Reproductive

WEEK 14: NURSING CARE OF PATIENTS WITH REPRODUCTIVE DISORDERS

CLASS ACTIVITY – DUE DECEMBER 1ST

• Reflection on Inclusivity in Caring for Transgender Patients

  • Reflect on specific ways to improve inclusivity and approach to caring for transgender patients.

  • Consider current roles as a student, future RN, and future APRN.

• Evidence-Based Practice (EBP) Assignment

  • Choose a reproductive disorder from this week's lecture.

  • Design a PICO(T) question that will impact client care.

  • Reference material from week 7's EBP lecture.

CONDITIONS OF THE BREAST

BENIGN CONDITIONS OF BREASTS & MANAGEMENT

• Mastalgia

  • Two types: Cyclical and Non-cyclical

  • Management Strategies:

  • Supportive bra

  • Eliminate caffeine and lower fat intake

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Natural therapies

  • Danazol and Tamoxifen

• Breast Cysts

  • Description: nonproliferative breast lesions, fluid-filled, round masses

  • Symptoms: Enlargement associated with severe, localized pain

• Fibroadenomas

  • Description: Proliferative lesions without atypia

  • Characteristics: Firm, round, movable, benign tumors

  • Diagnostic Method: “Triple test” which includes exam, imaging, and biopsy

• Atypical Ductal Hyperplasia

  • Description: Abnormal growth of ductal cells that does not meet criteria for Lobular Carcinoma In Situ (LCIS)

• Lobular Carcinoma In Situ (LCIS)

  • Description: Abnormal proliferation of breast cells

  • Diagnostic Consideration: Not visible on mammogram or palpable mass

  • Significance: Marker for increased risk for invasive cancer

  • Management options: Prophylactic mastectomy, increased surveillance, chemoprevention

COMPARISON OF VARIOUS BREAST MASSES

• The most common breast masses stem from cysts, fibroadenomas, or malignancy. Biopsy typically needed for confirmation.

  • Diagnostic Clues from Table 33-1:

  • Cysts

    • Age: 30-55 years of age, regress after menopause except with estrogen therapy

    • Characteristics: Usually round and mobile, soft to firm, elastic, usually tender

  • Fibroadenomas

    • Age: Puberty to menopause

    • Characteristics: Typically single, mobile, firm, and non-tender

  • Malignancy

    • Age: 30-90+ years of age, common in postmenopausal years

    • Characteristics: Usually single, irregular or stellate, firm or hard, may be fixed to skin or tissues, usually nontender

BREAST CANCER AND SCREENING GUIDELINES

American Cancer Society® Recommendations

• Ages 40 - 44

  • Women should have the choice to start annual breast cancer screening with mammograms if they wish.

• Ages 45-54

  • Women should get mammograms every year.

• Age 55 and older

  • Women can transition to mammograms every two years or continue yearly screening, as long as they are in good health and expected to live for at least 10 more years.

DIAGNOSING BREAST CANCER

• Mammogram

  • Considerations: Discomfort may occur from the squeezing of plates; avoid scheduling exam during the week before menstruation.

• Ultrasound

• MRI

• Breast Biopsy

NURSING MANAGEMENT POST-DIAGNOSIS

• Increased early detection and improved treatment modalities lead to increased survivor rates.

• Long-term effects may include:

  • Sexual issues

  • Menopausal symptoms: hot flashes, vaginal dryness, recurrent UTIs, weight gain, decreased libido, increased osteoporosis risk, fatigue, and sleep issues

  • Concerns regarding body image and follow-up surgeries including reconstructive surgery, tissue expander, and implants

  • Lymphedema precautions

  • Coping mechanisms for potential recurrence of disease

  • Support through groups, psychiatry, social work, and palliative care

QUESTION EXAMPLE

• A patient presents with a recently identified lesion on her left breast that is mobile, soft, and elastic with moderate tenderness. What is the most likely diagnosis?

