Nursing Care of Clients with Disturbances in Sexuality and Reproduction

Who are the candidates for pap smears?

Sexually-active women

Clinical manifestations of TSS involve 3 or more of:

Increased/Elevated	Decreased
Serum creatinine phosphate level Total bilirubin, AST, ALT levels elevated	Urine output L ventricular contractility Platelets

What are the s/sx that should be reported after brachytherapy? (Hint: A-BBB-D-E-F)

• Abdominal pain

• heavy vaginal Bleeding

• urethral Burning for more than 24 hours

• Blood in urine

• severe Diarrhea

• Extreme fatigue

• Fever (T > 38C)

X-ray of the cervix, fallopian tubes, and uterus; this test is used to evaluate tubal anatomy and patency

Hysterosalpingography (HSG)

What are the 3 endoscopic studies?

1. Colposcopy - cervix and vaginal wall

2. Laparoscopy - pelvic cavity

3. Hysteroscopy - uterus

Infertility refers to a couple’s inability to achieve pregnancy after _____ of unprotected intercourse

1 year

What are the 3 female factors that affect infertility?

1. Ovarian and ovulation factors (PCOS, hyperprolactinemia, premature ovarian failure)

2. Tubal factors (endometriosis)

3. Uterine factors (polyps, fibroids, congenital malformations)

What is an adverse effect of clomiphene?

Multiple gestation

In women with PCOS, what is their serum progesterone level during:

1. Pre-ovulation?

2. Mid-cycle?

1. Less than 1 ng/mL

2. 5-20 ng/mL

What hormone is excessive in women with PCOS?

Progesterone (mimics pregnancy)

Treatment: clomiphene

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

A

Diagnostic study: ovulation index

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

A

What are the 3 components in Rotterdam’s criteria?

1. Menstrual disorders

2. High levels of androgenic hormones

3. Enlarged ovaries upon UTZ

Treatment: dopaminergic drugs (e.g., Intropan, Inovan, Revivan, Dopastat)

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

B; these will decrease the prolactin levels

Manifestation: hirsutism and acne

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

A, B, and C

In premature ovarian failure, the ovaries stop working before _____ years of age

40

Hypergonadotropic hypogonadism

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

C

Treatment: oocyte donation

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

C

Manifestation: absent menstrual periods

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

C

Manifestation: symptoms of low estrogen levels (e.g., hot flashes, night sweats, and vaginal dryness)

A. Polycystic ovarian syndrome (PCOS)

B. Hyperprolactinemia

C. Premature ovarian failure

C

What are the major manifestations of endometriosis? (Hint: 4D)

1. Dyspareunia

2. Dysuria

3. Dysmenorrhea

4. Dyschezia

What is the treatment for polyps?

Surgery

Methods: intracervical, interauterine, intratubal/intrafallopian

A. Artificial insemination

B. In vitro fertilization (IVF)

C. Gamete intrafallopian transfer (GIFT)

D. Intracytoplasmic sperm injection (ICSI)

A

The male should not have ejaculated ____ hours prior to artificial insemination

24

Indication: inability of male to deposit semen in the vagina, inability of semen to be transported from vagina to uterine cavity (e.g., erectile dysfunction), single woman who desires to have a child

A. Artificial insemination

B. In vitro fertilization (IVF)

C. Gamete intrafallopian transfer (GIFT)

D. Intracytoplasmic sperm injection (ICSI)

A

Treatment of choice for women with ovarian failure

A. Artificial insemination

B. In vitro fertilization (IVF)

C. Gamete intrafallopian transfer (GIFT)

D. Intracytoplasmic sperm injection (ICSI)

C

Single sperm is injected through the zona pellucida and into the cytoplasm of oocyte

A. Artificial insemination

B. In vitro fertilization (IVF)

C. Gamete intrafallopian transfer (GIFT)

D. Intracytoplasmic sperm injection (ICSI)

D

Treatment of choice in severe male factor infertility

A. Artificial insemination

B. In vitro fertilization (IVF)

C. Gamete intrafallopian transfer (GIFT)

D. Intracytoplasmic sperm injection (ICSI)

D

In patients with endometriosis, GSCS is done to rule out _____ caused by chlamydia or gonorrhea

Pelvic inflammatory disease (PID)

True or false? Calcium and magnesium can treat endometriosis

False; these are only used for muscle relaxation

What is the side effect of the laparoscopic removal of endometrial implants and adhesions?

Temporary postoperative pain

Possibly caused by retrograde menstruation

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

A

Management: oral contraceptives

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

A

Manifestation: peeling of skin, abrupt onset of high fever, sunburn-like rashes, severe hypotension

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

B; pag toxic, PASS (creds to ley)

Affects the heart, kidneys, liver, and respiratory system

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

B

Management: IV antibiotics and corticosteroids

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

B

Management: platelet transfusions

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

B

True or false? Super-absorbent tampons should be used to prevent TSS

False

Causes: neuromuscular damage of childbirth, increased intra-abdominal pressure, weakening of pelvic support

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

C

Common in multiparous women

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

C

Grade of uterine prolapse in which the uterus bulges into the vagina, but the cervix does not protrude through the entrance to the vagina

Grade I

Grade of uterine prolapse in which the uterus bulges farther into the vagina, and the cervix protrudes through the entrance to the vagina

Grade II

Grade of uterine prolapse in which the body of the uterus and the cervix protrude through the entrance to the vagina. The vagina is turned inside out.

