Nursing Care of the Client: Reproductive and Sexual Health Unit 13 Nursing Care of the Client: Reproductive and Sexual Health

Chapter 44 Reproductive Systems

Anatomy and Physiology Review Female and male reproductive systems consist of external and internal structures and organs

Common Diagnostic Tests Laboratory tests Radiologic tests Biopsy Dilation and curettage (D&C) Laparoscopy Colposcopy Nocturnal tumescence penile monitoring Pelvic examination Schiller test Ultrasound

Benign Prostatic Hyperplasia (BPH) Progressive adenomatous enlargement of prostate gland that occurs with aging Symptoms: Hesitancy, decreased force of stream, frequency, and nocturia Treatment: Medications, balloon dilation, urethral stent, thermotherapy, transurethral resection (TURP), and transurethral needle ablation (TUNA) (continued)

Prostate Cancer Second leading cause of cancer deaths in males Early symptoms: Dysuria, weak urinary stream, and increased frequency Treatment depends on extent of disease and age of client: Surgery, radiation, and hormone therapy

Testicular Cancer Usually first symptom: Small, hard, painless lump Males should perform testicular self-examination (TSE) monthly Treatment: Surgery, chemotherapy, and radiation

Penile Cancer Bacteria harbored in foreskin of uncircumcised male are irritants to glans penis and prepuce Thought to be carcinogenic Symptoms: Painless nodular growth on foreskin, fatigue, and weight loss Treatment: Surgery (continued)

Epididymitis, Orchitis, and Prostatitis Inflammation of epididymis Orchitis Inflammation of testes Prostatitis Inflammation of prostate (continued)

Epididymitis, Orchitis, and Prostatitis Symptoms: Pain, fever, chills, dysuria, nausea/vomiting, urethral discharge, warmth, and swelling Treatment: Antibiotics, bed rest, scrotal support, and ice to area

Male Structural Disorders Hydrocele Benign, non-tender collection of fluid within space of testes and spermatic cord Spermatocele Benign non-tender cyst of epididymis or rete testis Varicocele Dilation of veins of scrotum Torsion of spermatic cord Twisting of vascular pedicle of testis

Hydrocele Palpable, round, non-tender mass in scrotum Most close by 1 year of age without intervention Surgery may be required

Cryptorchidism Failure of one or both testes to descend into scrotal sac Most descend spontaneously by 1 year of age Surgery may be required 37

Impotence Inability of adult male to have erection firm enough or to maintain it long enough to complete sexual intercourse Three types: Functional Atonic Anatomic Treatment: External devices to promote erection, surgery, and medications (continued)

Infertility Inability to produce offspring Basic infertility workup initiated when conception has not occurred after 6 to 12 months of unprotected intercourse Goal of treatment: Successful achievement of pregnancy carried to full term that produces healthy offspring Treatment varies with cause (continued)

Chapter 44 Reproductive Systems

Fibrocystic Breast Changes Symptoms: Lumpy, nodular, glandular breast tissue Treatment: Biopsy, aspiration, or surgical excision, breast self-examination, regular mammograms, Vitamin E, and elimination of caffeine from diet

Fibroid Tumors Benign tumors growing in or on uterus Symptoms: Menorrhagia, increasing pelvic pressure, dysmenorrhea, abdominal enlargement, and constipation Treatment: Periodic reexamination, D&C, myomectomy, and hysterectomy

Breast Cancer Key to cure: Most common symptom: Early detection by physical examination, mammography, and breast self-examination Most common symptom: Painless mass or thickening All changes in breasts should be reported to physician (continued)

Breast Cancer Treatment: Lumpectomy, mastectomy, radiation, chemotherapy, medications, targeted therapy, immunotherapy, photodynamic therapy, gene therapy, hyperthermia, and antiangiogenesis therapy

Cervical Cancer Most preventable gynecological cancer with regular Pap smears Symptoms: Abnormal bleeding, odor, pain in lower back or groin, difficulty voiding, hematuria, and rectal bleeding Treatment: Varying degrees of surgery, radiation, and palliation

Cervical Cancer

Endometrial Cancer Cancer of lining of uterus Symptoms do not appear until cancer is advanced Routine Pap smears and pelvic examinations not adequate for early diagnosis Treatment: Radiation, chemotherapy, and surgery

Anatomy prior to D & C

Possible indication for D & C

Cancer Treatment - Hysterectomy

Ovarian Cancer Originates in epithelial tissue of ovary Symptoms do not appear until cancer is advanced at inoperable stage Treatment: Combination of surgery, radiation, chemotherapy, immunotherapy, and palliation

Pelvic Inflammatory Disease (PID) Pathogenic invasion of uterus, fallopian tubes, ovaries, and vascular/supporting structures within pelvis Symptoms: Low-grade fever, pelvic pain, abdominal pain, “bearing down” backache, foul-smelling vaginal discharge, nausea and vomiting, dysmenorrhea, dyspareunia, and peritonitis (continued)