  • Options:

  • A) Breast cancer

  • B) Fibroadenoma

  • C) Breast cyst (Correct Answer)

  • D) Dysmenorrhea

ANSWER/RATIONALE

• Correct Answer: C) Breast cyst

  • Description: Cysts are usually soft to firm lesions with elastic consistency and may be tender.

  • Fibroadenomas are generally firm, mobile lesions that are nontender.

  • Breast cancer typically presents with a firm or hard lesion that is fixed and nontender.

  • Dysmenorrhea refers to painful menstruation, not breast lesions.

FEMALE TYPICAL REPRODUCTIVE DISORDERS

MENSTRUAL DISORDERS

• Amenorrhea: Absence of menses

  • Primary Causes:

  • Hypothyroidism

  • Turner syndrome

  • Pituitary disorders

  • Hyperandrogenism

  • Disorders of sexual development

  • Anatomic abnormalities, in utero exposure to DES

  • Secondary Causes:

  • Weight loss

  • Eating disorders

  • Pregnancy

  • Certain types of contraceptives

  • Female athlete triad

• Dysmenorrhea: Painful menses

  • Primary Dysmenorrhea:

  • Excessive prostaglandin production leading to increased contractions of the uterine lining muscle

  • Secondary Dysmenorrhea:

  • Associated conditions like endometriosis, fibroids, pelvic infection

  • Related to IUDs, congenital anomalies, ovarian cysts, tumors

COMPARING PRIMARY/SECONDARY DYSMENORRHEA

• Primary Dysmenorrhea

  • Pain: Sharp, intermittent

  • Timing: Begins with menarche

  • Age of Onset: At menarche

  • Additional Symptoms: Headache, fatigue, backache, dizziness, nausea, diarrhea, constipation

• Secondary Dysmenorrhea

  • Pain: Recurrent crampy, suprapubic

  • Timing: Symptoms begin earlier in cycle and last longer

  • Age of Onset: Between 30 and 40 years

  • Additional Symptoms: Change in bowel habits, rectal pressure, painful defecation, dyspareunia

ABNORMAL UTERINE BLEEDING

• Definition: Bleeding deviating from normal pattern

• Causes:

  • Coagulation disorders

  • Unopposed estrogen

  • Liver diseases

  • Cushing syndrome

  • Addison’s disease

  • Thyroid disorders

  • Polycystic ovarian syndrome

  • Weight fluctuations

  • Excessive exercise

  • Pelvic infections, endometriosis, trauma, tumors/lesions

• RN management includes:

  • Vital signs: Monitor orthostatic blood pressures, heart rates, body mass index

  • Pad counts to assess bleeding

  • Characteristics of flow assessment

  • Assistance with Pap Smears or Pelvic Ultrasounds

  • Treatment: Hormonal contraception

PREMENSTRUAL SYNDROME (PMS) AND PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

• PMS: Cluster of behavioral, emotional, and physical symptoms

• PMDD: More severe form of PMS

  • Over 100 physical, behavioral, and cognitive symptoms reported

  • Management:

  • Keep a menstrual cycle diary

  • Treatments include oral contraceptives, SSRIs/SNRIs, NSAIDs

  • RN Management: Lifestyle modifications (exercise, dietary changes, stress reduction)

VULVOVAGINAL INFECTIONS

• Candidiasis:

  • Description: Yeast infection

  • Risk Factors:

  • Broad-spectrum antibiotics

  • Exogenous hormones, corticosteroids

  • Pregnancy

  • Uncontrolled diabetes, obesity, sugary diet

  • New sexual partners/increased sexual activity

  • Symptoms: Vulvar pruritus, dysuria, pain with intercourse, thick white odorless discharge

  • Diagnosis: Wet mount

  • Treatment: Topical antifungals

• Bacterial Vaginosis (BV)/Gardnerella:

  • Description: Decreased lactobacilli

  • Risk Factors: New/multiple sex partners, douching, retained foreign body, coexisting STIs

  • Untreated Risks: Premature labor, post-abortion endometritis, infection post-hysterectomy

