Female Reproductive System

Male Reproductive System

Laboratory Studies
Instruct her to avoid douching or using vaginal hygiene sprays or deodorants for at least 24 hours before a test

Nursing intervention : Pre op explain the procedure to the client obtain an informed consent position the client in the lithotomy position Nursing intervention : Post op monitor vital signs assess pain levels and location carefully

Nursing intervention: pre-op explain the procedure obtain inform consent inform the client how she can expect to feel afterward NPO on the night before the procedure
Nursing intervention: post-op Take the clients V/S every 15 min for the first hour or until they are stable. If local anesthesia has been used, the woman can have fluids and a light snack as soon as she wants. After general anesthesia, the woman may have fluids and light snack as soon as she is fully awake and has no nausea. Teach her how to keep the incision clean and dry. After it heals, the scar will be barely noticeable. Sexual intercourse can be resumed with a week or less

LAPAROSCOPY

Colposcopy

Involves the use of stereoscopic binocular microscope (colposcope) to examine the cervical epithelium, vagina, and vulva

Nursing intervention Explain to the woman that the procedure is similar to a pelvic examination and that, when the speculum is in place, a special microscope is used to look at the cervix. Help woman into the lithotomy position

Mammography
The procedure can detect cancer in its early stages, when treatment is most effective. A mammogram can detect a breast abnormality as small as 0.5 cm (0.2 in), a size too small for a woman or her doctor to feel it as a lump.

Computed tomography (CT) and Magnetic resonance imaging (MRI) are modalities in which images of the pelvic organs are obtained in the assessment of the productive and urologic disorders. Nursing Intervention There is no special preparation for CT san and MRI unless a contrast agent (dye) is given Pregnancy and morbid obesity contraindicated both tests. Ask woman whether she has intrauterine device in place, the presence of which may contraindicate MRI.

Ultrasonography
Nursing intervention Obtain an informed consent No other special preparation is needed The bladder must be empty to promote comfort Inform the woman to expect the technician to manipulate the probe.

For Male (BLOOD STUDIES)

Prostate-Specific Antigen -screening tool for prostate cancer. Alkaline Phosphatase - It is used as a diagnostic test in men with prostate cancer as a measure of possible bone metastasis. Semen Examination - is used to evaluate fertility. Secretion Analysis - secretions from the throat, penis, and anus or lesions from the oral, pharyngeal, and perineal areas maybe examine for microorganism.

Infertility
Infertility
primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.

Nursing Diagnosis
1. Fear related to possible outcome of infertility studies 2. Situational low-esteem related to inability to conceive or feeling of failure 3. Altered sexuality patterns related to structured efforts to conceive or loss of spontaneity 4. Ineffective coping related to unmet expectations or feeling of loss 5. Deficient knowledge related to diagnostic and treatment procedure

1.

2.

3. 4. 5.

Spontaneous Abortion (miscarriage) Gestational age <20 weeks Considered early spontaneous abortion if <12 weeks Weight <500 grams Inevitable Abortion Bleeding and rupture of Gestational Sac <20 weeks Cervix dilated Menstrual-type cramping No products of conception expelled yet Missed Abortion (fetal demise) Retained non-viable conception products up to 4 weeks Septic abortion Incomplete abortion with secondary infection Results in Endometritis, parametritis or peritonitis Incomplete Abortion Incomplete evacuation of products of conception

6.

Complete Abortion

7. 8. 9.

Blighted Ovum (Embryonic Resorption) Subchorionic Hemorrhage Threatened Abortion

Gestational Sac and placenta present Failure of Embryo to develop

Complete evacuation of products of conception Difficult to differentiate from Incomplete Abortion May require dilatation and curettage for diagnosis

Blood collected between chorion and uterine wall Uterine bleeding Cervix closed Risk of Complete Abortion: 50% Pregnancy endometrium passed with miscarriage Consider Ectopic Pregnancy if passed intact Known as decidual cyst Elective Abortion or Therapeutic Abortion

10. Decidua

11. Induced Abortion

1. 2. 3. 4. 5. 6.

