Module 16: Female Reproductive

Learning Outcomes

• Evaluate nursing responsibilities related to diagnostic testing for selected reproductive disorders.
• Critically apply the nursing process to care for clients with cervical cancer undergoing surgery or radiation therapy.
• Apply the nursing process to clients undergoing surgical procedures.
• Develop a teaching plan for clients needing instructions on self-breast examination.
• Describe diagnostic tests used to detect breast cancer and cervical cancer.
• Use the nursing process as a framework for the care of clients with breast cancer.
• Compare therapeutic usefulness of chemotherapy, surgery, and radiation in treating breast cancer.
• Describe physical, psychosocial, and rehabilitative needs of clients who have had a mastectomy or hysterectomy.
• Identify pharmacological therapies, including indications and common adverse reactions.

Structures and Functions of the Female Reproductive System

• Main Functions of the Female Reproductive System:
  1. Production of ova (egg cells)
  2. Secretion of hormones
  3. Protection and facilitation of fetal development during pregnancy
• Pelvic Organs Include:
  • Ovaries
  • Fallopian tubes
  • Vagina
  • Uterus (located between the bladder and rectum; consists of fundus, body, cervix)
  • External genitalia (vulva)
  • Breasts
• Pelvis Structure:
  • Composed of four bones held together by ligaments.

Gerontologic Considerations

• Effects of Aging on the Female Reproductive System:
  • Changes in sexual practices and response.
  • Special attention needed due to societal attitudes toward the sexuality of older adults.
  • Nursing role: Provide accurate, unbiased information; emphasize normality.
  • Altered estrogen production during menopause leads to:
  • Decreased circulating estrogen and other sex steroids.
  • Atrophy of breasts and genitals.
  • Reduced bone mass; increased atherosclerosis risk.

Assessment of Female Reproductive Systems

• Key Areas of Assessment:
  • Past health history, co-morbidities, medications, surgical treatments, genetic risks, lifestyle choices.
  • Evaluate elimination patterns, activity-exercise patterns, and emotional health.
  • May include symptoms like pelvic pain, dyspareunia (painful intercourse), and fatigue.

Physical Examination Techniques

• Breast Examination:
  • Inspect and palpate for symmetry, size, shape, skin color, vascular patterns, and unusual lesions.
  • Pay special attention to the axillary tail of Spence, a common area for malignancies.
• Internal Pelvic Examination:
  • Usually performed by healthcare professionals with specialized training using a speculum; includes obtaining Pap smears.

Diagnostic Studies

• Types of Studies:
  • Urine and Blood Studies: To detect ovarian function, syphilis, pregnancy, menstrual irregularities.
  • Cultures and Tests: To identify infections such as Chlamydia, gonorrhea, etc.
  • Radiologic Studies: Mammograms, ultrasounds of the breasts/pelvis for diagnosis.
  • Invasive Procedures: Hysteroscopy, colposcopy, and pelvic laparoscopy.
  • Fertility Assessments: Through hormonal testing and imaging.

Breast Cancer Overview

• Epidemiology:
  • Second most common cancer in US women; significant mortality rates decreasing due to early detection.
  • More common in women aged 60 or older; many have no identifiable risk factors.
• Risk Factors Include:
  • Family history, environmental factors, early menarche, late menopause, genetics, hormone therapy, age.
• Screening Guidelines:
  • Yearly mammograms starting at age 45, or earlier for high-risk women.

Clinical Manifestations of Breast Cancer

• Commonly detected as: lump, thickening, mammography abnormalities.
• If palpable: may find hard, irregular, nonmobile lumps with possible nipple discharge.

Interprofessional Care and Treatment Options

• Treatment Plan Considerations:
  • Prognostic factors, clinical stage, biological characteristics.
• Staging of Cancer: TNM classification (Tumor size, lymph node involvement, metastasis).
• Surgical Options: Mastectomy (total, modified radical, nipple-sparing), lumpectomy.
• Therapies Include: Radiation, chemotherapy (often prior to surgery), hormone therapy, immunotherapy.

Nursing Care and Health Promotion

• Goals include patient engagement in decision making, managing side effects, follow-up adherence.
• Encourage lifestyle changes: maintain healthy weight, regular activity, limited alcohol use, smoking cessation.

Cervical Cancer

• High-risk factors, such as HPV infection, cervical changes, and lifestyle factors (smoking, multiple births).
• Clinical Manifestations: Often asymptomatic initially, followed by abnormal discharge, vaginal bleeding.
• Diagnostic Procedures: Co-testing (Pap smear and HPV), abnormally followed by colposcopy.

Ovarian Cancer

• Risk Factors: Genetic predisposition, personal/family history, nulliparity.
• Symptoms may be nonspecific: abdominal pain, bloating, or gastrointestinal symptoms.
• Diagnostic Studies: Elevated CA-125 levels and imaging for masses.