  • Symptoms: Often asymptomatic; foul discharge

  • Diagnosis: Clue cells in a wet mount, whiff test, elevated vaginal pH

  • Treatment: Metronidazole intravaginally (avoid alcohol)

RN MANAGEMENT OF VULVOVAGINAL INFECTIONS

• Educate on avoiding high-risk behaviors (multiple partners, unprotected intercourse)

• Promote proper hygiene, including perineal care and cleaning of sex toys

• Encourage adherence to medication therapy

• Support diabetes management for patients with diabetes

PROLAPSE

• Definition: Muscle weakening or increased pressure/damage to abdomen and pelvic floor

• Types of Prolapse:

  • Cystocele: Herniation of bladder into anterior vagina

  • Rectocele: Extrusion of rectum into posterior vagina

  • Enterocele: Descent of small intestine into vaginal vault

  • Uterine Prolapse: Downward displacement of uterus into vagina

  • Vault Prolapse: Top of vagina prolapses post-hysterectomy

SYMPTOMS AND MANAGEMENT OF PROLAPSE

• Common Symptoms: May be asymptomatic, “bulge” in vaginal area, back pain, urinary incontinence, difficulty during bowel movements

• Prevention: Core/abdominal muscle strengthening

• Treatment: Depends on severity

  • Mild uterine prolapse: Pessary first-line treatment

  • Non-surgical: Pelvic floor rehabilitation (Kegel exercises, biofeedback)

  • Surgical: Reconstructive pelvic surgery targeted at repairing ligaments and support structures

  • Patient Education:

  • Weight loss

  • Smoking cessation

  • Avoid heavy lifting

  • Proper care for pessary devices

  • Avoid unnecessary straining/constipation

BENIGN DISORDERS: OVARIAN CYSTS

• Description: Form due to hormonal influences

  • Functional Cysts: Simple cysts, usually harmless

  • Treatments include NSAIDs; suppression of follicle-stimulating hormone (FSH)

  • Non-Functional Cysts: Endometriomas (chocolate cysts) or dermoid cysts

  • Description: Develop from sloughed-off endometrial tissue, brown in appearance, may contain hair, teeth, etc.

  • Diagnosis: Pelvic ultrasound after missed menstrual cycle; considerations for surgery with cysts that rupture.

BENIGN DISORDERS: POLYCYSTIC OVARIAN SYNDROME (PCOS)

• Description: Involves multiple cysts due to chronic anovulatory cycles and hyperandrogenism

• Most Common Endocrine Disorder: Androgen excess and insulin resistance leading to lack of ovulation

• Risks: Increased risk for Type II Diabetes Mellitus, acne, endometrial cancer, hyperlipidemia, obesity, hirsutism, and infertility.

• Management Focus: Address primary concerns such as acne, infertility, obesity

  • Education: Exercise, low-fat diet, weight loss

  • Medication: Metformin (for insulin resistance) and combined oral contraceptives for regulating menstrual cycle

BENIGN DISORDERS: UTERINE FIBROIDS

• Description: Benign growths of the uterus

• Risk Factors: African American, overweight, and increasing age

• Symptoms: Heavy menstrual bleeding, possible infertility, often asymptomatic

• Diagnosis: Pelvic ultrasound

• Treatment: Hormonal suppressants, surgical options like hysterectomy, myomectomy, embolization, or cryoablation

BENIGN DISORDERS: ENDOMETRIOSIS

• Definition: Chronic inflammation of endometrial tissue outside of uterine cavity

• Symptoms: Persistent pelvic pain, scarring, infertility; low back pain, dysuria, pain with defecation, dysmenorrhea

• Treatment:

  • NSAIDs

  • Combined oral contraceptives to suppress ovulation

  • Surgery (last line; adhesion lysis and possible hysterectomy)

CANCER OF THE CERVIX

• Overview: Most common reproductive cancer among women; second most common cancer overall