Autosomal Trisomy (most common miscarriage etiology) Chromosomal Triploidy or Monosomy Uterine anomaly (e.g. Leiomyoma, DES Exposure) Incompetent cervix Progesterone deficiency (late Luteal Phase defect) Environmental factors risk factors

Etiology

Risk Factors: Associated with Spontaneous Abortion 1. Advanced maternal age 2. Cigarette smoking increases risk of euploidic abortion 1. Over 14 Cigarettes/day doubles risk over non-smokers 2. Relative Risk increases 1.2x for each 10 cigs/day 3. Alcohol Abuse increases risk of euplodic abortion 1. Abortion risk doubled for twice weekly Alcohol 2. Abortion risk tripled for daily Alcohol use 4. Illicit Drug Use 5. Occupational chemical exposure

6. Caffeine may be associated with miscarriage (variable evidence) 1. Small amounts of caffeine are safe in pregnancy 2. Limit caffeine intake to 200 mg/day (e.g. 12 ounces coffee) 3. Be aware of all potential caffeine sources 7. Uterine surgeries or anomalies 8. Diabetes Mellitus (Uncontrolled) 9. Incompetent cervix 10. Connective Tissue disorder 1. Systemic Lupus Erythematosus 2. Antiphospholipid Antibodies 1. Lupus Anticoagulant 2. Anticardiolipin Antibodies 11. Factors not associated with pregnancy loss 1. Stress 2. Sexual activity

NURSING DIAGNOSIS
1. 2. Anticipatory grieving related to the loss of pregnancy and effect on future pregnancy Deficient knowledge related to the treatment and effect on future pregnancies Acute pain related to the progression of the tubal pregnancy Powerlessness related to early loss of pregnancy Spiritual distress related to loss of pregnancy

3.
4.

5.

ANATOMY OF BREAST

Mastitis is an infection of the ducts of the breast. It usually only occurs in women who are breastfeeding their babies.

MASTITIS

Mastitis is most likely to occur in the fifth and sixth week of the postpartum period. Studies indicate an incidence of mastitis in 6-33% of all women who have a history of breastfeeding.

Pathophysiology

Generally occurs in Lactation several weeks postpartum Bacteria enter through a cracked nipple

Etiology
Staphylococcus aureus
is present on the skin, lining normal, uninfected nostrils. It is probably this bacteria, clinging to the baby's nostrils, that is available to create infection when an opportunity (i.e., a crack in the nipple) presents itself. A sluggish flow of milk and trauma to the nipples are the main contributing factors to the development of mastitis. Fatigue, stress, and returning to work may also predispose a nursing mother to developing the condition.

Escherichia coli

Prevention
Optimal Breast Feeding Technique with good latch-on by infant Address predisposing factors early Sore nipples suggest problems Correct latch-on problems Address dry nipples with lanolin Avoid plastic-backed breast pads Evaluate infant for anatomic problems (e.g. short frenulum, Cleft Palate) Cracked nipples colonized with Staphylococcus aureus should be treated Oral antibiotics (e.g. Dicloxacillin) are preferred Blocked milk ducts should be unblocked Blocked ducts will appear with a bleb overlying a tender, red area adjacent to nipple Remove bleb with moist cloth Yeast infection should be treated (both infant and mother)

Nursing Diagnosis
1. Pain related to development of mastitis 2. Health-seeking behaviors related to lack of knowledge about lactation and breast feeding technique 3. Risk for injury related to possible abscess formation 4. Deficient knowledge related to disease prevention and treatment 5. Anxiety related to inability to measure amount of food taken by baby.

Breast cancer is the most common cancer in women. Although the disease may develop any time after puberty 70% of cases occur in women over age 50.

BREAST CANCER

Pathophysiology

The exact causes of breast cancer remain elusive. Scientists have discovered specific genes linked to breast cancer (called BRCA1 and BRCA2) which confirms that the disease can be inherited from a persons mother or father. Those who inherit either of these genes have an 80% chance of developing breast cancer. Other significant risk factors have been identified.

Breast Cancer
PREDISPOSING FACTORS HIGH-FAT DIET PRECIPITATING FACTORS GENETIC AGE SEX RACE

ORAL CONTRACEPTIVES
LIFESTYLE/OBESITY NULLIGRAVIDA

EARLY MENARCHE/LATE MENOPAUSE

PHYSICAL INACTIVITY

SIGNS & SYMPTOMS

Treatment

CHEMOTHERAPY Cytotoxic drugs may be used either as adjuvant therapy or primary therapy. Decisions to start chemotherapy are based on several factors, such as the stage of the cancer and hormonal receptor assay results. HORMONAL THERAPY Hormonal therapy lowers the level of estrogen and other hormones suspected of nourishing breast cancer cells. Antiastrogen therapy, especially with tamoxifen, is used in post-menopausal women. Other commonly used drugs include the antiandrogen aminoglutethimide, the androgen fluoxymesterone, the estrogen diethylstilbestrol, and the progestin megestrol acetate

NURSING DIAGNOSIS
1. 2. 3. 4. 5. Deficient knowledge about the planned surgical treatments Anxiety related to the diagnosis of cancer Fear related to specific treatments and body image changes Decisional conflict related to treatment options Risk for ineffective coping related to the diagnosis of breast cancer and related options

Cervical cancer is malignant cancer of the cervix uteri or

cervical area. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages.Treatment consists of surgery in early stages and chemotherapy and radiotherapy in advanced stages of the disease.

