REPRODUCTIVE Flashcards

Question

Nursing and Collaborative Management | Prostatitis

Answer 1

``` Antibiotics Pain management Treat acute urinary retention Prostatic massage High fluid intake Management of fever ```

Answer 2

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

Answer 3

``` 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. ```

Answer 4

``` History and physical examination Digital rectal examination (DRE) Urinalysis with culture Prostate-specific antigen (PSA) level Serum creatinine Transrectal ultrasonography (TRUS) scan Uroflowmetry Cystourethroscopy ```

Answer 5

``` Goals: • Restore bladder drainage • Relieve symptoms • Prevent and treat complications Watchful waiting Dietary changes Timed voiding schedule ```

Answer 6

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)

Answer 7

Transurethral resection of the prostate (TURP) Transurethral incision of the prostate (TUIP) Prostatectomy

Answer 8

Transurethral microwave thermotherapy (TUMT) Transurethral needle ablation (TUNA) Laser prostatectomy Intraprostatic urethral stents

Answer 9

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

Answer 10

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

Answer 11

Wide range of clinical manifestations and severity | Etiology - not well understood

Answer 12

Infection of uterus, fallopian tubes, and/or ovaries | Acute or chronic

Answer 13

- Ascending infection from lower reproductive tract - ---Untreated cervicitis - ---Chlamydia and gonococcal infection - Bacteremia - Sexually transmitted diseases - Nonsterile abortions, - Childbirth.

Answer 14

Pelvic pain is usually first sign (Lower abdominal) ``` Increased temperature - fever, chills, Guarding Nausea and vomiting Leukocytosis Purulent vaginal discharge may be present. ```

Answer 15

Treatment usually requires aggressive antibiotic therapy in hospital.

Answer 16

Scarring of tubes increases risk of infertility and ectopic pregnancy. ``` Potential acute complications: Peritonitis Pelvic abscesses Septic shock Infertility Chronic Pelvic Pain ```

Answer 17

Leiomyomas (Fibroids) Cervical polyps Benign ovarian tumours (Polycystic ovary syndrome (PCOS)

Answer 18

``` • 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 surgery ```

Answer 19

* 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. •

Answer 20

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

Answer 21

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

Answer 22

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

Answer 23

• 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

Answer 24

Can be bacterial or viral | Usually start as lesions on genitals or mucous membranes and can spread to other areas

Answer 25

``` Earlier reproductive maturity Longer sexual life span Greater sexual freedom Media emphasis Lack of barrier methods during sexual activity ```

Answer 26

Oral contraceptive effects on acidity of vaginal/cervical secretions promote growth of certain organisms, causing STIs.

Answer 27

Easily killed by drying, heating, or washing with antiseptic Incubation period: 3 to 8 days Provides no immunity to subsequent reinfection

Answer 28

``` 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

Answer 29

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

Answer 30

Anorectal gonorrhea: Usually from anal intercourse Few symptoms Include soreness, itching, and discharge of anus Orogenital: Few symptoms Gonococcal pharyngitis can develop.

Answer 31

Eye infections in newborns Instillations of prophylactic erythromycin (0.5%) ophthalmic ointment or silver nitrate (0.1%) aqueous solution Untreated infants develop permanent blindness.

Answer 32

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 ```

Answer 33

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.

Answer 34

Mainly due to men who have sex with men

Answer 35

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)

Answer 36

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 ```

Answer 37

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

Answer 38

``` History, including sexual history PE Examine lesions. Note signs/symptoms. Dark-field microscopy Serological testing Testing for other STIs ```

Answer 39

Drug therapy: Benzathine penicillin G (Bicillin) Aqueous procaine penicillin G Recurring or persistent symptoms after drug therapy are re-treated.

Answer 40

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 ```

Answer 41

Caused by Chlamydia trachomatis Gram-negative bacteria Largely underreported because infected persons are asymptomatic Transmitted during vaginal, anal, or oral sex

Answer 42

Women and adolescents New or multiple sexual partners Sexual partners who have had multiple partners

Answer 43

“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

Answer 44

``` 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

Answer 45

``` 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

Answer 46

Not a reportable disease in most provinces and territories True incidence difficult to determine One of the most common STIs in North America

Answer 47

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.

Answer 48

History and physical examination Viral isolation by tissue culture Antibody assay for specific HSV viral type

Answer 49

``` 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 ```

Answer 50

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

Answer 51

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.

Answer 52

Rapid growth with pregnancy | Transmitted to newborn

Answer 53

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

Answer 54

``` 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 ```

Answer 55

``` Fever Visual assessment of lesions, warts, rash Purulent rectal discharge Proctitis Urethral and cervical discharge Laboratory findings ```

Answer 56

Risk for infection Anxiety Ineffective health maintenance

Answer 57

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

Answer 58

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

Answer 59

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.

Answer 60

``` Patient with STI will: Demonstrate modes of transmission Use appropriate hygienic measures Experience no re-infection Demonstrate compliance with follow-up protocol ```