exam 2 - reproductive

ED

inability to maintain or achieve erection

pharm tx → phosphodiesterase - 5 inhibitors (sildenafil, vardenafil, avanafil, tadalafil) - these should be taken prior to sextual activity and they can assist with an erection for a couple of hours. NO NITRATES (unsafe drop in BP).

vasoactive agents (injected into penis prior to sexual activity; alprostadil, papaverine, phentolamine; can cause fibrocystic tissue and priapism (prolonged erection)).

Gel pellet (penial suppository; alprostadil)

surgical tx → semirigid rod (constant firmness), inflatable (inflate prior to intercourse, deflate after)

breast cancer risk factors

female sex, most significant risk is increasing age, BRCA1 and BRCA2 gene mutation (large risk for developing, males can carry), family hx, previous breast condition (benign proliferative breast disease, atypical hyperplasia), radiation exposure, early menarche, late menopause (after age 55), never having a full term pregnancy, first full term pregnancy after age 30, recent contraception use, long term HRT, hx of ovarian or endometrial cancer, obesity, alcohol use, physical inactivity

breast cancer protective factors

maintain healthy weight, engage in regular exercise, limit alcohol, breast food for 1 year or longer, have children, increased risk pts can take medications to decrease risk, encourage screenings (mammogram, self/clinical breast exams)

care after an axillary lymph node dissection

avoid BP, injections, blood draws, IVs on affected arm, use sun protection (at least 15 SPF), apply insect repellent, wear gloves for gardening, use cooking mit when pulling things out of the oven, avoid cutting cuticles, push them back instead, electric razor for shaving underarms, avoid lifting more than 5-10 lbs, avoid tight jewelry, clothing, or elastic bandages on arm, avoid chemical hair removers and avoid cuts/nicks when shaving. if trauma or skin break occurs, use soap and water and apply OTC antibacterial ointment, watch for s/s of infection and report.

complications of a axillary lymph node dissection

lymphedema → impaired lymph drainage after lymph node removal (arm swelling, feeling of heaviness, tightness, decreased ROM, discomfort or aching pain

infection

seroma → collection of lymphatic fluid under the skin

hematoma

decreased shoulder mobility

never injury

recurrent breast cancer tx

local recurrence tx → surgery, radiation, hormonal therapy, chemo; tx is aggressive b/c cure it still possible. recurrence within 2 years of original dx may indicate higher risk for future systemic disease

metastic breast cancer tx

goal is to control disease instead of curing it

hormonal therapy, chemo, targeted therapy, immunotherapy, surgery or radiation

for postmenopausal pts = oophorectomy (surgical removal of ovaries)

monitor for disease progression

nursing mgmt for recurrent or metastic breast cancer

emotional support (encourage expressions of feelings, promote coping strategies, include family in care planning), improve QOL (set realistic goals, prioritize activities, manage sx, maintain independence), referrals (support groups, social work, psychiatry, palliative care), palliative care (relive pain, reduce sx, promote comfort, increase QOL), end of life care (ADRs, pt wishes, goals of care, hospice services

pelvic organ prolapse tx

muscle and ligaments that support the pelvic organs become weak, allowing organs to descend or bulge into the vaginal canal

conservative tx first → pessary (removable device that can be placed in the vagina for support)

pelvic floor muscle training → kegel exercises

biofeedback therapy → functional electrical stimulation, guided muscle training

surgical tx → sacrospinous fixation (repairs weak support structures), hysterectomy

pelvic organ prolapse nursing mgmt

teach wt loss, smoking cessation, avoid heavy lifting, prevent constipation, increase fluid intake, fiber and ambulation, proper pessary care, prevent straining (stool softeners, increase fiber, adequate hydration), provide emotional support

POP risk factors

pregnancy and child birth → large babies, multiple vaginal deliveries, difficult deliveries

aging

menopause (decreased estrogen weakens muscles)

obesity

chronic constipation

chronic cough (smoker, COPD)

perimenopause

the transition period leading up to menopause. Periods become irregular but still occur. Ovaries still produce some estrogen, but levels fluctuate. Fertility is decreasing, but pregnancy is still possible. Usually begins in the mid to late 40s. Can last 4-8 years or longer. Symptoms may include hot flashes, night sweats, mood changes, sleep problems, vaginal dryness, and irregular periods

menopause

the point where menopause is reached. No menstrual period for 12 consecutive months. Ovaries have largely stopped producing estrogen. Natural pregnancy is no longer possible. Usually occurs between 45-52 years old. Menopause itself is a specific point in time; after that, a person is considered postmenopausal. Many of the same symptoms may continue, but periods have completely stopped. 

perimenopause concerns and teaching

Concerns → irregular or unpredictable menstrual periods, hot flashes and night sweats, mood swings, anxiety, or irritability, sleep disturbances, vaginal dryness or painful intercourse, decreased fertility but continued risk of pregnancy, fatigue or difficulty concentrating. 