PID Treatment: Antibiotic therapy, bed rest, pain management, and possible hysterectomy

Endometriosis Growth of endometrial tissue outside uterus within pelvic cavity Symptoms: Low backache, painful intercourse, feeling of heaviness on pelvis, spotting, and possible infertility (continued)

Endometriosis Treatment: Medication and/or surgical removal of lesions and hysterectomy

Vaginitis Inflammation of vagina Causes: Candidiasis (fungus) Trichomoniasis (protozoan) Gardnerella vaginalis (bacterium) Chlamydia trachomatis (parasite) (continued)

Vaginitis

Also causes painful periods

Vaginitis Symptoms: Treatment: Discharge with burning/itching Vaginal application of creams and medications

Toxic Shock Syndrome Rare, life-threatening condition where Staphylococcus aureus enters bloodstream with tampon use Symptoms: Temperature of 102º F or greater, vomiting, diarrhea, hypotension, flulike symptoms, flat/red rash that peels in one to two weeks, and disorientation (continued)

Toxic Shock Syndrome Treatment: IV fluids, antibiotics, bed rest, and possible mechanical ventilation or dialysis

Menstrual Disorders Dysmenorrhea Amenorrhea Polymenorrhea Painful menstruation Amenorrhea Absence of menstruation Polymenorrhea Menstrual cycles of less than 21 days (continued)

Menstrual Disorders Oligomenorrhea Diminished menstrual flow that is not amenorrhea Treatment based on cause of disorder

Premenstrual Syndrome (PMS) Often occurs after ovulation More than 150 related symptoms reported Symptoms vary Treatment: Counseling, medications, dietary changes, and regular exercise

Menopause Climacteric cessation of menstruation and end of reproductive capability Decreasing level of ovarian hormone production affects females in variety of ways Treatment: Estrogen replacement therapy, dietary changes, and exercise

Female Structural Disorders Cystocele Downward displacement of bladder into anterior vaginal wall Urethrocele Downward displacement of urethra into vagina Rectocele Anterior displacement of rectum into posterior vaginal wall Prolapsed uterus Downward displacement of uterus into vagina (continued)

Female Structural Disorders This slide added. (continued) 122

Female Structural Disorders Treatment focused on relief of discomfort and restoration of structure and function of pelvic organs: Pessary, surgery, and Kegel exercises This slide added. 123

Contraception Prevention of pregnancy When choosing method, consider: Safety Ease of use Effectiveness Cost (continued)

Contraception Sterilization Permanent and effective

Prior to Tubal Ligation

Sexually Transmitted Infections Chapter 45 Sexually Transmitted Infections

Anatomy and Physiology Review Major system affected by sexually transmitted diseases: Reproductive system Males generally more symptomatic than females Seek medical care more readily (continued)

Anatomy and Physiology Review Any area of sexual contact may also exhibit signs and symptoms of disease

Chlamydia Caused by Chlamydia trachomatis Most infections asymptomatic If untreated, can cause tissue inflammation, ulceration, and scar tissue formation in both females and males (continued)

Chlamydia Treatment of choice: Test and treat both partners Doxycycline Test and treat both partners

Gonorrhea Caused by Neisseria gonorrhea Symptoms may occur within 2 to 10 days Males more symptomatic than females Symptoms: Burning and purulent discharge from penis Treatment: Cipro and Vibramycin

Syphilis Caused by Treponema pallidum Primary, secondary, latent, and tertiary stages Antimicrobial therapy destroys Treponema pallidum at any stage But damage irreversible Treatment: Penicillin G benzathine and other antibiotics

Syphilis

Genital Herpes Caused by herpes simplex virus Symptoms of first episode: Itching and burning sensations and blisters at site of infection Recurrences common No cure Treatment based on relieving symptoms

Herpes

Cytomegalovirus (CMV) Rarely causes symptoms Can cause congenital infection of infants Produces mental retardation, blindness, deafness, or epilepsy (continued)

CMV Can become life-threatening in clients with poorly functioning immune systems No treatment

Genital Warts Caused by human papillomavirus (HPV) Symptoms: Painless, soft, fleshy growths in genital area Appears to play role in development of cervical cancer (continued)

Genital Warts Treatment: Remove warts But may recur at any time

AIDS Mode of transmission: Not curable Fatal Sexual contact Not curable Fatal Results in severe disorder of body’s immune system Leads to inability of body to fight off disease

Trichomoniasis Caused by Trichomonas vaginalis Only 10 percent of females present classic symptoms: Severe itching of vulva, redness, swelling of vulva, pain on intercourse and urination, and grayish, malodorous discharge (continued)

Trichomoniasis Treatment: Treat both partners Metronidazole (Flagyl) and avoid alcohol Treat both partners

Hepatitis B Caused by hepatitis B virus Spread through sexual contact Symptoms: Inflammation of liver, anorexia, vague abdominal discomfort, nausea, vomiting, fatigue, and jaundice No specific therapy Treatment based on relieving symptoms