Reproductive Health

Reproductive Health

Nursing DX for Reproductive Health • Nsg Dx Discomfort/Pain Alternation in self esteem Knowledge deficit r/t self care, fertility, infertility High risk for transmission or infection r/t STD

Menstrual Cycle Compare phases of cycle • Ovarian • Hormonal • Endometrial Markers of fertility • Increase in BMT • Cervical mucosa

Menarche • Define • Nursing Dx :Knowledge deficit r/t ??? • Nursing interventions : Teach Normal physiology Self care Pads/tampons Sprays douching Relief of discomfort Risk of pregnancy

Secondary Dysmenorrhea • Define- pain with menses after menses well established. • Etiology: reproductive tract pathology • Interventions: DX and treat cause

Abnormal Bleeding • Amenorrhea- lack of menses • Common cause pregnancy and low weight • Menorrhagia- excessive bleeding- 5 days • Metroharragia- bleeding between cycles • Post menopausal bleeding At risk for anemia

Cause of Discomfort/Primary Dysmenorrhea • Pain during menses • Role of prostaglandin • Interventions Oral contraceptives Diet- Vitamins Rest exercise Heat Anti-prostaglandin

PMS • Exact etiology unknown • Thought to be: Hormonal imbalance Nutritional deficiency Prostaglandin excess Endorphin deficiency

Symptoms of Syndrome • DX takes 3-5 months • Physical symptoms include: fluid retention-weight gain-H/A- backache-N/V- diarrhea-constipation- craving- sleep disturbance • Emotional- Mood changes-hostility- depression-labile-anxiety- lethargy

Nursing Interventions • Diet • Foods to avoid • Multivitamins- B-complex and E • Exercise • Progesterone • Antidepressants

Menopause • Ovaries decrease production of estrogen • Cessation of menses before menopause • Peri menopausal 3-5 years • Average age is 51 • Estrogen produced by fat

Characteristics of Menopause • Physiologic Hot flashes-CV-osteoporosis-skin-Alzheimer’s Psychological- empty nest-new beginning- not hot flashes------power surges

Interventions • Estrogen replacement at risk for Ca • Hormonal replacement at risk for breast Ca • Calcium- • Natural sources of estrogen

Contraception • Situational • Spermicidal • Hormonal- estrogen-progestin Norplant-Depoprovera • Barriers- condom –diaphragm-cap-IUD • Permanent Tubal ligation-vasectomy

Termination of Pregnancy • Physiological • Surgical vs. medical • First- second- third trimester • Psychological • Psychological tasks of the trimester • Informed consent • Legal parameters • Age • Religious ethical

Surgical Termination • Rare contraindication • Rationale • Requires anesthesia • Surgical complications • Care provider has control

Medical Termination • Gestation less than 7 wks • First visit screening- counseling • Second visit-labs-utz- misoprostil • Third visit- 2-3 days later- utz- more miso • Fourth visit determine success

Medical Termination • May need surgical aspiration • Can take weeks to days • Avoidance of anesthesia • Bleeding may be heavy • Side effects of meds • Patient has control

Sexually Transmitted Diseases • Chlamydia- most common in US • Gonorrhea male vs. female sx • Herpes HSVI vs. HSVII • Human papilloma virus-Can be precursor to Ca • Syphilis • Sx • Stages

Common Infections • Vaginitis • Moniliasis yeast infection- common • Bacterial vaginosis- Gardinella • GBS • PID • Toxic shock- staph aureus • S/S • Prevention

Non- Malignant Breast Conditions • Fibrocystic breast disease- common • Fibroadenoma- freely moveable • Not associated with Ca • Intraductal papillomas -associated with menopause- potential for malignancy • Duct estasies- more common in woman who have children and not BF

Breast Cancer • Hereditary component • Usually over 50- under 50 aggressive Ca • Upper outer quadrant • Stressors include: • Family hx- prolonged exposure to estrogen-nullipara-early menarche- late menopause- HRT-ERT- breast d/o-obesity- alcohol

Detection • Breast self exam- one week past menses • Ab. Finding- lump –dimpling-vein-nipple discharge or retraction • Mammogram- biopsy • Baseline at 40 • 1-2 years 40-50 • Yearly past 50 • Earlier if family hx

