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NUR 131 > TLO 2.10 Reproductive > Flashcards

TLO 2.10 Reproductive Flashcards

1
Q

Obtaining sexual history and consideration

A 
Requires skill and tact
Considerate
-cultural components
-confidentiality
-trust
-start out with less invasive questions
-use words client understand
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2
Q

Obtaining sexual history

Male, common questions

A 
Any changes in erections
Difficulty urinating
Medications
Medial history
Lifestyle
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3
Q

Obtaining sexual history

Female, common questions

A 
Menstrual or menopause
Childbirth history
STI's
Bleeding after intercourse
Family history of cancer
Contraceptive use
Painful intercourse
Medical history
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4
Q

Gender Identity define the following
Agender?
Cisgender?
Gender fluid?

A

Agender: person who identifies with having no gender

Cisgender: person whose sex and gender identity align. Someone who is assigned male at birth and identifies as male/masculine

Gender fluid: person whose gender identity is not fixed. Person who is gender fluid may always feel like a mix of female/male or may feel they are more one gender some days and another gender another day

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5
Q

Gender Identity define the following
Gender non-conforming?
Genderqueer?
Non-binary?

A

Gender non-conforming: umbrella term, gender expression that differs from a given society’s norms or only male and female

Genderqueer: person whose gender identity falls outside the traditional gender binary of male and female

Non-binary: umbrella term, any gender identity that does not fit within the gender binary of male and female

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6
Q

Gender Identity define the following
Transgender man?
Transgender female?
Two-spirit?

A

Transgender male and female: person whose gender identify as opposite of birth gender

Two-spirit: Native American/Alaskan Native LGBTQ people, stemming from language meaning to have both female and male spirits within one person. Different meaning in different communities

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7
Q

Sexual orientation define the following
Asexual?
Bisexual?
Gay?

A

Asexual: person who experiences little or not sexual attraction to others

Bisexual: person who is emotionally and sexually attracted to people of their own gender and of people of the other binary gender

Gay: man who is emotionally and sexually attracted exclusively to other men

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8
Q

Sexual orientation define the following
Lesbian?
Pansexual?
Queer?

A

Lesbian: woman who is emotionally and sexually attracted exclusively to other women

Pansexual: person who is emotionally and sexually attracted to people of gender identities throughout the gender spectrum

Queer: umbrella term, people who think of their sexual orientation or gender identity as outside of societal norms. some view the term queer as more fluid and inclusive than traditional categories. NOT embraced or used by LGBTQ community

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9
Q

Nurse’s role

A 
Expand your knowledge
Know key LGBTQ definitions
Deepen your LGBTQ knowledge
Create welcoming environment
Ask relationship status, not marital status
Asking preferred names on forms
Use inclusive language and gender neutral language
Therapeutic communication
Respect
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10
Q

Physical assessment

Female age related changes

A

Breast atrophy with sagging
Labia flattened, hair decreases
Decreased vaginal lubrication
Uterus and fallopian tubes shrink, uterine prolapse
Menopause- estrogen production decreases causing wrinkling and growth of facial hair

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11
Q

Physical assessment

Male normal

A

Urinary meatus should be midline
Breast tissue not swollen, tender or enlarged
Foreskin easily retractable
No redness, swelling, drainage or lesions

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12
Q

Physical assessment

Male age related changes

A

Many have some degree of BPH
Reduced sperm count in men
Vascular changes of penis causes increased time in achieving an erection and ejaculation
Urinary hesitancy

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13
Q

Self assessment exams

A

Breast self exam: 7-10 days from 1st day of period, post menopausal choose day of the month. Important to know your normal and report changes

Clinical breast exam yearly at age 40 and every 3 year in 20-30’s

Testicular exam done monthly

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14
Q

Diagnostic testing
Mammogram?
Breast US?

A

Mammogram

  • yearly at age 40
  • x-ray detect tumors
  • no deodorant, powder, ointments prior

Breast US

  • used in conjunction with mammography
  • differentiates solid mass from cystic mass
  • aides in visualizing of mass to biopsy
  • used to evaluate mass in pregnant women when mammography is contraindicated
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15
Q

Diagnostic tests: PAP

A

Papanicolaou test (PAP)

  • <30 yr, every 2-3 yrs
  • > 65 yr, only if they are high risk
  • microscopic study of cells from the cervix
  • diagnose malignant and premalignant lesions
  • no douching, vaginal meds or intercourse 24-48 hr prior
  • void prior to exam
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16
Q

Diagnostic test: Pelvic US

A

Pelvic US

  • abdominal or vaginal
  • high frequency waves detects fibroid tumors, cysts, abscesses, neoplasms
  • need full bladder
  • men: used for testicular torsion or masses
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17
Q

Diagnostic test: Colposcopy

A

Colposcopy

  • done when pap test shows cells changes
  • direct visualization of cervix microscope
  • no douche or intercourse 48 hr
  • NSAIDS for pain/cramping post procedure
  • slight vaginal bleeding several days after
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18
Q

