Chapter 47

Nursing Care of a Family When a Child Has a Reproductive Disorder

LENY VICENTE-BAGUIO RN, MN

COLLEGE OF NURSING
XAVIER UNIVERSITY- ATENEO DE CAGAYAN
 Disorders Caused by Altered
Reproductive Development

• Ambiguous genitalia
• Precocious puberty
• Delayed puberty
Reproductive Disorders in Males
• Balanitis (balanoposthitis)
• Phimosis and paraphimosis
• Cryptorchidism
• Hydrocele
• Varicocele
• Testicular torsion
• Testicular cancer
Reproductive Disorders in Female

• Menstrual disorders
• Female circumcision
• Imperforate hymen
• Polycystic ovary syndrome
• Toxic shock syndrome
• Vulvovaginitis
• Pelvic inflammatory disease
Disorders of the Breast
• Accessory (supernumerary) nipples
• Breast hypertrophy
• Breast hypoplasia
• Fat necrosis
• Fibrocystic breast disease
• Fibroadenoma
• Mastitis
 Sexually Transmitted Infections #1
• Candidiasis
• Trichomoniasis
• Bacterial vaginosis
• Chlamydia trachomatis infection
• Human papillomavirus (HPV)
• Herpes genitalis (herpes simplex type 2)
Sexually Transmitted Infections #2

• Hepatitis B and hepatitis C

• Gonorrhea
• Syphilis
• Group B streptococcal infection
• HIV
Assessing Reproductive Disorders #1
Assessing Reproductive Disorders # 2
Assessing Disorders Caused by Altered
Reproductive Development
• Ambiguous genitalia
⚬ Karyotype or DNA analysis
• Precocious puberty
⚬ Accelerated skeletal maturation; increased breast
and genital development; in girls, menstrual
bleeding; in boys, genital growth; serum analysis
for estrogen or androgen levels
• Delayed puberty
⚬ Family history, physical exam
 Assessing Reproductive
Disorders in Males #1

• Balanitis (balanoposthitis)
⚬ Swollen prepuce and glans; purulent discharge; difficulty
voiding
• Phimosis and paraphimosis
⚬ Unretractable foreskin from the glans of the penis
• Cryptorchidism
⚬ Physical exam; laparoscopy
 Assessing Reproductive
Disorders in Females #1
• Menstrual disorders
⚬ Mittelschmerz
⚬ Dysmenorrhea
⚬ Menorrhagia
⚬ Metrorrhagia
 Assessing Reproductive
Disorders in Females #1
• Menstrual disorders
⚬ Menstrual migraine
⚬ Endometriosis
⚬ Amenorrhea
⚬ Premenstrual dysphoric disorder
 Assessing Reproductive
Disorders in Females #2

• Polycystic ovary syndrome

⚬ History; pelvic exam; possible ovarian ultrasound;
serum androgen and glucose levels

• Toxic shock syndrome

⚬ High temperature; vomiting, diarrhea; hypotension;
severe muscle pain; decreased platelet count; macular
rash
 Assessing Reproductive
Disorders in Females #

• Vulvovaginitis
⚬ Pain; odor; pruritus; vaginal discharge; possible
vaginal bleeding

• Pelvic inflammatory disease

⚬ Severe pain in the lower abdomen; heavy, purulent
discharge; fever; leukocytosis
Assessing Sexually Transmitted Infections
 Nursing Diagnoses
• Risk for infection
• Pain
• Disturbed body image
• Anxiety
• Fear
Therapeutic Techniques for Disorders Caused
by Altered Reproductive Development
• Ambiguous genitalia
⚬ Possible reconstructive surgery
• Precocious puberty
⚬ Hormone therapy
• Delayed puberty
⚬ Patient education
 Therapeutic Techniques for Reproductive
Disorders in Males #3
• Balanitis (balanoposthitis)
⚬ Local application of heat; possible local antibiotic
• Phimosis and paraphimosis
⚬ Circumcision
• Cryptorchidism
⚬ Delayed for the first year of life; possible 5-day course of
chorionic gonadotropin hormone; surgical correction
 Therapeutic Techniques for
Reproductive Disorders in Males #4
• Hydrocele
⚬ No therapy required
• Varicocele
⚬ Possible surgical correction
• Testicular torsion
⚬ Manual reduction under ultrasound guidance; laparoscopic
surgery, if needed
 Therapeutic Techniques for
Reproductive Disorders in Males #5

• Testicular cancer
⚬ Orchiectomy followed by radiation or chemotherapy
Therapeutic Techniques for Reproductive
Disorders in Females #4
• Menstrual disorders
⚬ Mittelschmerz/dysmenorrhea/menstrual migraine
￭ NSAID, patient education
⚬ Menorrhagia/metrorrhagia
￭ Progesterone, low-dose oral contraceptive or GnRH inhibitor
⚬ Endometriosis
￭ Estrogen/progesterone-based oral contraceptives; danazol; GnRH
agonist; aromatase inhibitor; laparotomy
 Therapeutic Techniques for
Reproductive Disorders in Females #5

• Menstrual disorders—(cont.)
⚬
￭
⚬
￭

• Female circumcision/imperforate hymen

⚬
Therapeutic Techniques for Reproductive
Disorders in Females #6

• Polycystic ovary syndrome

⚬ Symptom management; possible oral combined
contraceptive
• Toxic shock syndrome
⚬ Iodine douche; penicillinase-resistant antibiotic; IV
fluid therapy or vasopressor; osmotic therapy; patient
education
Therapeutic Techniques for Reproductive
Disorders in Females #7
• Vulvovaginitis
⚬ Local antibiotic ointment or warm baths; antibiotic, if
indicated; patient education

• Pelvic inflammatory disease

⚬ Analgesia; broad-spectrum antibiotic; drain the pelvic
abscess, if present; removal of IUD, if present; patient
education
 Question #1
A 12-year-old male is hospitalized for testicular pain. The
diagnosis of testicular torsion is made. Which treatment
would the nurse advise the parents to expect?

A. Nothing, it will resolve over the next few weeks.

B. Surgery to correct the problem
C. Steroids to decrease the inflammation
D. Over-the-counter pain medications with the application of ice and elevation of the
testes
 Question #2

An adolescent asks the nurse how to prevent toxic shock

syndrome. The nurse provides which is the best advice?

A. Strictly use maximum absorbency tampons only.

B. Use tampons on the first and last days of the menstrual periods.

C. Use two tampons at a time to increase absorbency.

D. Use sanitary pads rather than tampons at night.

Thank you!