Medical-Surgical Nursing: Concepts & Practice 3rd edition Chapter 38 Care of Women with Reproductive Disorders Copyright © 2017, Elsevier Inc. All rights reserved.

Female Reproductive System Female reproductive organs—internal, external structures, and accessory organs Female reproductive cycle Ovarian cycle Menstrual cycle

Female Reproductive System (Cont.) Fetal development Sexual maturation Menopause Effects of aging

Female Reproductive System (Cont.) Menstruation and normal menstrual bleeding Normal vaginal discharge Breasts Contraception and fertility

Contraception and Fertility Contraceptive options Emergency contraception Legal and ethical considerations: the “morning-after” pill Infertility Primary infertility Secondary infertility Menopause

Proper Application of a Condom See Figure 38-2 on p. 886. Modified from Leifer G: Introduction to maternity and pediatric nursing, ed. 5, Philadelphia, 2007, Saunders.

Proper Application of a Diaphragm See Figure 38-2 on p. 886. Modified from Leifer G: Introduction to maternity and pediatric nursing, ed. 5, Philadelphia, 2007, Saunders.

Contributing Factors to Infertility in Women Problems with ovulation An abnormality in the pathway between the cervix and fallopian tube An abnormality in the endometrium of the uterus, or malformation of the uterus Tumors in the reproductive tract Vaginal or cervical environment that is inhospitable to sperm motility or viability

Causes of Repeated Pregnancy Loss An abnormality in fetal chromosomes that result in spontaneous abortion Abnormalities of the cervix or uterus Disorders of the endocrine or immune system Infections Environmental factors, such as toxic agents

Infertility Emotional impact of infertility Patient teaching and communication Herbal products and fertility Assisted reproduction

Some Assisted Reproductive Therapies In vitro fertilization (IVF-ET) Zygote intrafallopian transfer (ZIFT) Therapeutic donor insemination (TDI) Intracytoplasmic sperm injection Surrogate mother See Box 38-2 on p. 892.

Health Risks of Menopause Osteoporosis Fosamax Coronary heart disease Treatment options during menopause Hormone therapy Bioidentical hormones Alternative therapies Diet, exercise, and support groups

Activities that Increase the Risk of Osteoporosis Inadequate lifetime intake of calcium and vitamin D Smoking Excess alcohol intake Excess caffeine, cola, or soft drink intake See Box 38-3 on p. 893.

Health Screening and Assessments Primary prevention decreases the probability of becoming ill. Secondary prevention focuses on early detection of specific at-risk diseases and early treatment like annual mammograms. Tertiary prevention minimizes the impact of an already-diagnosed condition.

Health Screening and Assessments (Cont.) Breast self-examination Vulvar self-examination Diagnostic tests Pelvic examination and Papanicolaou (Pap) smear Older adult considerations for screening Nursing management

Menstrual Dysfunctions Premenstrual syndrome Premenstrual dysphoric disorder Dysmenorrhea Primary dysmenorrhea Secondary dysmenorrhea

Pelvic Relaxation Syndrome Cystocele, rectocele, and enterocele Etiology and pathophysiology Signs and symptoms Diagnosis Treatment Nursing management

Treatment of Pelvic Relaxation Syndrome Nonsurgical management Kegel exercises Lifestyle changes Pessary Biofeedback and transcutaneous electrical nerve stimulation (TENS) Surgical management

Disorders of the Female Reproductive System Polycystic ovarian syndrome Dysfunctional uterine bleeding Oligomenorrhea Amenorrhea Metrorrhagia Menorrhagia Abnormal uterine bleeding

Leiomyoma Medical management Uterine artery embolization Myomectomy

Endometriosis Endometrial tissue is found outside the uterus, particularly on the ovaries, in the rectovaginal septum, and in the pelvis and abdomen. Continuous hormonal contraceptive therapy

Inflammations of the Lower Genital Tract Etiology and pathophysiology Signs, symptoms, and diagnosis Treatment Nursing management

Toxic Shock Syndrome Risk factors include the prolonged use of high-absorbency tampons, cervical caps, or diaphragms. Symptoms Sudden spiking fever, flu-like symptoms, hypotension, generalized rash resembling a sunburn, and peeling skin on the palms or soles Treatment

Cancer of the Female Reproductive Tract Vulvar cancer Cancer of the cervix Cancer of the uterus Cancer of the ovary

Warning Signs of Ovarian Cancer Abdominal pain Feeling full quickly when eating Feeling a frequent or urgent need to urinate Increased abdominal girth

Benign Disorders of the Breast Fibroadenoma Fibrocystic breast changes (FBCs) CAM therapy for FBCs Intraductal papilloma

Breast Cancer Etiology and pathophysiology Signs, symptoms, and diagnosis Prevention Treatment Surgery Radiation therapy

Breast Reconstructive Surgery Reduction mammoplasty Augmentation mammoplasty Reconstructive mammoplasty Nursing management Preoperative care Postoperative care Collaborative care Home and community care

Lymphedema Do not assess blood pressure in the affected arm. Do not give injections or do venipuncture in the affected arm. Provide meticulous skin care. Teach the patient to wear gloves in the kitchen and when gardening to prevent skin irritation or injury.

Lymphedema (Cont.) Teach the patient to avoid heavy lifting. Wear a compression garment during strenuous activities. Elevate and exercise the arm daily.

Risk Factors for Breast Cancer Family history of relative with breast cancer Early menarche, late menopause Late first pregnancy or no children Abnormal cells in previous breast biopsy Obesity Environmental exposure to hormone-modulating chemicals, polycyclic aromatic hydrocarbons Inherited BRCA1 or BRCA2 gene See Box 38-5 on p. 909.

Stages of Breast Cancer Stage I Stage II Stage III Stage IIIA Stage IIIB Stage IIIC Stage IV See Table 38-6 on p. 909.

Comparisons of Bacterial Vaginosis and Yeast Infection Primary causative organism(s) Onset Odor Itching Discharge Sexually transmitted Vulvar signs Vaginal signs Treatment See Table 38-5 on p. 906.

Nursing Management of a Woman with a Reproductive Disorder Care of a patient after a hysterectomy Care of a patient after breast lumpectomy See Nursing Care Plan 38-1 on pp. 899-901. See Nursing Care Plan 38-2 on p. 912.