Grade III

Manifestation: feeling as if “something is falling out”

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

C

Management: Kegel exercises, space-filling devices, and bladder training

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

C

Management: intravaginal estrogen therapy

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

C

Management: transvaginal repair and anterior/posterior colporrhaphy

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

C

True or false? Any woman can have a vaginal hysterectomy

False; pwede lang kapag hindi na magbubuntis at all o kapag na-achieve na ‘yung desired family size

What is the most common type of endometrial cancer?

Adenocarcinoma

What are the 4 stages of endometrial cancer?

I: confined in the endometrium

II: cervix

III: vagina or lymph nodes

IV: spread beyond the pelvis

Risk factors: late menopause, nulliparity

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D and E

Risk factors: DM, HTN, obesity

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D and E

Risk factor: taken Tamoxifen

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D

Manifestation: postmenopausal bleeding

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D

Manifestation: palpable uterine mass or uterine polyp

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D

Treatment: hysterectomy

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

C and D

Treatment: brachytherapy

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D; for stage II and III endometrial cancer

True or false? Heavy vaginal bleeding is expected in brachytherapy

False; report this s/sx

True or false? A woman on brachytherapy for endometrial cancer is radioactive between treatments

False; hence, there are no restrictions on her interactions with others

Treatment: chemotherapy (Doxorubicin, Ciplatin, Paclitaxel)

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D

Disordered growth in response to excessive exposure to estrogen

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

E

Risk factor: family history of hereditary nonpolyposis colon cancer (HNPCC)

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D and E

Risk factor: colorectal cancer and breast cancer

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

E

Manifestation: vague GI disturbances, urinary frequency/incontinence, unexpected weight loss, abdominal mass

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

E

Manifestation: abdominal pain

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

D, E, F

Diagnostic study: CA-125

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

A, D, E

Management: total abdominal hysterectomy, bilateral salpingo-oophorectomy (TAHBSO)

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

E

Treatment: chemotherapy (Cisplatin, Carboplatin, Taxanes)

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

E

The nurse should instruct patients with ovarian cancer to avoid tampons, douches, and sexual intercourse for at least _____ or as instructed after surgery

6 weeks

Complex infectious process in which organisms from lower genital tract migrate from endocervix upward through the uterine cavity into the fallopian tubes

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

F

What is the most common site of PID?

Fallopian tubes

Leading cause of infertility

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

F

Cause: STIs

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

F

Manifestation: vaginal discharge has a foul smell

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

F; indicates infection

Manifestation: may possibly experience no symptoms

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

F

What is the diagnostic criteria for PID?

• Sexually active woman and at risk for STIs

• Pelvic or lower abdominal pain

• No other causes for illness can be found; AND

  • Uterine tenderness, or

  • Adnexal tenderness, or

  • Cervical motion tenderness (chandelier sign)

The antibiotic therapy for women with PID lasts for how many days?

14 days (1 shot lang for males unfair!!!!!)

Management: maintain rest in a semi-Fowler’s position

A. Endometriosis

B. Toxic shock syndrome (TSS)

C. Uterine prolapse

D. Endometrial cancer

E. Ovarian cancer

F. Pelvic inflammatory disease

F; para mawala ‘yung pressure sa abdomen

True or false? Women on antibiotic therapy for PID can still have sexual intercourse

False; avoid sexual intercourse hangga’t hindi ka pa cleared ng doktor

Exact cause is unclear

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

A

Pathophysiology: increased dihydrotestosterone (DHT) levels

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

A

_____ is the most common cause of hematuria among men

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

A

How is the specimen for urine GSCS obtained?

Via a straight/foley catheter

Management: 5-alpha reductase inhibitor (5-ARI) and alpha-1 selective blocking agents

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

A

After TURP, the patient should have an indwelling urinary catheter for at least _____

24 hours

Also known as impotence

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

B

What are the 2 major types of erectile dysfunction?

• Organic ED: gradual deterioration of function

• Functional ED: psychological cause; onset is usually sudden and follows a period of high stress

Diagnostic study: nocturnal penile tumescence test

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

B; differentiates urogenic from psychogenic cause

During deep sleep, men can have ____ erections

3-5

Management: PDE-5 inhibitors (e.g., sildenafil, vardenafil, tadalafil)

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

B

PDE-5 inhibitors should be taken at least _____ prior to sexual intercourse

1 hour

Intracorpeal injections (e.g., alprostadil, paverine, phentolamine) should be done at least _____ prior to sexual intercourse

30 minutes

True or false? Priapism affects the 2 corpora cavernosa, while corpus spongiosum and glans penis are unaffected

True

Management: prostatic massage, sedation, ice packs, bed rest, meperidine, urinary catheterization

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

C

Management: aspiration of corpora cavernosa with large-bore needle

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

C

Urologic emergency

A. Benign prostatic hyperplasia

B. Erectile dysfunction

C. Priapism

C

It is a cytologic study that is effective in detecting precancerous and cancerous cells from the cervix

Pap smear

How are specimens obtained via Pap smear?

1. A speculum is inserted into the vagina and several cell samples from the cervix are obtained with a small brush or spatula.

2. Specimens are placed on a glass slide and sent to the laboratory for examination.

When should a Pap smear be scheduled?

Between menstrual periods so that the menstrual flow does not interfere with the test interpretation

What should be included in the health teaching before a Pap smear?

Teach women not to:

• douche,

• use vaginal medications or deodorants, and

• have sexual intercourse for at least 24 hours before the test