Teaching → track menstrual cycles and report heavy or abnml bleeding, continue using contraception bc pregnancy is still possible until menopause is reached. Dress in layers and avoid triggers such as caffeine, alcohol, and spicy foods if hot flashes occur. Establish good sleeping habits and keep the bedroom cool at night. Use water-based lubricant for vaginal dryness.  

menopause concerns and teaching

Concerns → complete cessation of menstrual periods for 12 months, hot flashes and night sweats may continue, vaginal dryness and urinary symptoms, increased risk for osteoporosis due to lower estrogen levels, increased risk for CVD, weight gain and changes in metabolism, mood changes and decreased QOL r/t symptoms.  

Teaching → understand that menopause is a normal part of aging and not a disease, increase calcium and vitamin D intake to support bone health, participate in weight-bearing activities like walking or light strength training, follow a heart healthy diet, maintain a healthy weight, schedule regular health screenings, report any vaginal bleeding after menopause.  

breast bx - fine needle aspiration

removes cells or fluid from the breast mass using a needle. 

breast bx - ultrasound guided breast bx

used for lesions visible on ultrasound. Needle guided by ultrasound and titanium clip is placed at site.

breast bx - stereotactic breast bx

used for macrocalcifications or lesions not seen on ultrasound. Breast compressed between x-ray plates and a computer-guided needle obtains tissue samples; titanium clip is placed.  

breast bx - MRI guided bx

used when lesions cannot be seen on mammograms or ultrasound. 

breast bx - surgical bx (lumpectomy)

removes the entire lesion when needle biopsy is not possible. May follow wire placed during mammogram

nursing considerations for breast bx

Assess for psychosocial issues and fears of patient, discontinue anticoagulation, NPO: length depending on surgeon and procedure, assess for bleeding and pain steri-strips in place for 7-10 days, wear supportive bra

surgical interventions for breast CA - lumpectomy

breast conserving surgery

tumor and small margin of normal tissue around tumor is removed followed by 5-7 weeks of radiation therapy. Good prognosis. It also may include lymph node removal if invasive cancer is present. 

surgical interventions for breast CA - simple (total) mastectomy

entire breast and nipple-areola complex is removed, axillary lymph nodes are not removed

surgical interventions for breast CA - modified radical mastectomy

entire breast, nipple-areola complex and some axillary lymph nodes are removed, the pectoralis major and minor muscles stay. Used for invasive breast cancer

surgical interventions for breast CA - radical mastectomy

entire breast, axillary lymph nodes and pectoralis major and minor muscles are removed.  

surgical interventions for breast CA - sentinel lymph node bx

determines weather the cancer has spread to the lymph nodes. Dye is injected near the tumor, it may travel to the first draining lymph nodes (sentinel nodes) and those nodes will be biopsied. 

complications of surgical interventions for breast CA - lymphedema

swelling caused by impaired drainage after lymph nodes removal, especially after an axillary lymph node removal.  

Nursing interventions → measure and assess arm, refer to lymphedema specialist, encourage prescribed exercises, teach arm protection measures, encourage manual lymphatic drainage if indicated. No BP, IV, blood draws or injections on effected arm. Teach pt to avoid tight clothing, jewelry, trauma to arm and lifting (5-10 lbs)  

complications of surgical interventions for breast CA - hematoma

collection of blood in the surgical cavity. Occure within the first 12 hours after surgery.  

Nursing interventions → assess site, monitor drainage output, notify surgeon if rapid swelling, excessive bleeding, or increased bloody drainage.  

complications of surgical interventions for breast CA - seroma

a collection of clear fluid under the incision or in the axilla.  

Nursing interventions: assess drain patency, monitor swelling, notify surgeons if symptoms worsen.  

complications of surgical interventions for breast CA - infection

Nursing interventions → assess site, teach patient signs of infection (redness, warmth, tenderness, purulent or foul-smelling drainage, fever, chills), encourage hang hygeine, report symptoms promptly.  

fistula

an abnormal passageway between two internal organs or an internal organ and the outside of the body. 

rectovaginal fistula

between the rectum and the vagina. Results in fecal matter leaking through vagina, passage of gas through the vagina, and fecal incontinence, pain with intercourse, frequent infections, decreased libido  

vesicovaginal fistula

between the bladder and the vagina. Urinary leakage through the vagina, urinary incontinence, frequent UTI’s 

anal fistula

between anal canal and skin around the anus, common cause is an anal abscess. May be associated with cancer and should be evaluated.  

sx of fistulas

urinary or fecal incontinence, malodorous drainage, vaginal d/c, recurrent UTIs, pelvic pain, perineal irritation, skin breakdown

assessment and nursing mgmt for fistulas

Assessment → ask about childbirth injuries, recent surgery, radiation therapy, Chorns disease, diverticular disease, cancer hx. Inspect genital area, assess for drainage, check for skin breakdown, evaluate odor and appearance of d/c.  