Diagnostic test: Laparoscopy

A

Laparoscopy

  • surgical procedure done as outpatient
  • used in assessment of uterus, tubes, ovaries and perform tubal ligation
  • common to have shoulder pain from gas
  • follow surgical prep procedures: NPO, enema, shower
  • vaginal bleeding may occur post-op shouldn’t be heavy lifting
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19
Q

Diagnostic test: D&C

A

Dilation and curettage (D&C)

  • cervix is dilated and curette is used to scrape uterine lining
  • to remove tissue after miscarriage, abortion or removal of placental pieces
  • diagnose or treat abnormal uterine bleeding
  • uterine tissue examined for abnormal cells
  • cramping, spotting, bleeding post op
  • avoid anticoagulants
  • no intercourse until discharge stopped
  • avoid tampons 2 wk post op
  • avoid heavy lifting 2 wk post op
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20
Q

Diagnostic test: CT or Pelvis with or w/o contrast

A

Used to detect tumors within the pelvis
If contrast is used, check for allergies to iodine/shellfish
Contrast accentuates differences in tissue density
Flushing feeling common with contrast
Contrast contraindicated in renal/hepatic disease

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21
Q 
Terminology
Menarche?
Menorrhagia?
Metrorrhagia?
Amenorrhea?
A

Menarche: age 1st started menstruation
Menorrhagia: excessive or prolonged bleeding
Metrorrhagia: bleeding between menstrual periods
Amenorrhea: absence of menstruation

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22
Q

Premenstrual syndrome (PMS)

A 
Occurs 3-14 days before menstruation
Causes thought to be r/t hormonal changes
Manifestations:
mood swings
breast tenderness
fatigue
irritability
food cravings
depression
23
Q

Premenstrual syndrome treatment

A 
Avoid caffeine
Regular exercise
Adequate rest
Diet high in complex CHO's, low Na+, no ETOH
Relaxation, stress management
B6 foods or supplements have helped some
24
Q

Endometriosis

A

Chronic inflammatory disease where endometrial tissue is outside the uterus

Risk factors:
early menarche
regular period with cycle less than 27 days
menses’ that last longer than 7 days
heavy flow, increased mensural pain
first degree female relative with endometriosis

Manifestations:
pain during intercourse (dyspareunia)
infertility, bleeding, throbbing pain lower ab and pelvis
rectal pressure during BM

Treatment:
medication therapy, birth control (depo, pill, Lupron)
laparoscopy with ablation

