REPRODUCTIVE

CARE OF THE PATIENT WITH A REPRODUCTIVE DISORDER

1. Introduction

  • Author: K. Conover RN, MSN, CMSRN

  • Published by Mosby, an imprint of Elsevier Inc.

2. Learning Objectives

  • List and describe the functions of the organs of the male and female reproductive tracts.

  • Discuss menstruation and the hormones necessary for a complete menstrual cycle.

  • Discuss the impact of illness on the patient’s sexuality.

  • Discuss nursing interventions for the patient undergoing diagnostic studies related to the reproductive system.

  • Discuss the importance of the Papanicolaou test in early detection of cervical cancer and mammography as a screening procedure for breast cancer.

  • List nursing interventions for patients with menstrual disturbances.

3. Male Reproductive System

  • Organs:

    • Testes (testicles)

    • Ductal system

    • Epididymis

    • Ductus deferens (vas deferens)

    • Ejaculatory duct

    • Urethra

    • Accessory glands

    • Urethra and penis

    • Sperm

4. Female Reproductive System

  • Components:

    • Ovaries

    • Fallopian tubes (oviducts)

    • Uterus

    • Vagina

    • External genitalia

    • Accessory glands

    • Perineum

    • Mammary glands (breasts)

5. Anatomy of the Female Reproductive System

  • Structures:

    • Uterine (fallopian) tube, Ovary, Uterus (Body, Fundus, Cervix), Rectum, Urinary bladder, Clitoris, Vagina

    • Layers of the Uterus:

    • Endometrium

    • Myometrium

    • Perimetrium

  • Features of External Genitalia:

    • Labium minora, Labium majora, Clitoris, Vestibule, Greater vestibular (Bartholin) gland

6. Menstrual Cycle

  • Terms:

    • Menarche: First menstrual cycle.

  • Phases of the Cycle:

    • Menstrual phase

    • Preovulatory phase

    • Postovulatory phase

  • Cycle Characteristics:

    • Normal blood loss: 30-80 mL

    • Cycle duration: 28 days (5 days long)

  • Hormonal Regulation:

    • Follicle-stimulating hormone (FSH) initiates the menstrual cycle, estrogen sustains the cycle, progesterone influences the bodies preparing for a potential pregnancy.

7. Effects of Normal Aging

  • Menopause:

    • Occurs between ages 42-58 years.

    • Menstrual flow ceases; hormone levels decrease.

    • Symptoms include hot flashes and brittle bones.

  • Men's Aging:

    • Subtle hormone changes; sperm production decreases but does not cease, maintaining healthy sexual function.

8. Illness and Sexuality

  • Illness can alter a patient’s self-concept, impacting sexual function and desire.

  • Recovery from illness leads to resumption of sexual activity; some illnesses may induce sexual dysfunction.

9. Diagnostic Exams Related to Reproductive Health

  • Tests Include:

    • Colposcopy

    • Culdoscopy

    • Laparoscopy

    • Papanicolaou (Pap) test (smear)

    • Biopsy

    • Mammography

    • Semen analysis

    • Prostatic smears

    • Cystoscopy

    • Dilation and Curettage (D&C)

10. Importance of Papanicolaou Test (Pap Test)

  • A simple smear method to examine stained exfoliative peeling and sloughed-off tissue or cells.

  • Recommended annually starting 3 years after sexual activity or no later than age 25.

  • Crucial for early detection of cervical cancer.

11. Menstrual Disturbances

  • Types Include:

    • Amenorrhea: absence of menstrual flow.

    • Dysmenorrhea: menstrual cramps.

    • Dysfunctional uterine bleeding (DUB)

    • Menorrhagia: excessive bleeding.

    • Metrorrhagia: bleeding between menstrual cycles.

    • Premenstrual syndrome (PMS)

    • Menopause: officially no period for a full year.

  • Symptoms:

    • Changes in hormone levels, fatigue, hair thinning, hot flashes, and more.

12. Medications for Reproductive Disorders

  • Common Medications:

    1. Acyclovir ointment (Zovirax) - for herpes.

    2. Conjugated equine estrogen (Premarin) - hormone therapy.

    3. Miconazole nitrate (Monistat) - for vaginal yeast infections.

    4. Testosterone cypionate (Andro-Cyp) - for hormonal management.

    5. Medroxyprogesterone acetate - for abnormal bleeding and pregnancy prevention.

13. Erectile Dysfunction

  • Definition: Inability to maintain or attain an erection.

