Reproductive Assessment Flashcards
changes in the reproductive system related to females
graying and thinning of pubic hair
decreased size of the labia majora and clitoris
drying, smoothing, and thinning of vaginal walls
decrease size of the uterus
atrophy of the endometrium
decrease size and marked convolution of the ovaries
loss of tone and elasticity of the pelvic ligaments and connective tissue
increased flabbiness and fibrosis of the breasts, which hang lower on the chest wall; decreased erection of nipples
changes in reproductive system related to males
graying and thinning of pubic hair
increased drooping in the scrotum and loss of rugae
prostate enlargement, with an increased likelihood of urethral obstruction
nutrition history assessment collected for reproductive system
high alcohol intake increases risk of ovarian cancer
diet high in fat and low in fruits and vegetables increase risk of reproductive cancers
ex: prostate and ovarian cancer
family history and genetic risk assessment collected for reproductive system
daughters of women given diethylstilbestrol (DES) to control bleeding during pregnancy are at increased risk for infertility and reproductive tract cancer
specific BRCA 1 and BRCA 2 gene mutations increase overall risk for breast or ovarian cancer
men with first degree relatives (father, brother) with prostate cancer are at greater risk
physical assessment for reproductive system
focused assessment related to specific concerns and needs of the patient
current health problems: pain, bleeding, discharge, masses
Labs for female reproductive
Pap smear
HPV
Vaginal cultures
alpha fetoprotein (AFP)
cancer antigen 125 (CA 125)
Pap smear
cytologic study effective in detecting precancerous and cancerous cells from the cervix
Annual pap smear starting at age 21
HPV
used to identify many high risk types of HPV associated with the development of cervical cancer
cells are collected from the cervix at the same time a pap test is completed
vaginal cultures
used to detect bacterial, viral, fungal, and parasitic disorders
AFP
elevated with ovarian cancer
Cancer antigen CA 125
elevated with ovarian cancer
Labs for male reproductive
prostate specific antigen (PSA) test, early prostate cancer antigen (EPCA-2) and serum acid phosphate, alpha fetoprotein (AFP), beta human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH)
Prostate specific antigen (PSA) test
normal less than 2.5 ng/ml for age 50 and increases with age (possibly up to 6.5 ng/ml)
used as a screening lab for prostate cancer because other prostate problems can increase the level
some variance on the PSA value and how it is affected by age
early prostate cancer antigen (EPCA-2) and serum acid phosphate
elevations indicative of prostate cancer
EPCA-2 is very sensitive and can detect early
alpha fetoprotein (AFP), beta human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH)
elevations indicative of testicular cancer
Imaging for reproductive system
CT, MRI, Ultrasonography, hysterosalpingography, mammogram
CT Reproductive
evaluate for metastasis with different reproductive cancers, evaluate for ovarian cancer
MRI reproductive
evaluation for breast cancer for women with high risk factors
ultrasonography reproductive
transvaginal- ovarian and endometrial cancer
transrectal- prostate cancer
ultrasound- evaluate for testicular masses versus fluid
also used for breast cancer evaluation
hystersalpingography (HSG)
x ray that uses an injection of a contrast medium to visualize the cervix, uterus, and fallopian tubes
used to evaluate tubal anatomy and patency and uterine problems such as fibroids, tumors, and fistulas
“pre” considerations for HSG
assess for allergies to contrast dye
“post” considerations for HSG
some pelvic and referred shoulder pain
mammography
x ray of the soft tissue of the breast
now have 3D mammograms that visualize all layers
annually for women ages 40 and older
may experience discomfort during procedure
“pre” consideration for mammogram
no creams, lotions, powders, or deodorant on breast on under arms
“post” considerations for mammogram
reinforce continued self breast exams and clinical breast exams
endoscopic studies
colposcopy, laparoscopy, hysteroscopy
colposcopy reproductive
examination of the cervix and vagina using a colpscope
laparoscopy reproductive
direct examination for the pelvic cavity through a endoscope
performed under anesthesia
“pre” considerations for laparoscopy
NPO
“post” considerations for laparoscopy
some pelvic and referred shoulder pain
observe incision sites for infection
can also used during surgical procedures
hysteroscopy