Nursing management → encourage good perineal hygiene, frequent pad changes, regular sitx baths, keep area clean and dry. Teach skin care (assessing for redness, skin breakdown, irritation, etc.). Teach to monitor for infection (fever, increased drainage, faul odor, pain, s/s of UTI)

tx for prostate CA - radical prostatectomy

entire prostate gland, seminal vesicles and surrounding tissues, nerves lymph nodes and vessels are removed. Standard first line treatment.  

tx for prostate CA - radiation therapy

radiation directed at prostate from outside of body. Treatment 5 days/week for 6-8 weeks.  

tx for prostate CA - brachytherapy

80-100 radioactive seeds are implanted into prostate. Educate to avoid prolonged close contact with infants and pregnant women.  

tx for prostate CA - hormonal therapy

reduce testosterone levels and slow cancer growth is the goal.  

complications of tx for prostate CA

Hemorrhage 

Infection 

DVT 

Obstructed catheter: blocked catheter -> bladder distension -> pressure on surgical site -> hemorrhage  

Sexual dysfunction (ED)

syphilis

Symptoms →

• primary syphilis is about 2-3 weeks after infection, chancre (painless, round, firm, usually a single lesion, appears at site of inf.) is the classic finding.

• Secondary syphilis happens about 2-8 weeks after chancre appears: rash on trunk, arms and legs, palms of hands, soles of feet.

• Latent syphilis: there are no symptoms.

• Tertiary syphilis happens years after infection and is a progressive inflammatory disease.

• General s/s: Chancre, lymphadenopathy, arthritis, meningitis, hair loss, fever, malaise, weight loss.

• Untreated: inflammation aorta, neuro complications (dementia, stroke, psychosis, meningitis) 

Causes → caused by spirochete bacterium Treponema pallidum. Transmission is sexual contact, contact with lesions, congenital transmission (parent to fetus)   

Nursing management →administer prescribed abx, teach to avoid sexual activity until tx is completed, notify sexual partners, use condoms, complete all prescribed tx.  

chlamydia

Symptoms → women may be asymptomatic (silent infection) or have cervical mucous. Men are more likely to have sx: burning with urination and d/c  

Cause → caused by bacteria chlamydia trachomatis  

Complications →

• females: PID (infection spreads upward through reproductive tract causing chronic pelvic pain, scarring and infertility), ectopic pregnancy, endometriosis, infertility.

• Men: epididymitis (inflammation of the epididymis that cause testicular pain, swelling, tenderness – can lead to infertility)  

Nursing management → first line tx is doxycycline. Azithromycin may be used. Teach pt to abstain from sex for 1 week after tx, ensure sexual partners are treated, use condoms, limit number of partners, complete all prescribed medications.  

gonorrhea

Symptoms → women may have UTI or vaginitis, men may have swollen testicles  

Cause → caused by bacteria Neisseria gonorrhoeae 

Complications →

• females: PID (infection spreads upward through reproductive tract causing chronic pelvic pain, scarring and infertility), ectopic pregnancy, endometriosis, infertility.

• men: epididymitis (inflammation of the epididymis that cause testicular pain, swelling, tenderness – can lead to infertility)  

Nursing management → first line tx is ceftriaxone IM (single dose). Teach pt to abstain from sex for 1 week after tx, ensure sexual partners are treated, use condoms, limit number of partners, complete all prescribed medications. Can also cause septic arthritis and bloodstream infections.  

herpes simplex virus

Symptoms → HSV-1: oral herpes (cold sores), HSV-2: genital herpes. General s/s: pain, itching, redness, macules (flat marks) to vesicles (fluid filled blisters), ulcers, crusting lesions, flu-like sx after blisters appear  

Cause → caused by herpes simplex virus  

Complications → extragenital spread (can spread to buttocks, thighs, eyes – prevent by washing hands after touching lesions), neonatal transmission.  

Nursing management → no cure exists for HSV, ts focuses on reducing sx, shortening outbreaks, preventing transmission and reducing reoccurrences. Treated with acyclovir, valacyclovir, famciclovir. Teach to take antivirals as prescribed, wash hands after touching lesions, avoid touching eyes after lesion contact, inform sextual partners, use condoms, recognize recurrence triggers. Education on prevention