• Risk Factor: Human papilloma virus (HPV) linked to 70% of cervical cancers

• Recommendations for HPV Vaccine: Administered to males and females aged 11 to 12, up to age 26 for females, and 21 for males

CANCER OF THE CERVIX SCREENING AND TREATMENT

• Pap Smear: Most effective preventative measure

• Diagnosis: Colposcopy and directed biopsy for suspicious Pap test results

• Treatment Options:

  • Cold knife conization

  • Loop electrosurgical excision procedure (LEEP)

  • Radical hysterectomy

  • Chemotherapy

  • Pelvic radiation

• Role of Nurses: Educating about disease and promoting HPV screening

MALE TYPICAL DISORDERS

ERECTILE DYSFUNCTION (ED)

• Definition: Inability to achieve or maintain an erection sufficient for sexual activity.

• Prevalence: Affects up to 50% of men aged over 40.

• Causes:

  • Psychogenic: anxiety, fatigue, depression

  • Organic: vascular disease, endocrine disorders, medications, etc.

• Diagnosis Methods: History, physical exam, nocturnal penile tumescence tests

ERECTILE DYSFUNCTION (ED) TREATMENT

• Medical: Therapy for associated conditions, sexual therapy

• Medications:

  • Phosphodiesterase-5 inhibitors: Sildenafil citrate (Viagra)

  • Vasoactive medications: Alprostadil (direct injection)

• Surgical Options: Penile implants (semirigid or inflatable)

• Nursing Care: Empathic communication, referrals for therapy as needed

PROSTATITIS

• Definition: Inflammation of prostate gland

• Most Common Cause: E. Coli

• Symptoms: Perineal discomfort, dysuria, urgency, nocturia, fever, chills

• Complications: Retention, epididymitis, bacteremia

• Diagnosis: History, urine sample with elevated WBC, digital rectal exam (DRE) for chronic evaluation

• Treatment: Analgesics, antibiotics, sitz baths, stool softeners

• Nursing Management: Comfort measures, hydration, educating on preventive care

BENIGN PROSTATIC HYPERPLASIA (BPH)

• Risk Factors: Smoking, alcohol use, hypertension, diabetes

• Symptoms: Frequent urination, nocturia, urgency, weak stream

• Diagnosis: DRE shows a large, rubbery prostate

• Treatment Options:

  • Catheterization (Coude catheter)

  • Alpha-adrenergic blockers

  • 5-alpha-reductase inhibitors

  • Herbs with caution

CANCER OF THE PROSTATE

• Risk Factors: Age, family history, diet low in red meat/high-fat, African American men

• Symptoms: Often asymptomatic in early stages; as it progresses, may show signs similar to BPH

• Screening: Digital rectal examination (DRE), prostate-specific antigen (PSA)

• Diagnosis: Confirmation through biopsy

• Treatment:

  • Radical prostatectomy, radiation therapy, hormone therapy for advanced stages

  • Drugs include leuprolide (hormonal suppressors) and flutamide (antiandrogens)

CONDITIONS IMPACTING THE TESTES

• Orchitis: Inflammation of the testes, often due to infection (e.g., Chlamydia)

  • Symptoms include pain and swelling in scrotum, dysuria

  • Treatment includes rest, antibiotics, pain management

• Hydrocele: Fluid collection around the testis

  • Diagnosed by transillumination; surgical intervention if symptomatic

• Varicocele: Dilation of scrotal veins, potential infertility

  • Treatment only if painful or affecting fertility; often resolved via microsurgery

• Testicular Cancer: Common cancer in younger males, average diagnosis age is 33.

  • High cure rate if treated early; symptoms include painless enlargement or mass on testis

  • Diagnosis via self-examination, tumor markers, imaging studies, and biopsy

  • Treatment involves orchiectomy, chemotherapy, possible radiation

CONDITIONS AFFECTING THE PENIS

• Phimosis: Inability to retract foreskin; may require circumcision

• Priapism: Prolonged erection, a urologic emergency

  • Treated via venous drainage to alleviate ischemia

QUESTIONS?