25
Ovarian cysts
Cysts are fluid filled sacs Most resolve spontaneously Cause pain, menstrual irregularity or amenorrhea Laparoscopy or US to diagnose Oophorectomy (ovary removal) if cysts are very large
26
Uterine Leomyoma (fibroid)
Benign tumor of uterus of the smooth muscle of the uterus. ``` Manifestations: asymptomatic in small fibroids pelvic pressure from other organs being crowded pain, dysmenorrhea, menorrhagia fatigue ``` Treatment: myomectomy (removal of fibroid only) hysterotomy
27
Hysterectomy Indications Recover
Indications: medical management of bleeding is unsuccessful cancer is present can be done abdominal or vaginal BSO: bilateral salpingectomy oophorectomy (tubes and ovaries removed) Recovery: TAH (total abdominal hysterectomy) 4-6 wks, higher risk of complications LAVH (laparoscopy assisted vaginal hysterectomy) 1-2 wks., lower risk
28
Hysterectomy post op care
Pain control DVT prevention Urine output (min 30ml/hr) Report backache or decreased urine output Cough and deep breathing Teach how to splint incision Monitor s/s infection No intercourse 4-6 wk No heavy lifting 2 months Surgical menopause if ovaries removed, may initiate HRT (hormone replacement therapy) Monitor bleeding, peri-pad, ab dressing (moderate serosanguinous vaginal bleeding expected if vaginal hysterectomy)
29
Problems with pelvic support
Uterine prolapse Cystocele Rectocele **aging, genetics, childbirth and couching are associated risk factors
30
Uterine prolapse
``` Uterus protrudes into vaginal canal Rated by degrees: 1-3, 3 uterus is outside body) S/S: constipation urinary incontinence dysmenorrhea dyspareunia backache infertility hemorrhoids bearing down sensation painful intercourse ``` Treatment: pessary hysterectomy
31
Cystocele
``` Herniation of bladder into vagina Anterior colporrhaphy (shortens pelvic muscles providing tighter support for bladder) ```
32
Rectocele
``` Herniation of into vagina Posterior colporrhaphy (shortens pelvic muscles providing support for rectum) ```
33
Inflammatory conditions
Pelvic inflammatory disease Vaginitis Cervicitis
34
Pelvic inflammatory disease | Terms
Salpingitis: fallopian tubes Oophoritis: Ovaries Cervicitis: cervix Vaginitis: vagina * *risk factors: history of STI's, multiple partners, douching * *condoms reduce risks
35
Pelvic inflammatory disease manifestations
``` Fever Lower ab or back pain Painful intercourse Purulent vaginal discharge Abnormal bleeding ```
36
Pelvic inflammatory disease diagnosis and treatment
CBC= increased WBC's and sedimentation rate Laparoscopy, shows inflammation of pelvic organs Treatment PO or IV Analgesics Semi fowlers position to promote drainage and prevent abscesses from occurring
37
Vaginitis infections
Bacterial vaginosis: most common, antibiotics, hygiene Candidiasis: yeast infection Trichomoniasis: parasite, most curable
38
Inflammatory condition | Prostatitis, symptoms, cause, complicatons
Symptoms: Fever, chills, back and perineal pain, dysuria Urgency, frequency, cloudy urine Causes: Bacterial infection or abnormal inflammatory cells present Complications: Erectile dysfunction, post ejaculation pain, libido problems Epididymitis and cystitis
39
Inflammatory condition Prostatitis Treatment/diagnosis
``` UA and culture, PSA to r/t cancer Antibiotics NSAIDS or opioids for pain Supra Pubic cath for urinary retention Prostate massage or ejaculation encouraged 2-3x week to drain prostate of infected fluid ```
40
Inflammatory condition Epididymitis what is it?
Acute, painful, inflammatory process of the epididymis R/T infection, trauma, or urinary reflux down the vas deferens Sexually active men <35 yr
41
``` Inflammatory condition Epididymitis manifestations? complications? treatment? ```
Manifestations: pain and edema of scrotum usually unilateral Complications: abscess formation infertility obstruction of blood supply to testis Treatment: antibiotics elevate scrotum, ice packs, analgesics
42
Inflammatory condition Orchitis what is it?
Acute inflammation of testes | Causes genitourinary infection or complication of systemic illness (mumps, scarlet, fever)
43
Inflammatory condition Orchitis manifestations treatment
``` Manifestations: Sudden onset High fever, increased WBC's Unilateral or bilateral scrotal redness, edema, pain Sterility if both testes are involved ``` Treatment: Supportive- antibiotics, scrotal support/elevation Pain meds, cold compresses
44
Fibrocystic breast disease
Benign condition, usually related to hormonal changes Moving cysts in breast Often corresponds to hormonal changes Multiple mobile cysts form in breasts, excess fibrous tissue develops Pain or tenderness in breasts upper outer quadrants Breasts feel "thick" or "lumpy" Nipple discharge may be present
45
``` Breast cancer surgical treatments Lumpectomy? Partial mastectomy? Simple? Modified radical? Radical? ```
Lumpectomy: removes lump and surrounding margin of tissue Partial mastectomy: more tissue removed than lumpectomy Simple: removes entire breast Modified radical: breast and some axillary lymph nodes removed Radical: breast, axillary lymph nodes, and pectoral muscles removed (rarely done)
46
Post op care for mastectomy
``` Cough and deep breathing Pain control Monitor for bleeding Numbness common in axillary region No BP or lab draws on surgical side Exercises for affected arm Elevate arm on pillow Teach drain care Encourage discussion r/t grief/sexual concerns Encourage participation in care when ready (drain, dressing) ```
47
Mammoplasty what is it? types?
``` Group of surgical procedures where goal is to reshape or modify appearance of the breast Types: Reduction: make smaller Augmentation: make larger Reconstructive: post mastectomy option ```
48
Male reproductive disorders | Varicocele
Abnormal dilation of vein in the spermatic cord Dilated vein forms soft mass that may be painful Interferes with blood flow thru testis causing infertility
49
Male reproductive disorders | Spermatocele
Ducts in epididymis dilate and form a cyst Causes thought to be r/t leakage of sperm due to trauma or infection Treatment not usually necessary Not associated with infertility
50
Male reproductive disorders | Testicular torsion
Twisting of spermatic cord that supplies blood to the testes and epididymis Sudden onset of scrotal swelling, pain, N/V Occurs spontaneous or after trauma or physical exertion Surgical treatment: detorsion ASAP Orchiectomy
51
Male reproductive disorders | Phimosis
Constriction of foreskin in uncircumcised men, retraction is difficult Interferes with intercourse and urination Increased risk of penile cancer
52
Male reproductive disorders Testicular cancer Symptoms
Rare but common in males Risk factors: undescended testicle, Caucasian, family history Orchiectomy, radiation, chemo Symptoms: painless lump in scrotum scrotal swelling and heaviness dull ache in lower ab, perianal, scrotum
53
Prostate cancer
Prostate specific antigen (PSA) blood levels can stage prostate cancer and monitor response to treatment
54
Transurethral resection or prostate (TURP)
AKA simple prostatectomy urethral scope inserted and prostate tissue removed No external incisions Removed prostate tissue is flushed into bladder and flushed out of bladder at end of procedure Complications: hemorrhage, clot retention inability to void, UTI's incontinence, impotence, retrograde ejaculation

NUR 131 (38 decks)

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