progression of hypertrophy Combination of finasteride (Proscar) and doxazosin (Cardura)
Invasive therapy
BPH
Transurethral resection of the prostate (TURP)
Transurethral incision of the prostate (TUIP)
Prostatectomy
Minimally invasive therapy
Transurethral microwave thermotherapy (TUMT)
Transurethral needle ablation (TUNA)
Laser prostatectomy
Intraprostatic urethral stents
Benign Prostatic Hyperplasia: Complications
Leads to frequent infections - Urinary tract infection (UTI) and sepsis, Incomplete bladder emptying with residual urine provides medium for bacterial growth
Continued obstruction - distended bladder, dilated ureters, hydronephrosis, and renal failure if untreated.
Acute urinary retention: common complication is indication for surgical intervention
Endometriosis
Presence of normal endometrial tissue in sites outside of the endometrial cavity. Ectopic endometrium responds to cyclical hormone changes. Bleeding leads to inflammation and pain
MANI AND ETIO
Wide range of clinical manifestations and severity
Etiology - not well understood
Infections: Pelvic Inflammatory Disease (PID)
Infection of uterus, fallopian tubes, and/or ovaries
Acute or chronic
PID Causes:
- Ascending infection from lower reproductive tract
- —Untreated cervicitis
- —Chlamydia and gonococcal infection
- Bacteremia
- Sexually transmitted diseases
- Nonsterile abortions,
- Childbirth.
Infections: PID: Manifestations
Pelvic pain is usually first sign (Lower abdominal)
Increased temperature - fever, chills, Guarding Nausea and vomiting Leukocytosis Purulent vaginal discharge may be present.
PID
treatment
Treatment usually requires aggressive antibiotic therapy in hospital.
Infections: PID: Complications
Scarring of tubes increases risk of infertility and ectopic pregnancy.
Potential acute complications: Peritonitis Pelvic abscesses Septic shock Infertility Chronic Pelvic Pain
Benign Tumours of the Female Reproductive System
Leiomyomas (Fibroids)
Cervical polyps
Benign ovarian tumours
(Polycystic ovary syndrome (PCOS)
Leiomyoma (fibroids)
• Benign tumor of the myometrium
• Common during the reproductive years
• Classified by location
• Usually multiple, well-defined, unencapsulated masses
o Abnormal bleeding may occur.
o May interfere with implantation
• Often asymptomatic until large growth
• Hormonal therapy or surgerySTI: Bacterial
Chlamydial infections
- most common STIs
- Chlamydia trachomatis
Males
• urethritis = dysuria, itching, white discharge from penis
• epididymitis = painful, swollen scrotum, usually unilateral, fever
• inguinal lymph nodes swollen
Females
• Often asymptomatic until PID or infertility develops
• Newborns may be infected during birth.
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Gonorrhea
Neisseria gonorrheae
Many strains have become resistant to penicillin and tetracycline.
Second most frequently occurring STI
Direct physical contact with infected host
Males 20-24
Inflamed urethra
Some males are asymptomatic.
Females 15-19
Frequently asymptomatic
PID and infertility are serious complications.
May infect the eyes of the newborn, causing irreversible damage and blindness
May spread systemically to cause septic arthritis
STIs: Syphilis
Treponema pallidum,
Primary stage: Presence of chancre at site of infection --Genital region --Anus --Oral cavity Painless, firm, ulcerated nodule Occurs about 3 weeks after exposure Lesion heals spontaneously but client is still contagious
Secondary stage:
If untreated, a flulike illness occurs, with a widespread symmetrical rash—self-limited but client remains contagious
Latent stage:
May persist for years
Transmission may occur.
Tertiary syphilis—irreversible changes
Gummas in organs and major blood vessels
Dementia, blindness, motor disabilities
STIs: Syphilis (Cont.)
Organism can be transmitted to fetus in utero
Baby born with tertiary syphilis changes that are not reversible
Treatment is usually antimicrobial drugs.
Increase in antibiotic resistant strains causing an increase in prevalence
STIs: Viral Infections
Genital herpes—herpes simplex
• Caused by HSV-2 or HSV-1
• HSV-1 possible with oral sex
• Lesions similar to HSV-1
• Recurrent outbreaks of blister-like vesicles on the genitalia
o Preceded by tingling or itching sensation
o Lesions are extremely painful.
