Nursing Care of Women With Reproductive System Disorders - Chapter 42 (Williams & Hopper)
Chapter Concepts
Health Promotion
Family
Self
Reproduction and Sexuality
Benign Breast Disorders
Cyclic breast discomfort
Fibrocystic breast disease
Mastitis
Breast Cancer
Risk factors
Age
Black, Asian, Hispanic
Personal or family history
Overweight or obese
High alcohol intake
Smoking
Estrogen replacement therapy
Early menarche
Late menopause
First pregnancy after 30
Low vitamin D level
Eating grilled meats
Low intake of fruits and veggies
Certain garden chemical exposure
Signs and symptoms
Lump or thickening
Dimpling
Clear or bloody discharge
Swelling
Tenderness
Discoloration
Prevention
Caution regarding fat intake, alcohol intake, hormone use
Breastfeeding
Exercise
Early identification
Diagnostic tests
Breast self-examination
Clinical breast examination
Mammography
Biopsy
Therapeutic interventions
Lumpectomy
Mastectomy (Partial, Simple, Radical)
Radiation
Chemotherapy
Hormonal therapy
Targeted therapies
Immunotherapies
Mastectomy reconstruction (conceptual)
Blood vessel–skin flap approaches; latissimus dorsi muscle flap; rectus muscle–skin flap; skin flaps; incisions and scars
Nursing Diagnoses for mastectomy
Risk for Ineffective Peripheral Tissue Perfusion
Acute Pain
Risk for Ineffective Coping
Cue Recognition 42.1: scenario overview
12 hours post bilateral mastectomy with increasing right-sided pain
Actions include data gathering, inspect sites, check drains, leave dressings unless ordered
Cue Recognition 42.1: rationale
Drains can become obstructed leading to hematoma and increased pain; infection unlikely within 12 hours
Other breast modification surgeries
Mammoplasty
Breast reduction
Mastopexy
Augmentation
Reconstruction
Breast Reduction (illustrations in notes)
Skin removed and areola moved; tissue removal details
Breast Implants
Subglandular implant (above chest muscle)
Submuscular implant (between chest muscles)
Menstrual Flow/Cycle Disorders
Disorders include: Amenorrhea, ext{ Hypermenorrhea}, ext{ Hypomenorrhea}, ext{ Menometrorrhagia}, ext{ Menorrhagia}, ext{ Oligomenorrhea}, ext{ Polymenorrhea}
Diagnostic tests
Pap smear
Endometrial biopsy
Cultures
Laparoscopy
Ultrasound
Pregnancy testing
Urine and blood testing
Therapeutic interventions
Dilation and curettage (D&C)
Laser ablation
Hysterectomy
Nursing care
Weigh pads (1 g = 1 mL)1 ext{ g} = 1 ext{ mL}
Teach regarding D&C
Dysmenorrhea
Definition: painful menstruation
Primary
Secondary
Diagnostic tests
Hormone levels
Laparoscopy
Imaging studies
Biopsy
Cultures
Interventions
Aspirin
NSAIDs
Hormone replacement
D&C
Correct underlying cause
Education and self-care
Regular exercise
Stress management
Heating pad or warm bath
Knee-chest position for retroversion
Premenstrual Syndrome / Premenstrual Dysphoric Disorder
Signs and symptoms of PMS
Water retention
Headache
Discomfort
Change in affect
Change in concentration
Signs and symptoms of PMDD
Depression
Irritability
Mood swings
Feelings of hopelessness
Suicidal thoughts
Interventions
Medications: NSAIDs, ext{ Contraceptives}, ext{ Antidepressants}, ext{ Diuretics}, ext{ Supplements}
Exercise
Stress management
Limitation of: ext{Alcohol, Caffeine, Nicotine, Salt, Simple sugars}
Nursing care
Have an understanding attitude
Collaborate with RN to teach lifestyle measures
Follow up if thoughts of suicide
Endometriosis
Definition: endometrial tissue outside the uterus
Signs and symptoms
Pain
Swelling
Organ damage
Scar tissue
Infertility
Interventions
Surgical intervention
