8 Reproductive

Recognizing Cues: Assessment

• Respect & Dignity: Ensure patients are treated respectfully

  • Acknowledge the sensitivity surrounding reproductive topics

  • Cultural & religious beliefs may impact comfort levels

    • Ex. Female Muslim pts may prefer female healthcare providers

• Patient History: Gather comprehensive medical history

• Chronic Conditions: Review any chronic medical issues

  • Inquire about chronic conditions

    • Anorexia which may impact menstrual cycles

• Reproductive Screenings: Assess previous screenings

  • Assess history of reproductive screenings (e.g., Pap smears, mammograms) and their timing

  • Importance of screenings for early detection of cancers and other conditions

• Medications: Document current medication regime

  • Assess medication use, especially antihypertensives, which can lead to erectile dysfunction in males

• Family History: Understand family medical background

  • Document any family history of reproductive cancers and infertility issues

  • Menopause scenarios; daughters may inherit timelines related to their mothers

• Current Problems: Focus on presenting symptoms

  • Identify current reproductive issues presented by patients (e.g., pain, unusual discharges)

  • For females, inquire about menstrual issues or pelvic pain

  • For males, check for testicular masses or any unusual growths

• Pain: Evaluate any pain experienced by the patient

• Discharge Planning: Outline post-care requirements

• Masses: Identify any observable masses

Diagnostic Studies: Laboratory

Papanicolaou Test (Pap Smear)

• Essential for cervical cancer screening, can be performed annually or every 3 years depending on results

  • If screening is abnormal = typically 6 months routine check up

  • Typically at 21 years old or within 3 years after sexual intercourse

• Cells collected from cervix to detect abnormalities

• Education: Advise scheduling between menstrual cycles

  • **At least a week after the cycle**

• Pre-Test Instructions: No intercourse, douching, or vaginal creams/powders 24 hours prior

• During a pap, you can test for HPV

Human Papillomavirus (HPV) Test

• HPV = changes the cells in the cervix

  • Most common cause of cervical cancer

• Detects DNA for high-risk HPV, identifying cancer risk

  • Cervical screening tool

• Does not replace Pap test; should be used in conjunction

• Negative Result Implications:

  • No abnormal cells seen

  • Normal pap & negative HPV = low risk of cervical cancer

  • Very low risk for pre-cancer or cancer in next 5-10 years

• Abnormal pap & positive HPV = high risk

Diagnostic Studies: Imaging

Mammogram

• X-ray of breast tissue assessing density and screening for breast cancer

• Preparation/Education: No lotions, powders, or deodorants before test

  • Shouldn’t test during the menstrual cycle, as breast tissue may be more sensitive and can affect the accuracy of the results

• Age Recommendations:

  • Start at age 40, annual between 45-54, every other year 55+

  • FDA says “Pts must know if their breast tissue is dense or not”

Ultrasonography

• Used for evaluating breast masses and examining reproductive organs such as the uterus and ovaries

• Can assess:

  • Breast

  • Uterine fibroids

  • Cysts

  • Masses

  • Prostate

  • Scrotal

  • Rectal

  • Testicular

Benign Breast Disorders

• Can impact both men & women

• Common Conditions:

  • Fibroadenoma = common benign tumor, typically found in their 20s and 30s

    • Solid rubbery mobile mass

    • Not associated w/ breast cancer

  • Fibrocystic Breast Changes = affected by the menstrual cycle, causes breast tenderness & lumpy texture; not cancerous

    • Women ages 20-50

    • Pain = can come and go

    • Associated w/ hormonal imbalance (elevated estrogen levels)

    • Diagnosis = ultrasound

    • Treatment

      • analgesics

      • supportive bra

      • heat/cold therapy

      • decrease caffeine intake

  • Gynecomastia = enlargement in the breast tissue in men, often temporary & can be caused by hormones or certain medications

    • Can happen from young boys to older men

    • Spiraldactone: a medication that can be used to treat gynecomastia by blocking certain hormones that contribute to breast tissue growth

    • Pyschosocial — not wanting to take off their shirt

Vaginal and Uterine Disorders

The Menstrual Cycle Terminology

• Menstruation = menstrual cycle

  • Menses = time between each period

  • Menstrual Period = time between the periods

  • Cycle = menstrual period

  • Period

• Menarche = first period ever

• Perimenopause = transition into menopause

• Menopause = the end of menstruation and fertility, typically occurring between the ages of 45 and 55

  • Avg. 51

  • Period must be gone for 20 consecutive months

• Normal = ~28 days

• Bleeding = 5-7 days

Leiomyomas (Fibroids)

• Benign tumors of uterine muscle

• S/S:

  • Painful intercourse (dyspareunia)

  • Heavy vaginal & menstrual bleeding

  • Heavy cramping

  • Pelvic pressure

  • Issues w/ constipation

  • Doesn’t feel like they are fully emptying their bladder while peeing

• Diagnostics

  • Ultrasound — transvaginal ultrasound

  • Labs

    • H/H

  • Endometrial biopsy = a probe that comes up the tissue to test for cancer

• Management/Treatment includes:

  • Uterine artery embolization = a minimally invasive procedure that blocks blood flow to fibroids, causing them to shrink