  • Causes:

    1. Psychological causes: Stress, depression.

    2. Organic causes: Diabetes, hypertension, low testosterone.

  • Treatments:

    • Pharmacological options include sildenafil citrate (Viagra) and tadalafil (Cialis).

    • Alternative methods: injections and penile pumps.

    • Contraindications include interaction with nitrates.

14. Infertility

  • Definition: Inability to conceive after one year of unprotected intercourse.

  • Causes:

    • Male: Damaged sperm, lifestyle factors, genetic defects, hormone imbalances.

    • Female: Structural abnormalities, hormone imbalances (like estrogen, progesterone).

  • Diagnostics and Management:

    • May require scopes, biopsies, medications like Clomid.

15. Inflammatory and Infectious Disorders of the Female Reproductive Tract

  • Types:

    1. Simple vaginitis

    2. Senile vaginitis (atrophic vaginitis)

    3. Cervicitis

    4. Pelvic Inflammatory Disease (PID)

    5. Toxic Shock Syndrome (TSS)

16. Pelvic Inflammatory Disease (PID)

  • Causes: Gonorrhoeae, streptococci, staphylococci, chlamydiae.

  • Symptoms: Elevated temperature, chills, severe abdominal pain, purulent vaginal discharge.

  • Diagnostic Tests: Gram stains of secretions.

  • Treatment: Antibiotics to eradicate infection.

17. Toxic Shock Syndrome (TSS)

  • Association: Commonly linked with tampon use.

  • Symptoms: Flu-like symptoms, headache, diarrhea, hypotension, myalgia.

  • Management: Monitor vital signs, hydration, and antibiotic therapy.

18. Disorders of the Female Reproductive System

  • Conditions Include:

    • Endometriosis

    • Vaginal fistula

    • Uterine prolapse

    • Cystocele and rectocele

    • Leiomyomas

    • Ovarian cysts

19. Endometriosis

  • Definition: Endometrial tissue located outside the uterus.

  • Symptoms: Painful menstrual periods (dysmenorrhea).

  • Diagnostics: Ultrasound and laparoscopy with biopsy.

  • Management Options: Hormonal therapy, hysterectomy, anti-inflammatory medications.

20. Vaginal Fistula

  • Definition: Abnormal opening between two organs.

  • Types: Urethrovaginal, vesicovaginal, rectovaginal fistulas.

21. Relaxed Pelvic Floor Muscles

  • Causes: Tissues of the bladder relax, causing displacement.

  • Conditions: Includes cystocele and rectocele with symptoms of urinary urgency and pelvic pressure.

  • Nursing Interventions: Patient teaching, surgical care.

22. Disorders of the Female Breast

  • Include fibrocystic breast condition, mastitis, and breast cancer.

23. Surgical Interventions for Breast Cancer

  • Types:

    1. Lumpectomy

    2. Mastectomy: single, modified radical, or bilateral.

24. Adjuvant Therapies for Breast Cancer

  • Options include radiation, chemotherapy, hormonal therapy, and monoclonal antibody therapy.

25. Nursing Interventions for Patients Undergoing Mastectomy

  • Observations of vital signs, wound care, pain management, and patient education.

26. Male Reproductive Disorders

  • Conditions Include: Prostatitis and epididymitis, examining tests and symptoms associated with these facilities.

27. Hydrocele and Varicocele

  • Hydrocele: Fluid accumulation around the testicle; treatment only necessary if uncomfortable.

  • Varicocele: Dilated veins in scrotum causing pain; may require surgical intervention.

28. Testicular Self-Examination

  • Recommended monthly, examining for lumps or abnormalities; perform after bathing.

29. Sexually Transmitted Infections (STIs)

  • Use the "5 Ps": Past STIs, Partners, Practices, Prevention, Pregnancy.

  • Important patient teaching about safe practices, symptoms, and the necessity of prompt treatment.

30. Birth Control Methods

  • Categories include hormonal (Combined, Progestin Only), barrier methods (condoms, IUDs), and permanent solutions.