1. Reproductive Disorders Female

2. Learning Objectives At the end of this lesson, the SPN will be able to: – 1. Describe the different anatomical structures that make up the female reproductive system and discuss their function – 2. Discuss the different diagnostic tests that are used to diagnose disorders of the female reproduction system – 3. Describe the different disorders that affect the female reproductive system including: pathophysiology, s/s, diagnostics, treatment, and nursing care – 4. Describe the different medications used to treat female reproductive disorders

3. Anatomy Review Ovaries- How Many?__________________ What size are they? Where are they located?____________________ What is Fimbrae?____________________ What hormones do they release?_________________________________ What is released during the menstrual cycle?

4. FALLOPIAN TUBES Are a pair of_____________opening at one end into the ______________________and at the other end into the ______________________________, over the ____________________________. The entire inner surface of the tubes is lined with____________________. When the _______________________follicle of the ovary ruptures and releases the mature_______________, the_______________sweep the ___________ into the fallopian tube.

5. UTERUS Is shaped like an inverted pear and measures 3 inches by 2 inches by 1 inch in the nonpregnant state Is situated between the________________________ and the ___________ Consists of _____layers The______________is the inner layer The_____________is the middle layer The______________is the outer layer

6. Uterus Con’t. The uterus is divided into three major portions. The _______________(upper, rounded portion ) is the insertion site of the fallopian tibes The larger midsection is the ___________(body). The smaller, narrower lower portion of the uterus is the ___________, part of which descends into the vaginal vault. The lining of the uterus is the endometrium, which itself consists of 2 layers. The ______________layer, adjacent to the myometrium, is vascular but very thin and is a permanent layer

7. Uterus Con’t. The ____________________layer is regenerated and lost during each menstrual cycle. Under the influence of _______________and ______________________from the ovaries, the growth of blood vessels thickens the this layer in preparation for a possible embryo. If fertilization does not occur, this layer sloughs off in menstruation. During pregnancy, the endometrium forms the maternal portion of the placenta

8. Vagina The vagina is a muscular tube about 4 inches long that extends from the cervix to the vaginal orifice in the perineum(pelvic floor) The functions of the vagina are to: – 1. – 2. – 3.

9. External Genitals The female external genital structures may also be called the _______________. The external structures include: – 1. – 2. – 3. – 4.

10. The Breast The mammory glands are structurally related to the skin but functionally related to the reproductive system because they produce milk for the nourishment of offspring Enclosed within the breasts, the mammory glands are anterior to the pectoralis major muscles The alveolar glands produce milk after pregnancy; the milk enters the lactiferous ducts which converge at the nipple The skin around the nipple is a pigmented area called the areola

11. HORMONES 1. FSH--- 2. LH--- 3. Estrogen--- 4. Progesterone---

12. ASSESSMENT/ DIAGNOSTIC STUDIES Pelvic Exam-most common method of diagnosis. Includes inspection and palpation of the external and internal genitalia Includes the vagina, cervix, uterus, and ovaries Before the exam, the woman should empty her bladder so that reproductive structures may be palpated more easily Douching before the exam will wash away secretions that may help diagnose problems The patient is place in the lithotomy position and stirrups are used to support her legs and feet

13. Pelvic Exam-Con’t. The external genitalia is inspected, then a speculum is inserted into the vagina. The speculum stretches the external vagina, enabling the examiner to see the walls of the vagina and the cervix Smears and cultures can be taken at this time. The Papanicolaou test is usually done at this time

14. PAPANICOLAOU SMEAR (PAP SMEAR) Provides a means to microscopically exmine exfoliated cells that are tested for malignancy Used mainly to detect early cancer of the cervix, which is the most common form of malignancy of the reproductive tract A sample of cells from the cervix is obtained by aspiration or scraping The sample is smeared on a special slide that is placed in a fixing solution The slide is then labeled and sent to the lab for examination

15. PAP Smear Classification Results Class I- Class II- Class III- Class IV- Class V-

16. Assessment- Subjective Data Bleeding- – Characteristics – Associated factors – History – Significance

17. Assessment- Subjective Data Vaginal Discharge- – Characteristics – Associated factors – History – Significance

18. ASSESSMENT- Subjective Data Pelvic Pain – Characteristics – Associated Factors – History – Significance

19. Diagnostics 1. Endometrial Smear and Biopsy are used to determine the presences of carcinoma menstrual disorders and infertility. Of the 2, an endometrial biopsy is most accurate Biopsy- a special curet obtains a tissue sample. Aspiration suction may also be used to obtain an endometrial sample. Procedure can be ontained without anesthesia, although a local anesthetic may be used. An endometrial smear can be obtained by several methods. One method is to insert a malleable cannula through the cervix and into the uterine cavity. The cannula is attached to a syringe that is used to aspirate secretions

