Reproductive Health Nursing Lecture

Pap Smear / Cervical Screening

• Preparation instructions (must be reinforced EVERY visit)
  • No vaginal medications, douching, or sexual intercourse for at least 24\;\text{h} before the examination.
  • If client is actively bleeding, postpone the smear unless it is an emergency.

• Patient‐teaching focus
  • Explain the reason for abstinence/delay (semen, lubricants, or medications obscure cytology results).
  • Normalize embarrassment; emphasize preventive value of the test.

Human Papilloma Virus (HPV)

• Key facts
  • >200 serotypes; high-risk oncogenic strains 16 & 18 linked to cervical, oropharyngeal, anal cancers.
  • Virus can clear spontaneously; median clearance in young adults ≈ 8{-}24\text{ mo}.
  • Men are often asymptomatic carriers—the virus “sheds” from penile epithelium so visual inspection is unreliable.

• Vaccine counseling (page 571)
  • 2- or 3-dose series depending on age at first injection.
  • Continue routine Pap/HPV co-testing even if vaccinated.
  • Address myths: vaccine does NOT promote sexual activity; provides cancer prevention.

Toxic Shock Syndrome (TSS)

• Etiology: Staphylococcus aureus exotoxin + retained or long-dwelled foreign body (tampon, older IUD design, nasal packing, IV catheter).

• Classic presentation
  • Sudden high fever (≥38.9^{\circ}\text{C}), vomiting/diarrhea, hypotension, diffuse rash ➔ desquamation ➔ multi-organ sepsis.

• Nursing actions
  • Remove foreign object, initiate sepsis bundle, obtain cultures, start broad-spectrum IV antibiotics.
  • Report immediately: vomiting, watery diarrhea, “sun-burn” rash, rapidly rising temperature.

Breast Surgery Types & Screening Controversy

• Surgical vocabulary
  • Total (simple) mastectomy – excision of the entire breast tissue.
  • Radical mastectomy – removal of breast, pectoral muscles, axillary nodes, sometimes part of chest wall → concave under-arm “caved in” appearance.

• Updated screening guidelines (U.S.)
  • Trend toward less frequent mammography in average-risk women ⇒ risk of missed early cancers in high-risk clients (family history, BRCA).
  • Nursing role = client advocacy: if risk factors present, insist on earlier/frequent imaging even if outside “algorithm.”

Menopause & Premenstrual Dysphoria

• Non-hormonal symptom control
  • Monitor blood glucose, weight, triglycerides.
  • SSRIs / SNRIs (e.g., Fluoxetine ≈ “Prozac”) used cyclically: start \approx 1\text{ wk} pre-menses → stop end-menses to reduce hot flashes & mood liability.

Male Acute Scrotum

• Epididymitis
  • Infective/post-traumatic inflammation of epididymis; worst pain typically on awakening.
  • Risk ↑ with uncircumcised status, multiple partners, UTI instrumentation (cystoscopy), prolonged sexual activity.
  • Prehn’s sign (+): gentle elevation relieves pain.
  • Tx: broad-spectrum antibiotics + scrotal support, ice, NSAIDs.

• Testicular torsion
  • Twisting of spermatic cord ⇒ ischemia (surgical emergency <6\text{ h}).
  • Prehn’s sign (−): lifting gives NO relief.
  • Send to ER STAT for Doppler or immediate OR.

Recurrent Vaginitis / Yeast & Bacterial Causes

• Common pathogens
  • E.\;coli (most common bacterial because of rectal proximity).
  • Candida albicans (after high-dose/long-term antibiotics wipe normal flora)

• Management pearls
  • Always obtain post-treatment test of cure (urine or swab) to confirm eradication.
  • For antibiotics ≥10 days, pre-emptively prescribe Fluconazole (\text{Diflucan}) 150\,\text{mg} PO ×1–2.
  • Reinforce perineal hygiene for BOTH partners (shower before sex, front-to-back wiping).

Pelvic Organ Prolapse – Cystocele & Rectocele (pp 568-569)

• Pathology
  • Cystocele: bladder herniates into anterior vaginal wall.
  • Rectocele: rectum herniates into posterior vaginal wall.

