TLO 2.10 Reproductive Flashcards
Obtaining sexual history and consideration
Requires skill and tact Considerate -cultural components -confidentiality -trust -start out with less invasive questions -use words client understand
Obtaining sexual history
Male, common questions
Any changes in erections Difficulty urinating Medications Medial history Lifestyle
Obtaining sexual history
Female, common questions
Menstrual or menopause Childbirth history STI's Bleeding after intercourse Family history of cancer Contraceptive use Painful intercourse Medical history
Gender Identity define the following
Agender?
Cisgender?
Gender fluid?
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
Gender Identity define the following
Gender non-conforming?
Genderqueer?
Non-binary?
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
Gender Identity define the following
Transgender man?
Transgender female?
Two-spirit?
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
Sexual orientation define the following
Asexual?
Bisexual?
Gay?
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
Sexual orientation define the following
Lesbian?
Pansexual?
Queer?
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
Nurse’s role
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
Physical assessment
Female age related changes
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
Physical assessment
Male normal
Urinary meatus should be midline
Breast tissue not swollen, tender or enlarged
Foreskin easily retractable
No redness, swelling, drainage or lesions
Physical assessment
Male age related changes
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
Self assessment exams
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
Diagnostic testing
Mammogram?
Breast US?
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
Diagnostic tests: PAP
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
Diagnostic test: Pelvic US
Pelvic US
- abdominal or vaginal
- high frequency waves detects fibroid tumors, cysts, abscesses, neoplasms
- need full bladder
- men: used for testicular torsion or masses
Diagnostic test: Colposcopy
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
Diagnostic test: Laparoscopy
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
Diagnostic test: D&C
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
Diagnostic test: CT or Pelvis with or w/o contrast
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
Terminology Menarche? Menorrhagia? Metrorrhagia? Amenorrhea?
Menarche: age 1st started menstruation
Menorrhagia: excessive or prolonged bleeding
Metrorrhagia: bleeding between menstrual periods
Amenorrhea: absence of menstruation
Premenstrual syndrome (PMS)
Occurs 3-14 days before menstruation Causes thought to be r/t hormonal changes Manifestations: mood swings breast tenderness fatigue irritability food cravings depression
Premenstrual syndrome treatment
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
Endometriosis
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
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
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
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
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)
Problems with pelvic support
Uterine prolapse
Cystocele
Rectocele
**aging, genetics, childbirth and couching are associated risk factors
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
Cystocele
Herniation of bladder into vagina Anterior colporrhaphy (shortens pelvic muscles providing tighter support for bladder)
Rectocele
Herniation of into vagina Posterior colporrhaphy (shortens pelvic muscles providing support for rectum)
Inflammatory conditions
Pelvic inflammatory disease
Vaginitis
Cervicitis
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
Pelvic inflammatory disease manifestations
Fever Lower ab or back pain Painful intercourse Purulent vaginal discharge Abnormal bleeding
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
Vaginitis infections
Bacterial vaginosis: most common, antibiotics, hygiene
Candidiasis: yeast infection
Trichomoniasis: parasite, most curable
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
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
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
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
Inflammatory condition
Orchitis
what is it?
Acute inflammation of testes
Causes genitourinary infection or complication of systemic illness (mumps, scarlet, fever)
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
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
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)
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)
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
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
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
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
Male reproductive disorders
Phimosis
Constriction of foreskin in uncircumcised men, retraction is difficult
Interferes with intercourse and urination
Increased risk of penile cancer
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
Prostate cancer
Prostate specific antigen (PSA) blood levels can stage prostate cancer and monitor response to treatment
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