fibroptic camera that is inserted into the vagina
examines the cervix and uterus
performed with regional nerve block
“post” considerations for hysteroscopy
some pelvic and referred shoulder pain
biopsy studies for reproductive
cervical, endometrial, breast, prostate
cervical biposy
cervical tissue is removed for cytologic study
early in menstrual cycle so less vascular
“pre” considerations for cervical biopsy
depends on anesthesia used
address anxiety
“post” considerations for cervical biopsy
monitor for bleeding and infections
nothing in vagina for 2 weeks
no heavy lifting
endometrial biopsy
used to obtain cells directly from the lining of the uterus to assess for cancer of the endometrium
assess menstrual disturbances and infertility
“post” considerations for endometrial biopsy
some cramping may occur
monitor for bleeding and infections
spotting for 1-2 days
nothing in vagina for 1-2 days
breast biopsy
tissue aspirated through a large bore needle or through small incision, local anesthetic, aspirated fluid from benign cysts may appear clear to drank green/brown
“pre” considerations for breast biopsy
depends on anesthesia used
address anxiety
“post” considerations for breast biopsy
mild pain alleviated with analgesics, ice or heat
monitor incision for bleeding and infection
numbness may occur around biopsy site
wear supportive bra for 1 week
prostate biopsy
definitive diagnostic tool for prostate cancer
transurethral biopsy
insert needle through the area of skin between the anus and scrotum
transrectal biopsy
passing the needle through the wall of the rectum
“pre” considerations for prostate biopsy
discuss positioning and discomfort during procedure
address anxiety
“post” considerations for prostate biopsy
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 signs of excessive bleeding, infection and urinary retention
post biopsy antibiotic
A patient has been informed that she
has a specific BRCA 1 and BRCA 2 gene
mutations. Which brochure would the
nurse prepare for the patient?
A. “Role of nutrition therapy in
reproductive health”
B. “Risk factors and treatments for
infertility”
C. “Risk factors and treatments for breast
cancer”
D. “ Colposcopy and other tests for cervical
cancer”
C
A 79 year old man is being seen for
difficulty voiding and blood in urine.
Which is the first screening test likely
to be done?
–A. Cytology culture
–B. Prostate specific antigen
–C. Serum testosterone level
–D. Serological studies
B
Which test detects cancerous and
precancerous cells of the cervix?
–A. Serologic studies
–B. Vaginal cultures
–C. Pap smear
–D. Human papilloma virus (HPV) test
C
Which test is used to assess tubal
anatomy and patency, and uterine
problems?
–A. CT scan
–B. Laparoscopy
–C. Colposcopy
–D. Hysterosalpingography
D
The nurse is caring for a patient who had
a laparoscopy. What is included in the
postoperative care for this patient?
–A. Notify the HCP of postoperative shoulder
pain
–B. Reassure the patient that most painful
sensations disappear within 4-6 weeks
–C. Teach the patient to observe the incision
for signs of infection or hematoma
–D. Remind the patient to avoid strenuous
activity for 4-6 weeks after procedure
C
What post procedure instructions would
the nurse give to a patient who just had
a colposcopy?
–A. Do not drive or operate heavy machinery
while taking prescribed pain medication
–B. Do not use tampons and abstain from
sexual intercourse for at least a week
–C. Wear a perineal pad and expect bleeding
with small clots for the first 24 hours
–D. Perform breast self examinations every
month and report changes to provider
B
What pre-procedural instructions would
the nurse give the patient about a
mammogram?
–A. Do not eat or drink anything 6 to 7
hours prior
–B. Abstain from sex prior to test
–C. Do not use lotions, creams or
powders on breasts
–D. Wear a supportive bra and bring a
breast pad for after testing
C
The nurse is helping a patient
schedule a cervical biopsy. When does
the nurse advise the patient that the
procedure should be done?
–A. 5 days after menses has ceased
–B. 5 days before the beginning of
menses
–C. During the menstrual cycle
–D. Whenever she can get 3-4 days off
work
A
What post procedure instructions would
the nurse give to a patient who had a
prostate biopsy?
–A. Light rectal bleeding and blood in the
urine or stools is expected for a few days
–B. Swelling of the biopsy area and difficulty
urinating are expected for 1 week
–C. Low grade fever and bright red penile
discharge are normal for several days
–D. Return to see the health care provider in
1 week for recheck of biopsy site
A