Estrogen reduction (medications or oophorectomy)
Analgesics
Relaxation exercises
Heat to abdomen or back
Endometriosis sites (illustrated in slides)
Umbilicus, Uterine wall, Ovary, Pelvic colon, Scar on abdominal wall, Anterior cul-de-sac and bladder, Vulva, Perineum, Posterior cul-de-sac, Rectovaginal septum
Education and pain relief (with RN)
Alternative pain relief measures: relaxation, heat
Menopause
Perimenopause signs and symptoms
Erratic menses
Tissue atrophy
Decreased lubrication
Hot flashes
Night sweats
Mental changes
Treatment approaches
Hormone replacement therapy (HRT)
Dietary phytoestrogens
Calcium/vitamin D supplementation
Dress in layers
Vaginal lubricant
Healthy diet
Inflammation of the Vagina and Vulva
Overgrowth of organisms
Candidiasis
Bacterial vaginosis
Cytolytic vaginitis
Trichomoniasis
Contact vulvovaginitis
Atrophic vaginitis
Signs and symptoms
Itching
Burning
Discharge
Foul odor
Redness
Medications and routes
Antifungal agents
Antibiotics
Routes: oral, cream, suppository, douche
Toxic Shock Syndrome (TSS)
Systemic life-threatening infection
Staphylococcus aureus
Streptococcus
Causes
Highly absorbent tampons
Other packing
Signs and symptoms
Fever
Sore throat
Headache
Dizziness
Confusion
Hypotension
Redness of palms and soles
Skin rash, blisters, petechiae
Prevention
Change tampon every 4 ext{ hours}
Substitute pads
Wash hands
Use caution with barrier contraceptives
Report symptoms promptly
Nursing care for patient in shock
Monitor airway, breathing, circulation
Vital signs, oxygen saturation, peripheral circulation
Administer oxygen as ordered
Administer fluids and antibiotics as ordered
See Chapter 9
Genital Organ Development Disorders
Agenesis
Hypoplasia
Imperforate openings
Displacement Disorders
Includes cystocele, rectocele, uterine position disorders, uterine prolapse
Uterine positions
Anteversion, Anteflexion, Retroversion, Retroflexion
Uterine prolapse stages
Normal uterus
First-degree prolapse
Second-degree prolapse
Third-degree prolapse
Diagnostic tests
Ultrasonography
Hysterosalpingography
CT scan
MRI
Endoscopy
Therapeutic interventions
Pessary
Surgical correction
Kegel exercises
Squeeze pubococcygeus muscle
Hold 10 seconds
Relax
Repeat 15 times daily
Nursing diagnoses
Pain
Urinary Incontinence
Constipation
Sexual Dysfunction
Grieving
Nursing interventions
Teach Kegel exercises
Advise healthy diet and weight management to avoid obesity
Fertility Disorders
Categories: Ovulation, Tubal, Uterine, Other
Reproductive Life Planning includes a spectrum of methods
Reproductive Life Planning and Contraception Methods
Reproductive Life Planning options
Oral contraceptives
Contraceptive implants
Depot medications
Contraceptive ring
Transdermal patch
Barrier methods
Spermicides
Intrauterine devices (IUDs)
Natural family planning
Lactational amenorrhea method
Tubal ligation
Visual aids
Female condom application
Uterus, cervix, vaginal canal anatomy for ring/condom diagrams
Diaphragm
Covers cervix
Sterilization
Tubal ligation
Vasectomy
Pregnancy Termination
Ethical issues
Therapeutic versus routine
Reasons
Ectopic pregnancy
Prenatal abnormalities
Risks
Methods
Chemical methods
Menstrual extraction
Vacuum aspiration
Dilation and evacuation (D&E)
Hysterotomy
Post-Abortion Care
Monitor for bleeding
Teach to report bleeding or signs of infection
Abstain from intercourse (about 3 ext{ weeks})
Birth control
Grief counseling
Benign Growths
Fibroids/leiomyomata
Polyps
Cysts
Bartholin cysts
Dermoid cysts
Polycystic Ovary Syndrome (PCOS)
Endocrine imbalance