Potential Cofactors Involved in HPV

Human Papillomavirus (HPV) types: 16, 18, 31, 33, 35

High Parity

Coinfection With Other Sexually Transmitted Infections

Oral Cotraceptives

HPV
Smoking

Diet

Endogenous Hormones HIV

Cervical Cancer

Genetic Factors

Staging
Carcinoma-in-situ (Pre-invasive cervical cancer) Stage 1: Cancer confined to cervix Stage 2: Cancer spread to vagina and neighboring tissue Stage 3: Cancer extension to pelvic wall Stage 4: Cancer extension beyond pelvis

Signs and Symptoms

The early stages of cervical cancer:

may be completely asymptomatic Vaginal bleeding contact bleeding or (rarely) a vaginal mass may indicate the presence of malignancy moderate pain during sexual intercourse vaginal discharge are symptoms of cervical cancer In advanced disease, metastases may be present in the abdomen, lungs or elsewhere.

Symptoms of advanced cervical cancer:

loss of appetite weight loss Fatigue pelvic pain back pain leg pain single swollen leg heavy bleeding from the vagina leaking of urine or faeces from the vagina bone fractures.

Management

Carcinoma-in-situ (Pre-Invasive Cancer)

Hysterectomy Cryosurgery Cone biopsy Laser Surgery

Stage 1

Early: Hysterectomy Late:

Stage 2

Radical Pelvic Surgery Pelvic Radiation therapy

Stage 3
Stage 4

Radical Pelvic Surgery Pelvic Radiation therapy Pelvic Radiation therapy Chemotherapy Pelvic Radiation therapy

Surgical Procedures for Cervical Cancer

Total hysterectomy removal of the uterus, cervix, and ovaries Radical hysterectomy removal of the uterus, ovaries, fallopian tubes, proximal vagina, and bilateral lymph nodes through and abdominal incision Radical vaginal hysterectomy vaginal removal of the uterus, ovaries, fallopian tubes and proximal vagina Bilateral pelvic lymphadenectomy removal of the common iliac, external iliac, hypogastric and obturator lymphatic vessel nodes Pelvic exenteration removal of the pelvic organs, including the bladder or rectum and pelvic lymph nodes, and construction of diversional conduit, colostomy and vagina Radical Trachelectomy removal of the cervic and selected nodes to preserve childbearing capacity in a woman of reproductive age with cervical cancer

Nursing Diagnosis
1. 2. 3. 4. Sexual dysfunction related to change in body image. Anxiety related to the diagnosis and surgery Self-care deficit related to lack of understanding of perineal care Acute pain related to the surgical incision Impaired skin integrity related to the wound

5.

SEXUALLY TRANSMITTED DISEASES (STD)

Refers to any infection contracted primarily through sexual activities or contact. Also known as STI( sexually transmitted infection)

Also known as Clap, white, drip, strain, and dose

Both men and women may have conjunctivitis or pharyngitis due to orogenital contact or proctitis from anal contact

Also called bad blood, lues, pox,and syph.

Syphilis is a known contractor for development of HIV infection. Syphilis can progress to irreversible blindness, mental illness, paralysis, heart disease and death.

Lesions are small, discrete, waxy-pink, domeshaped growths with depressed centers.

1. Intravenous (IV) drug use 2. Other substances abuse 3. High risk sexual activity (use of prostitutes, multiple or casual sexual partners, sex with IV drug users and infected people, unprotected sex ,exchanging sex for money or drugs). 4. Younger age (children and adolescents) 5. Younger age at sexarche (the beginning of sexual activity) 6. Inner city residence 7. Poverty 8. Poor nutrition 9. Poor hygiene

The following are specific risk factors for acquiring STDs:

Client presents with manifestations of an STI Client presents with visible genital warts, an exposure to known HPV, or has an abnormal Pap Smear

Client has vaginal or penile discharge, abdominal pain, urinary manifestations, or bleeding irregulaties

Client has genital ulcers

Test for chlamydia and gonorrhea with cervical/ urethral swabs or urine specimens. Tissue culture is best indicator. Other rapid, non-culture, less expensive test include DFA antibody, EIA, nucleic acid hybridization, NAATs to detect antigens. Culture for other organisms if suspected.

Syphilis serology (VDRL,RPR,FTAABS, TP-PA) followed by direct test for T. pallidum if indicated. Culture or antigen for HSV.

HPV DNA testing on cervical swab ( Reflex testing is available.)

Nursing Diagnosis
1. Acute pain related to the genital lesions 2. Anxiety related to the diagnosis 3. Deficient knowledge about the disease and its management 4. Non-compliance with treatment 5. Risk for infection or spread of infection