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
