1. Elsevier items and derived items © 2006 by Elsevier Inc. Assessment of the Reproductive System Lectures Petrenko N., MD, PhD

2. Female Reproductive System External genitalia: vulva, labia majora, labia minora, clitoris, vestibule, perineum Internal genitalia: vagina, uterus, corpus, cervix, fallopian tubes, ovaries Breasts Menstruation and menopause External genitalia: vulva, labia majora, labia minora, clitoris, vestibule, perineum Internal genitalia: vagina, uterus, corpus, cervix, fallopian tubes, ovaries Breasts Menstruation and menopause

3. Male Reproductive System External genitalia: penis, scrotum Internal genitalia: testes and spermatic cord, epididymis, vas deferens, seminal vesicles and ejaculatory ducts, prostate gland Inguinal area External genitalia: penis, scrotum Internal genitalia: testes and spermatic cord, epididymis, vas deferens, seminal vesicles and ejaculatory ducts, prostate gland Inguinal area

4. reproductive anatomy http://www.youtube.com/watch?v=FiIdsIUOG q0&feature=relatedhttp://www.youtube.com/watch?v=FiIdsIUOG q0&feature=related http://www.youtube.com/watch?v=FiIdsIUOG q0&feature=relatedhttp://www.youtube.com/watch?v=FiIdsIUOG q0&feature=related

5. Assessment Techniques: Female History: pain, bleeding, discharge, masses Physical assessment –Breast examination –Abdominal examination –Examination of the external genitalia –Pelvic examination –Bimanual examination –Rectovaginal examination History: pain, bleeding, discharge, masses Physical assessment –Breast examination –Abdominal examination –Examination of the external genitalia –Pelvic examination –Bimanual examination –Rectovaginal examination

6. Assessment techniques History The nurse uses data about client’s age, sex, and culture to assess the risk for certain diseases. The nurse considers the client’s age in evaluating the reproductive system. Personal history( the nurse assesses he client’s health habits, such as diet, sleep, and exercise patterns.)

7. Family history helps to determine the client’s risk for conditions that affects reproductive system functioning. Diet history is often critical for the correct interpretation of presenting symptoms of the reproductive system. Social history of the client provides insight into the whole person, including stressors, job history, education.

8. Obstetric History Number of pregnancies, live deliveries, stillbirths, abortions Difficulties with pregnancies, deliveries Birth weight of babies Problems with infertility

9. Use of Contraception Type used (past and present) Difficulties with method, suitability If discontinued, reasons for doing so

10. Sexual History Sexual orientation Regularity of intercourse Number of partners in the past 12 months Associated symptoms (e.g., pain, postcoital bleeding) Sexual dysfunction

11. Current health problem If a client seeks medical attention for a problem related to the reproductive system, the nurse asks additional questions to explore the chief complaint.

12. 1.Onset (sudden or gradual) 2.Chronology 3.Current situation (improving or deteriorating) 4.Location 5.Radiation 6.Quality 7.Timing (frequency, duration) 8.Severity 9.Precipitating and aggravating factors 10.Relieving factors 11.Associated symptoms 12.Effects on daily activities 13.Previous diagnosis of similar episodes 14.Previous treatments 15.Efficacy of previous treatments

13. Most complaints concern pain, discharge, masses, and reproductive functioning

14. Pain Onset, location, radiation, character, severity Relation to menstruation Aggravating and relieving factors Use of analgesics and their effect Associated gastrointestinal, urinary or vaginal symptoms Are symptoms related to an encounter with a new sexual partner? The nurse should not assume that the initial medical diagnosis is conclusive

15. Vaginal Discharge The nurse asks about: Onset, color, odor, consistency, quantity Relation to menstrual period Associated symptoms (e.g., rectal or urethral discharge, vaginal itch or burning, urinary symptoms, malaise, abdominal pain, fever) Relation to medication use (e.g., antibiotics, steroids) History of previous vaginal or pelvic infections and their treatment

16. Masses any reported masses in the breast should be evaluated Soreness, tenderness and their relation to menstrual cycle Redness, swelling, nipple discharge Change in contour, presence of masses Is client breast-feeding?

17. Bleeding Heavy bleeding or lack of bleeding may concern the woman. The possibility of pregnancy is considered in any sexually active woman with amenorrhea. Any postmenopausal bleeding needs to be evaluated. The nurse asks when the bleeding occurs in relation to certain events, such as the menstrual cycle or menopause, intercourse, trauma. In additional, the nurse notes the presence of associated symptoms

18. Other Associated Symptoms Ulcerations Persistent lesions Sense of pelvic relaxation (pelvic organs feel as though they are falling down or out) Infertility Pelvic infection

19. reproductive system assessment http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1 http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1 http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1 http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1http://www.youtube.com/watch?v=au3jakiaZ W0&has_verified=1

20. Assessment Techniques: Male Examination of the external genitalia Examination for inguinal hernia Examination of the rectum and prostate Examination of the external genitalia Examination for inguinal hernia Examination of the rectum and prostate

21. Digital rectal exam http://www.youtube.com/watch?v=wr6DSDrP n5ohttp://www.youtube.com/watch?v=wr6DSDrP n5o http://www.youtube.com/watch?v=pGmFm54 vC9Y&feature=relatedhttp://www.youtube.com/watch?v=pGmFm54 vC9Y&feature=related http://www.youtube.com/watch?v=wr6DSDrP n5ohttp://www.youtube.com/watch?v=wr6DSDrP n5o http://www.youtube.com/watch?v=pGmFm54 vC9Y&feature=relatedhttp://www.youtube.com/watch?v=pGmFm54 vC9Y&feature=related

22. Papanicolaou Test Client preparation for pap test Procedure Follow-up care Client preparation for pap test Procedure Follow-up care

23. Blood Studies Pituitary gonadotropin Steroid hormones Serologic tests Syphilis detection Prostate-specific antigen Pituitary gonadotropin Steroid hormones Serologic tests Syphilis detection Prostate-specific antigen

24. Other Studies Urinalysis for steroid hormones Wet preparation (smears) Cultures General x-rays CT scans for reproductive system disorders Hysterosalpingography: an x-ray of the cervix, uterus, and fallopian tubes (Continued) Urinalysis for steroid hormones Wet preparation (smears) Cultures General x-rays CT scans for reproductive system disorders Hysterosalpingography: an x-ray of the cervix, uterus, and fallopian tubes (Continued)

25. Other Studies (Continued) Mammography Ultrasonography Magnetic resonance imaging to scan for pelvic tumors Colposcopy Mammography Ultrasonography Magnetic resonance imaging to scan for pelvic tumors Colposcopy

26. Other Studies (Continued) Laparoscopy Hysteroscopy Laparoscopy Hysteroscopy

27. Other Studies (Continued) Cervical biopsy Endometrial biopsy and Aspiration http://howtosmokeweed.com/video/at- CfWUiClg/Endometrial-Biopsy-of-the- Uterus.html Breast biopsy and aspiration biopsy of breast fluid or tissue http://howtosmokeweed.com/video/_tDR0Vwm3go /Breast-Tissue-Biopsy.html Cervical biopsy Endometrial biopsy and Aspiration http://howtosmokeweed.com/video/at- CfWUiClg/Endometrial-Biopsy-of-the- Uterus.html Breast biopsy and aspiration biopsy of breast fluid or tissue http://howtosmokeweed.com/video/_tDR0Vwm3go /Breast-Tissue-Biopsy.html

28. Other Diagnostic Tests Needle biopsy of the prostate Semen analysis Needle biopsy of the prostate Semen analysis