    • uterus preserving surgeries

    • quick recovery

    • can experience a lot of cramping

  • Myomectomy = removes uterine fibroids

    • uterus preserving surgeries

  • Hysterectomy = a surgical procedure that involves the removal of the uterus

    • No longer will have periods or kids

    • Fibroids won’t come back

    • Can be done = vaginally, laparoscopically, abdominally

Types of Hysterectomies

• Types:

  • Total Hysterectomy = removal of the entire uterus along with the cervix

  • Partial Hysterectomy = removal of the upper part of the uterus while leaving the cervix intact

  • Radical Hysterectomy = removal of the uterus, cervix, part of the vagina, and surrounding tissue, often used to treat certain types of cancer

  • Salpingo-oophorectomy (removal of ovaries) = surgical procedure that may be performed alongside hysterectomy to address ovarian disease or reduce cancer risk

Hysterectomy Nursing Care

• Preoperative Care:

  • Education on procedure

  • Medications

    • Hold anticoagulants & antiplatelet meds

  • Psychological assessments

    • Misconceptions of thinking they’re a man

• Postoperative Care:

  • Early ambulation

  • Assess incisions

  • Bleeding expectation

    • They won’t have a period anymore

    • Will have a pad on and bleeding should be minimal

  • Elimination

    • no straining

    • order stool softeners

  • Address activity levels — limited

    • Limit stair walking — once a day

    • Don’t sit for long periods of time

    • No driving until cleared by doc

  • Address sexual activity

    • 6 weeks no sexual activity

Pelvic Organ Prolapse (POP)

• Where one or more pelvic organs fall down or slip out of place

  • Caused by:

    • Childbirth and increased abdominal pressure

  • Diagnostics include pelvic exams and ultrasounds

• Types include:

  • Uterine prolapse = uterus protruding into the vagina

    • Caused by weakening of the pelvic floor muscles & ligaments

  • Cystocele = protrusion of the bladder through the interior vaginal wall

    • can lead to UTIs and stress incontinence

  • Rectocele = protrusion of the rectum in the posterior vaginal wall

    • Can lead to constipation & hemorrhoids

• Risk Factors

  • Childbirth

  • Pregnancy

  • Obesity

  • Chronic constipation

  • Decreased estrogen

• Treatment

  • Kegel exercises

  • Intravaginal estrogen

  • Surgical repair

Surgical Management of Uterine Prolapse

• Approaches:

  • Transabdominal repair

  • Reconstructive surgery

• Post-surgical advice includes avoiding strain and heavy lifting

Benign Prostatic Hyperplasia (BPH)

• Non-malignant enlargement of prostate tissue causing urethra obstruction

• Think “big prostate that holds back urine”

• Common disorder in older men

• Complications include obstruction, recurrent UTI

• Symptoms

  • Urinary frequency

  • Urinary incontinence

  • Urinary urgency

  • Urinary retention

  • Post-void dribbling

  • Hematuria

  • Frequent UTIs

• Diagnostics

  • Digital Rectal Exam (DRE) = provider inserts a finger into the rectum & palpates the prostate gland through the rectal wall & checks for enlargement

  • PSA test = a blood test that measures the level of prostate-specific antigen in the blood, which can indicate prostate abnormalities

    • expected to be under 4

    • >4 = potential indication of prostate cancer or other prostate issues, necessitating further evaluation

  • Cystoscopy = a procedure that allows a provider to examine the bladder and urethra using a thin, lighted tube called a cystoscope, which is inserted through the urethra

• Clinical Manifestations

  • Increased frequency

  • Urinary urgency

  • Weak urine stream

  • Fatigue

  • Hematuria

• Nursing Implications

  • Provide privacy and adequate time for urination

  • Monitor intake/output

• Treatment

  • Alpha-Adrenergic Antagonists:

    • Tamsulosin (Selective)

      • TeraSLOWWsin = teach slow position due to orthostatic hypotension

      • Avoid BP meds

        • Ex. Viagra

      • Good w/ grapefruit juice

    • Terazosin (Non-selective)

      • TeraGOsin = Helps the pt go pee

  • 5-Alpha-Reductase Inhibitors:

    • Finasteride

      • Think Fun Ride

    • Dutasetide = for prostate shrinkage

  • TURP surgery

Transurethral Resection of the Prostate (TURP)

• A minimally invasive surgery that removes inner prostate core to facilitate urine flow

• Not gonna cure BPH, just a treatment

• Post-op Care

  • Monitor for complications

  • Manage bladder irrigation

  • Administer analgesics

• Discharge Teaching

  • Emphasize fluid intake

  • Pelvic floor exercises

  • Avoiding heavy lifting

  • Monitoring urinary function

Calculating Intake & Output (I&O)

• Critical measurement for patient management; track irrigation and urinary output

• Ex.

  • Intake 3,000 mL irrigation solution

  • Output 3,800 ml ouput in drainage bag

  • 800 mL

Sexually Transmitted Infections (STIs)

Syphilis

• Complex STI with systemic potential

• Diagnostic tests include antibody assays

• Stages of Syphilis

  • Primary (localized)

  • Secondary (systemic)

  • Tertiary (late-stage)

  • Neurosyphilis symptoms can appear at any stage

• Treatment

  • Penicillin and follow-up with additional tests

Genital Herpes

• Common viral infection treated with antivirals (acyclovir)

Human Papillomavirus (HPV)

• Most common STI with various strains; associated with cancers

• HPV Shot = Gardasil 9: Recommended for children aged 11-12 to prevent cancers associated with HPV