Cancer Staging • Stage 1- less than 2cm and in breast only • Stage 2- less than 5cm, mobile lymph node- not attached • Stage 3-greater than 5 cm/ fixed lymph/ local extension • Stage 4- distant metastases

Treatment Options • Surgical • Radical vs. partial • Lumpectomy • Chemotherapy • Radiation • Breast reconstruction

Treatment Options • Hormonal • Androgens- anti estrogen • Estrogens (DES) • Corticosteroids (Prednisone) • Anti hormones Meds • Megace • Tamoxifen

Nursing- Mastectomy • Preoperative- Discuss tx options • Support decision • Reduce fear- improve coping • Postoperative • Pain control • Maintain skin integrity • Self care • Coping • Sexual adjustment • Prevent lymph edema

Conditions of Female Reproductive Tract • Endometriosis • May be due to infection or retrograde flow • Pain • Fertility problems • Tx • Uterine mass • Ovarian cysts • Cystocele and rectocele

Cervical Cancer • Incidence- childbearing age • Stressors- early intercourse, STD, multiple partners, smoking, DES • Symptoms- none early, watery discharge • Prevention- regular Pap smears

Classifications of Pap smear • Class I- healthy • Class II- metaplasia, mild hyperplasia • Class lll- moderate hyperplasia • Class lV- severe • Class V- carcinoma in situ (Ca)

Cervical Cancer Tx • Early- remove or tx local lesion • Cryo-colposcopy-conization • Late treatment- hysterectomy

Endometrial Cancer • Most often in post menopausal women • 1/3 of postmenopausal bleeding due to EC • Stressors- nulliparity-late menopause- ERT- obesity • Screening- endometrial biopsy (not pap) • Tx- hysterectomy

Ovarian Cancer • 3% of women over 50 • Stressors- familial or personal hx of breast, endo, colon Ca, diet, nulliparity, fat diet, smoking, infertility • Symptoms- none early, late GI due to mets • DX- bi manual exam, utz, Ca 125 not reliable • Tx-oophorectomy

Female Reproductive Surgeries • Hysterectomy- vaginal vs. abdominal Total/ subtotal With of without BSO Anterior/ posterior colphorrhaphy

Nursing Care • Nursing Diagnosis • Pain – urinary retention- gas • Anticipatory interventions • Post operative interventions

Health Maintenance • Self breast exams- monthly • Mammogram- every year past 50 • Pap smear- yearly past 16 or when sexually active • Pelvic exam- yearly with Pap • Assisting with a pelvic exam

Violence Against Women • Incidence • What is abuse? • Power • Characteristics of abuser • Nursing Interventions

Cycle of Violence • Victims of abuse • Characteristics of abuser • Children –outcome • Nursing interventions

Non- Malignant Conditions in Men • Testes Cryptorchidism- undescended testes Testicular torsion- acute pain Hydrocele, varicocele- increase fluid • Prostate Benign hypertrophy (TURP) • Penile Erectile dysfunction

Cancers in Men • Prostate- most common 1/11 over 50 • Detection- PSA-DRE • TX- prostectomy- sequelae= impotence • Testicular Cancer most common 20-35 yrs • Detection –TSE • Associate with cryptorchidism • HCG tumor marker • Penile cancer uncommon in US

Infertility • Definition unable to conceive after 1 yr • Female - blocked tubes, endometriosis, 40% of cases attributed to women • Dx-hystosalpingography • Tx- surgery medications • Male- sperm problems, 40% attributed to male • DX- semen analysis • Tx- artificial insemination- donor

Stressors Related to Infertility • Physiological • Psychological- self esteem, scheduled intercourse, expensive • Sociocultural expectations • Developmental • Spiritual- grieving

Genetics • Determination of sex- male sperm • Barr body • Cause of trisomy • Autosomal recessive • Autosomal dominant • Sex linked recessive

Genetic Counseling • Mothers 35 or over at time of birth • Carriers of X linked disease • Abnormal MS- AFP, many false positives • Couples with familial hx • Personal hx • Previous birth defect

Reproductive Health