• After acute stage, virus migrates back to dorsal root ganglion
• Infectivity greater when symptoms are present
Sexually Transmitted Infections
Can be bacterial or viral
Usually start as lesions on genitals or mucous membranes and can spread to other areas
Contributing factors to STI rates
Earlier reproductive maturity Longer sexual life span Greater sexual freedom Media emphasis Lack of barrier methods during sexual activity
oral contraceptives
Oral contraceptive effects on acidity of vaginal/cervical secretions promote growth of certain organisms, causing STIs.
GonorrheaEtiology and Pathophysiology
Easily killed by drying, heating, or washing with antiseptic
Incubation period: 3 to 8 days
Provides no immunity to subsequent reinfection
Men
and gonorrhea
Initial site infection is urethra. Symptoms Develop 2 to 5 days after infection Dysuria Profuse, purulent urethral discharge Unusual to be asymptomatic
complications:
Include prostatitis, urethral strictures, and sterility
Often seek treatment early, so less likely to develop complications
Women and gonorrhea
Mostly asymptomatic or have minor symptoms
Vaginal discharge
Dysuria
Frequency of urination
After incubation:
Redness and swelling occur at site of contact.
Greenish, yellow purulent exudate often develops.
May develop abscess
Disease may remain local or may spread by tissue extension to uterus, fallopian tubes, and ovaries.
complications:
Include pelvic inflammatory disease (PID), Bartholin’s abscess, ectopic pregnancy, and infertility
Usually asymptomatic, so seldom seek treatment
Gonorrhea
Clinical Manifestations
Anorectal gonorrhea:
Usually from anal intercourse
Few symptoms
Include soreness, itching, and discharge of anus
Orogenital:
Few symptoms
Gonococcal pharyngitis can develop.
Gonorrhea and babies
Eye infections in newborns
Instillations of prophylactic erythromycin (0.5%) ophthalmic ointment or silver nitrate (0.1%) aqueous solution
Untreated infants develop permanent blindness.
Gonorrhea
Diagnostic Studies
Must have culture to confirm diagnosis
History and physical examination Laboratory tests Gram-stained smear to identify organism Culture of discharge Nucleic acid amplification test Testing for other STIs
Gonorrhea
Collaborative Care
Drug therapy:
Treatment generally instituted without culture results
Treatment in early stage is curative.
Most common- Oral dose of cefixime (Suprax)
All sexual contacts of patients must be evaluated and treated.
Patient should be counselled to abstain from sexual intercourse and alcohol during treatment.
Re-examine if symptoms persist after treatment.
Syphilis
Mainly due to men who have sex with men
SyphilisEtiology and Pathophysiology
Caused by Treponema pallidum
Spirochete bacterium
Enters the body through breaks in skin or mucous membranes
Facilitated by abrasions that occur during sexual intercourse
Complex disease in which many organs and tissues can become infected
Causes production of antibodies that react with normal tissues
Not all exposures cause disease.
Destroyed by drying, heating, or washing
Incubation 10 to 90 days
Spread in utero after 10th week of pregnancy(still birth or baby can die)
HIV-infected patients with syphilis appear to be at greatest risk for clinically significant central nervous system (CNS) involvement and may require more intensive treatment with penicillin than do other patients with syphilis.
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Syphilis
Clinical Manifestations
Variety of signs/symptoms can mimic another disease.
Primary stage Chancres appear. Painless indurated lesions Occur 10 to 90 days after inoculation Lasting 3 to 6 weeks
Syphilis
Complications
Occur most often in late syphilis
Gummas can produce irreparable damage to bone, liver, or skin.
Aneurysm may press on structures such as intercostal nerves, causing pain.
Sudden attacks of pain
Loss of vision and sense of position
Syphilis
Diagnostic Studies
History, including sexual history PE Examine lesions. Note signs/symptoms. Dark-field microscopy Serological testing Testing for other STIs
Syphilis
Collaborative Care
Drug therapy:
Benzathine penicillin G (Bicillin)
Aqueous procaine penicillin G
Recurring or persistent symptoms after drug therapy are re-treated.
Chlamydial Infections
Most prevalent bacterial STI in Canada
Incidence is 2 times higher in women than in men.
Major contributor to: PID Ectopic pregnancy Infertility in women Nongonococcal urethritis in men
Chlamydial Infections
Etiology and Pathophysiology
Caused by Chlamydia trachomatis
Gram-negative bacteria
Largely underreported because infected persons are asymptomatic
Transmitted during vaginal, anal, or oral sex
Risk factors
of chlamydia
Women and adolescents
New or multiple sexual partners
Sexual partners who have had multiple partners
Chlamydial Infections
Clinical Manifestations
“Silent disease”
Symptoms may be absent or minor.