Infertility
Obesity
Menstrual disturbance
Masculinization
Diabetes mellitus
Hypertension
Coronary artery disease
Endometrial cancer (risk)
Therapeutic interventions
Oral hypoglycemics
Oral contraceptives
Antiandrogen agents
Gonadotropin-releasing hormone (GnRH) agonists
Diet and exercise
Malignant Disorders
Vulvar cancer
Cervical cancer
Endometrial cancer
Ovarian cancer
Vulvar Cancer
Risk factors
HPV
Immune system suppression
Smoking
Signs and symptoms
Persistent itching
White or red patches
Skin ulcers
Wart-like growths
Therapeutic interventions
Destruction of cancerous cells
Radical vulvectomy
Skin grafting
Radiation
Chemotherapy
Immunotherapy
Targeted therapy
Cervical Cancer
Risk factors
HPV (most common)
Multiple sex partners
More than three pregnancies
Smoking
Overweight
Long-term use of oral contraceptives
Chlamydia, gonorrhea, syphilis
HIV/AIDS
Signs and symptoms
Serosanguineous discharge
May be asymptomatic
Diagnosis
Pap smear
Biopsy
HPV self-check kit
Interventions
Cryotherapy
Laser therapy
Surgical excision
Hysterectomy
Radiation implant
Chemotherapy
Endometrial Cancer
Risk factors
Estrogen excess
Estrogen therapy
Obesity
Never pregnant
Older age
Signs and symptoms
Abnormal bleeding
Diagnostic testing
Ultrasound
Hysteroscopy
Endometrial biopsy
Interventions
Hysterectomy
Radiation
Chemotherapy
Ovarian Cancer
Risk factors
Early menarche
Late menopause
Long-term estrogen replacement therapy
Family history
Signs and symptoms
None until late
Weight loss
Urinary frequency
Pelvic discomfort
Gastrointestinal discomfort
Diagnostic tests
Pelvic examination
Ultrasound
CT scan
MRI
Blood tests for tumor markers
Interventions
Oophorectomy
Estrogen-blocking therapy
Radiation
Chemotherapy
Gynecological Surgery
Endoscopic surgery
Laparoscopy
Culdoscopy
Hysteroscopy
Salpingoscopy
Postoperative Care for Endoscopic Surgery
Monitor
Vital signs
Bleeding
Temperature
Pain
Administer analgesics
Teach patient
Hysterectomy
Types (with or without bilateral salpingo-oophorectomy)
Total
Supracervical
Radical
Methods
Abdominal
Vaginal
Laparoscopic
Robotic
Rationale for hysterectomy
Menstrual problems
Benign tumors
Prolapse
Cancer
Nursing Diagnoses for Hysterectomy
Grieving
Risk for Urinary Retention
Risk for Constipation
Risk for Delayed Surgical Recovery
Anxiety
Case Study: SBAR Hand-Off (42. Example)
Case: Ms. Winston, 38, left breast red, swollen, tender after using hot tub; not breastfeeding; vitals normal
SBAR hand-off practice
Situation
Background
Assessment
Recommendation
Review Questions (Key Points)
Question 1: Risk factors for breast cancer include
Age
Late menopause
Being Black, Asian, Latina
High alcohol intake
Incorrect options (Hypertension) are not risk factors per the slide
Answer rationale: 1, 3, 4, 5 correspond to age, race/ethnicity risk factors, and alcohol use among listed items
Question 2: Foods to limit with PMS
Alcohol, caffeine
Question 3: Preventing Toxic Shock Syndrome (TSS)
Change tampon every 4 ext{ hours}
Substitute pads for tampons
Wash hands before/after handling tampons
Question 4: Displacement disorder prevention
Perform Kegel exercises
Question 5: Vaginal bleeding in a long-term menopausal patient
You should see your provider as soon as possible
Question 6: Virus associated with cervical cancer
HPV
Question 7: Non-drug interventions for endometriosis pain
Try a warm compress to abdomen
Try relaxation exercises
Question 8: Handling a phlebotomist drawing from the affected arm post-mastectomy
Stop phlebotomist and have blood drawn from the other arm
End of notes