Reproductive System

1. Reproductive System Ch. 30-33

2. Female Reproductive Structures • Internal structure • Ovaries • Fallopian tubes • Uterus • Vagina

3. Ovaries • Location • End of fallopian tubes • Produce hormones • Estrogen • Progesterone • Store • Ovum

4. Fallopian tubes • Thin tubes • Smooth muscle • Lined with cilia • Fertilization occurs

5. Uterus • AKA: womb • Location • Between • Bladder • Rectum • Function • Receive fertilized egg • Site for growth & development of the fetus

6. Uterus • 3 parts • Fundus • Body • Cervix

7. Uterus • 3 layers • Perimetrium • Outer layer • Myometrium • Middle layer • Endometrium • Innermost layer

8. Endometrium • Responds to changes in • Estrogen • Progesterone • During the ovarian cycle • To prepare for implantation of the fertilized embryo

9. Vagina • AKA: Birth canal • Fibromuscular tube • Between: • Bladder/urethra • Rectum • Function • Birth canal • Menstrual flow • Intercourse

10. External Genitalia • Mons pubis • Pad of adipose tissue • Labia • Fold of tissue • Vestibule • Area between labia • Clitoris • Vaginal opening • Urethral opening

11. Breast / Mammary glands • Supported by • Pectoral muscles • Richly supplied with • Nerves • Blood • Lymph nodes • Primary purpose • Nourishment

12. Breast • Nipple • Areola • Mammary glands • Tail of Spence

13. Endometrial changes during the menstrual cycle • Menstrual phase • Hemorrhages, sloughs and sheds • Proliferative phase • Repairs and thickens • Secretory phase • h vascularity • Prepares to support fertilized ovum

14. Assessment of Female Reproductive System • Breast Exam • Size • Symmetry • Contour • Skin color • Lesions

15. Assessment of Female Reproductive System - • Position • Lithotomy • Inspect • Palpate • Have client “bear down” • Bulging • Protrusion • Incontinence

16. Mammography • X-ray of breast • Purpose: • Screen for breast CA

17. Abdominal Laparoscopy • Visual examination of the abdomen using a fiberoptic tube. • abd. Filled with gas

18. http://www.google.com/url?url=http://www.youtube.com/watch%3Fv%3DxECrwui9Lks&rct=j&sa=X&ctbm=vid&ei=-jm7TpHyGqOTiAKihrz_BA&sqi=2&ved=0CFEQuAIwAA&q=laparoscopic+hysterectomy&usg=AFQjCNHWtQoElG3corx6WIgqnaMeykfQjQ&cad=rjahttp://www.google.com/url?url=http://www.youtube.com/watch%3Fv%3DxECrwui9Lks&rct=j&sa=X&ctbm=vid&ei=-jm7TpHyGqOTiAKihrz_BA&sqi=2&ved=0CFEQuAIwAA&q=laparoscopic+hysterectomy&usg=AFQjCNHWtQoElG3corx6WIgqnaMeykfQjQ&cad=rja • http://www.google.com/url?url=http://www.youtube.com/watch%3Fv%3D7VfLv6gIMTA&rct=j&sa=X&ctbm=vid&ei=-jm7TpHyGqOTiAKihrz_BA&sqi=2&ved=0CIgBELgCMAg&q=laparoscopic+hysterectomy&usg=AFQjCNEnllO1PhW_sOIgCvEF4JkKe08_mw&cad=rja • http://www.google.com/url?url=http://www.youtube.com/watch%3Fv%3Dh-zuB2wsY5I&rct=j&sa=X&ctbm=vid&ei=-jm7TpHyGqOTiAKihrz_BA&sqi=2&ved=0CGYQuAIwAw&q=laparoscopic+hysterectomy&usg=AFQjCNEpuHV-R9FWz2gNhE_G6mSTAicSNg&cad=rja

19. Nursing Care - Laparoscopy • Before • Informed consent • Reinforce teaching • Clarify questions • NOC before • douche • Antiseptic scrub • Empty bladder • Baseline vital signs

20. Nursing Care - Laparoscopy • After • Monitor Vital signs • Report temp > 101oF • Apply perineal pad • Change q4 • Observe dressing • Drainage • Bleeding • Hematoma formation

21. Nursing Care - Laparoscopy • May occur • Shoulder pain • Gas through vagina • Hiccups • Keep IV until PO resumed • Provide discharge instructions

