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

2. Chapter 44
Reproductive Systems

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

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

13. 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)

21. 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

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

26. 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)

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

28. 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

29. 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

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

37. 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

41. 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)

42. 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)

43. Chapter 44
Reproductive Systems

51. 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

54. 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

56. 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)

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

74. 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

76. Cervical Cancer

81. 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

85. Anatomy prior to D & C

86. Possible indication for D & C

90. Cancer Treatment - Hysterectomy

94. 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

98. 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)

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

100. 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)

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

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

104. Vaginitis

106. Also causes painful periods

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

108. 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)

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

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

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

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

119. 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

121. 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)

122. Female Structural Disorders
This slide added.
(continued)
122

123. 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

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

126. Contraception
Sterilization
Permanent and effective

132. Prior to Tubal Ligation

136. Sexually Transmitted Infections
Chapter 45
Sexually Transmitted Infections

137. 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)

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

139. 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)

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

141. 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

142. 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

143. Syphilis

146. 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

147. Herpes

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

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

150. 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)

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

152. 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

155. 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)

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

157. 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