20. Nursing Implications –Endometrial Smear and Biopsy Assist the patient into dorsal lithotomy position and explain procedure A prostaglandin inhibitor may be administered to decrease uterine cramping post-operatively Inform patient that she may experience light bleeding and occasional cramping for a few days Instruct patient to report fever, chills, and increased bleeding

21. Cervical Biopsy Also known as conization. There are 2 types: – 1. Punch Biopsy- Several specimens are obtained by punching out small samples of cervical tissue. This procedure is very painful! – 2. Cone Biopsy- invasive surgery. Requires outpatient surgery. Under general anesthesia, a large amount of cervical tissue is removed. Advantage- diagnosis and remove cancerous tissue – Nursing Interventions- – cramping or spotting, pain can be relieved with a mild analgesic – Notify MD if severe pain or heavy bleeding – Instruct patient to avoid tampons, douching, or intercourse for 2 weeks

22. Colposcopy Instrument is called a colposcope Examination of the cervix and the vagina with a bright light and magnification of 10 to 40 times Used to determine distribution of abnormal squamous epithelium and to pinpoint areas from which biopsy tissue can be taken A cervical biopsy and PAP smear can be done at this time Procedure is preferably done when the cervix is least vascular Usually no pain, mild discomfort relieved with a mild analgesic Contact MD if severe pain or symptoms of shock

23. CULDOSCOPY An operative procedure in which an incision is made through the perineum into the posterior vagina so that a culdoscope can be inserted to visualize the uterus, fallopian tubes, broad ligaments, uterosacral ligaments, rectal wall, sigmoid, and even the small intestine Nursing Considerations- – Will receive either local, general, or regional anesthesia – Patient will be placed in the knee-chest postion – Sutures will be placed following the procedure – No vaginal intercourse for a period prescribed by the physician – Educate regarding signs of internal bleeding – The pt. may experience pain in the abdomen from air entering the pelvic cavity

24. LAPAROSCOPY Endoscopic visualization of the pelvic and abdominal cavities through a small incision below the umbilicus; used to evaluate pelvic pain and infertility, treat endometriosis adhesions, and perform tubal sterilizations(the most common use) Nursing Considerations- – Instruct patient to report excessive bleeding, fever, severe cramping – Analgesics for shoulder or abdominal discomfort from injection of CO2 which is given to separate the intestines from the pelvic organs

25. Laparoscopy Nursing Considerations Con’t. – The pain that the patient experiences is usually mild to moderate pain around the umbilicus and in the back – Avoid strenuous activities until bleeding stops – Passing gas and bowel movements may be difficult due to manipulation of the intestines, ambulation and fluids will be helpful

26. Dilation and curettage (D&C) Common GYN surgery for diagnostic and therapeutic purposes Consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curet Performed to control uterine bleeding, secure endometrial and endocervical tissue for cytologic exam, and treat incomplete abortion Nursing Considerations – Monitor for S&S of hemorrhage, provide sanitary pads, check for voiding – Avoid strenuous activity until bleeding stops

27. Tumor Markers Let us look at the handout

28. Hysterosalpingogram Is a fluoroscopic x-ray study of the uterus and fallopian tubes Is used to determine tubal patency, detect pathology in the uterine cavity, and identify peritoneal adhesions A speculum is introduced while the patient is in the lithotomy position Contrast medium is injected into the uterine cavity The contrast medium will enter the peritoneum in 10 to 15 minutes if tubes are patent

29. Hysterosalpingogram Nursing Considerations – Determine date of LMP-test is done a few days after menses ends, before ovulation – Administer enema before procedure to decrease intestinal gas – Administer prescribed meds to reduce anxiety – After procedure, apply perineal pad for drainage of excess contrast medium or blood and instruct patient to notify MD if bleeding lasts for more than 3 days or if any signs of infection are present – Inform the patient that pain med may be necessary for shoulder discomfort due to dye irritation of the phrenic nerve

30. Pelvic Ultrasonography A noninvasive test that uses high-frequency sound waves to form images of the interior pelvic cavity Used to detect uterine, tubal, ovarian, and pelvic cavity pathology, measure organ size, and evaluate pregnancy Nursing considerations – The pt. should have a full bladder – Following the procedure, help the pt. wipe off ultrasound gel from abdomen and allow her to empty bladder