Infection often is not diagnosed until complications appear.
Men:
Urethritis- Dysuria and Urethral discharge
Proctitis- Rectal discharge and Pain during defecation
Epididymitis- Unilateral scrotal pain and Swelling
Women:
Cervicitis-Mucopurulent discharge and Hypertrophic ectopy
Urethritis- Dysuria and Pyuria
Bartholinitis-Purulent exudate
Perihepatitis- Fever, nausea, vomiting, right upper quadrant pain
PID
Chlamydial Infections
Diagnostic Studies
Laboratory tests: Nucleic acid amplification test (NAAT) Direct fluorescent antibody (DFA) Enzyme immunoassay (EIA) Testing for other STIs Culture for chlamydia
Cervical or urethral discharge less purulent, watery, and painful in chlamydia than in gonorrhea
Chlamydial InfectionsCollaborative Care
Drug therapy: Doxycycline (Vibramycin) 100 mg bid for 7 days Azithromycin (Zithromax) 1 g in single dose
Abstinence from sexual intercourse for 7 days after treatment
Follow-up care for persistent symptoms
Treatment of partners
Encouraging use of condoms
Genital Herpes
Not a reportable disease in most provinces and territories
True incidence difficult to determine
One of the most common STIs in North America
Genital Herpes
Etiology and Pathophysiology
Caused by herpes simplex virus (HSV)
Enters through mucous membranes or breaks in the skin during contact with infected persons
HSV reproduces inside cell and spreads to surrounding cells.
Virus enters peripheral or autonomic nerve endings.
Ascends to sensory or autonomic nerve ganglion, where it is dormant
Recurrence when virus descends to initial site of infection
Persists for life
Virus sheds even in absence of lesion.
Genital Herpes
Diagnostic Studies
History and physical examination
Viral isolation by tissue culture
Antibody assay for specific HSV viral type
Genital HerpesCollaborative Care
Drug therapy: Inhibit viral replication Suppress frequent recurrences Acyclovir (Zovirax) Valacyclovir (Valtrex) Famciclovir (Famvir) Not a cure, but shorten duration and healing time and reduce outbreaks
Genital Warts
Highly contagious
Of adult population in Canada, at least 70% have at least one genital HPV infection over lifetime
Caused by human papillomavirus (HPV)
Highly contagious
Frequently seen in young, sexually active adults
Genital Warts
Clinical Manifestations
White to grey and pink-fleshed coloured
May form large cauliflower-like masses
Itching may occur with anogenital warts.
Bleeding on defecation may occur with anal warts.
genital warts and babies
Rapid growth with pregnancy
Transmitted to newborn
Genital Warts
Diagnostic Studies
Diagnosis on basis of appearance of lesions
May be confused with other diseases
Primary goal: removal of symptomatic warts
Serological and cytological tests:
HPV DNA test to determine if women with abnormal Pap test results need follow-up
Identify women who are infected with high-risk HPV strains
Recurrences and re-infection possible
Careful long-term follow-up advised
Vaccine to prevent cervical cancer, precancerous genital lesion, and genital warts due to HPV
Nursing Management
Nursing Assessment
Subjective data: Past medical history, including sexual history Medication use IV drug use Nausea/vomiting Dysuria Urethral discharge Burning lesions Vaginal discharge Presence of genital or perianal lesions
Objective data
Fever Visual assessment of lesions, warts, rash Purulent rectal discharge Proctitis Urethral and cervical discharge Laboratory findings
Nursing Management
Nursing Diagnoses
Risk for infection
Anxiety
Ineffective health maintenance
Nursing Management
Planning
Patient with STI will:
Demonstrate understanding of mode of transmission and risks imposed
Complete treatment and follow-up
Notify or assist in notification of sexual contacts
Abstain until infection is resolved
Demonstrate knowledge of safer sex practices
Nursing Management
Nursing Implementation
Discuss practices with all patients.
Screen for cervical cancer.
Teach to inspect partner’s genitals.
Some protection if void immediately after intercourse; wash genitalia and adjacent areas with soap and water
Nursing Management
Nursing Implementation
Proper use of condoms
Avoiding sexual contact with HIV-infected persons
Establishing risk of contracting STI
Compassion and respect
Screening programs
Locating and examining all contacts of person with STI for testing and treatment
Abstinence during treatment period, condoms afterward
Avoid oral-genital contact.
Nursing Management
Evaluation
Patient with STI will: Demonstrate modes of transmission Use appropriate hygienic measures Experience no re-infection Demonstrate compliance with follow-up protocol