22. Nursing Care - Laparoscopy • When to notify MD • Bleeding • Intense abd pain • Fever • fluid leakage • Malaise • Difficulty breathing

23. Colposcopy • Examine • Vagina • Cervix • Brightly lighted microscope

24. Colposcopy • http://www.google.com/url?url=http://medicalvideos.eu/video/c6f9bd5d256af06/Getting-a-Colposcopy-Exam&rct=j&sa=X&ctbm=vid&ei=9Oy6TrvZFoLTiALE-oC4DA&ved=0CFwQuAIwATgK&q=colposcopy&usg=AFQjCNEu7hbpErmFG94yVa9SKIoXouI6Eg&cad=rja

25. Small Group Questions • A patient is going to have a colposcopy. What teaching would you do before the procedure? • What would you note in a breast exam as being abnormal and worthy of further investigation? • Identify the anatomical structures that an ovum travels through and then exits the body (and their functions) • What is the endometrium and how is it different than other tissue of the body? • What would you teach your client following a laparoscopic procedure?

26. Endometriosis • -osis • Abnormal condition • Endometri/0 • Inner lining of the uterus • Endometrial tissue is found outside the uterus

27. Endometriosis • Ectopic locations • Pelvic organs • Diaphram

28. Endometriosis • Ectopic tissue respond to ovarian cycle • Inflammation • Cysts • Scarring • Adhesions

29. S&S: Endometriosis • Just before / during menses • Dysmenorrhea • Backache • Cramps • Dysuria • Infertility

30. Dx: Endometriosis • Laparoscopy

31. Rx: Endometriosis • Pain • Mild analgesics • NSAIDS • Suppress ovarian function • Oral contraceptives • Pg

32. Pelvic Inflammatory Disease (PID) • Infection of the pelvic organs • Fallopian tubes • Ovaries • Uterus • Cervix

33. Cause by infection • Gonorrhea • Chlamydia • Major cause of female infertility

34. Pathophysiology • Organism travels up vagina  • spreads

35. S&S: PID • High fever • Vaginal discharge • Severe lower abd pain • Nausea • Malaise • Dysuria

36. Rx: PID • Antibiotics • Analgesics • Treat the partner too!

37. Small Group Questions • Describe the pathophysiology of endometriosis? • What are the S&S of endometriosis? • What are the complications of endometriosis? • What is the pathophysiology of PID? • What is the primary cause of PID? • What is the usual treatment option for PID?

38. S&S: Breast Cancer • Small hard painless lumps or masses • Change in size/shape of breast • Dimpling • Rash, discharge, flaking • Location • Upper outer quadrant

39. Breast cancer is the 2nd leading cause of cancer deaths in women, what is the leading cause of cancer deaths in women? • Cervical • Ovarian • Stomach • Lung • Uterine

40. Breast Exam • Emphasize the importance of continuing regular breast exams after menopause because the risk for breast cancer increases with age.

41. Mastectomy • Before surgery • Preoperative care • Reinforce teaching • Allow access to support persons • Offer emotional support

42. Mastectomy • After surgery • Routine post-op care • Reinforce teaching

43. Mastectomy • Teaching • Empty the drain and replace dressing daily • Return for drain removal in 2-4 days per order • Take analgesics before pain becomes severe per order • Report excessive bleeding

44. Mastectomy • Numbness & tingling in axillary are common • Arm / shoulder exercises per MD order • Drive • within 7-10 days • Return to work • 4-6 weeks • Don’t lift with arm on operated side

45. NrsDx MastectomyGrieving • Listen attentively • Spend time • Explain feelings are normal • Enlist support

46. Nrs. Dx. MastectomyRisk for infection • Assess dressing, incisions • Enc well balanced diet • Teach incision care • Report S&S of infection • avoid deodorant • skin care

47. Nrs. Dx. MastectomyRisk for Injury • Use nonsurgical side • Elevate arm on a pillow • Enc. ROM • Teach protective measures

48. Nrs. Dx. MastectomyRisk for Disturbed Body Image • Enc. Verbalization • Explain • Include partner • Provide resources • Enc. to look at the incision • Reassure

49. Cervical Cancer • Common • Most r/t • Human papillomavirus (HSP) • STD/STI

50. Cervical Cancer is highly treatable if found in the early stages. What is the best way to detect cervical cancer? • Signs and symptoms • MRI • CT-Scan • Pap smear • Palpation (via a self physical exam)