• Surgical repair (anterior/posterior colporrhaphy)
  • Pre-op: bowel prep, voiding trial, baseline post-void residual, d/c anticoagulants.
  • Post-op nursing
  – Foley catheter 24{-}48\text{ h}; monitor I&O.
  – No heavy lifting, straining, or intercourse \ge 6\text{ wk}.
  – Stool softeners & high-fiber diet to avoid Valsalva.
  – Teach S/S infection, report urinary retention or foul discharge.

Total Abdominal Hysterectomy (TAH) (pp 575-576)

• Pre-operative teaching
  • D/C NSAIDs, aspirin \ge 7 days prior.
  • Bowel prep, NPO midnight, incentive spirometer practice.
  • Discuss possible surgical menopause if ovaries removed ➔ HRT options.

• Post-op care
  • Early ambulation to prevent DVT, IS q2h while awake.
  • Monitor lochia (<1 saturated pad/h after first 24 h). • Avoid lifting >4.5\,\text{kg}, driving, or sexual intercourse 4{-}6\text{ wk}.

Erectile Dysfunction (ED)

• Multifactorial origin
  • Vascular (diabetes, HTN), neurogenic, psychogenic, low testosterone, meds (beta-blockers, SSRIs).

• Therapies
  • PDE-5 inhibitors (Sildenafil/Tadalafil) – ensure NO concurrent nitrates.
  • Vacuum erection device.
  • Surgical implants
  – Malleable rod (semi-rigid bendable “pipe-cleaner”).
  – Inflatable 3-piece (pump in scrotum → cylinders in corpora).
  • Topical compounded creams (newer, variable success).

Testicular Cancer & Self-Examination

• Monthly TSE: warm shower, roll each testis between thumb & fingers; feel for pea-sized, painless nodule.

• Suspicious mass ⇒ radical inguinal orchiectomy (remove testis via inguinal canal, THEN biopsy to avoid scrotal spread).

Colposcopy (page 545)

• Pre-procedure: same pelvic prep (no sex/vag meds 24\text{ h}, NSAIDs for cramp prophylaxis, void prior).

• Post-procedure: watery, coffee-ground discharge 24{-}48\text{ h} normal; no intercourse, tampons, douching \ge 1\text{ wk}; watch for >38^{\circ}\text{C} fever or heavy bleeding.

Herpes Simplex Virus 1 & 2

• Either serotype can infect oral OR genital region (old rule of “1 = above waist, 2 = below” obsolete).

• Dx: viral culture or PCR swab.

• Tx: antivirals (Acyclovir, Valacyclovir) episodic or suppressive; safe-sex education (condoms reduce but do not eliminate shedding).

Amenorrhea ("absence of period")

• Primary vs secondary; multifactorial causes
  • Stress, anxiety, extreme low body weight, eating disorder, malnutrition.
  • Medications (antipsychotics, chemo), thyroid or pituitary disease, PCOS, ovarian failure.

• Evaluate: hCG, prolactin, TSH, FSH/LH, pelvic US; treat underlying cause.

Sexually Transmitted Infections

1. Trichomoniasis
   • S/S: profuse, frothy yellow-green discharge, vulvar pruritus.
   • Drug of choice: Metronidazole (\text{Flagyl}) 2\,\text{g} PO single dose OR 500\,\text{mg} PO BID ×7 d.
   • Caution: NO alcohol \pm 24\text{ h} before & \ge 48\text{ h} after (disulfiram-like reaction).

2. Chlamydia trachomatis (page 598)
   • Often asymptomatic; latency months.
   • Test all sexually active ≤25 yrs or new partner.
   • Tx: Doxycycline 100\,\text{mg} BID ×7 d OR Azithromycin 1\,\text{g} PO ×1.
   • Treat partners, abstain 7\text{ d} after regimen & until all partners treated; retest \ge 3\text{ mo}.

3. Syphilis (page 595)
   • Stages: primary chancre → secondary rash/condyloma lata → latent → tertiary (gumma, neuro, cardio).
   • Gold-standard therapy: Benzathine Penicillin G (2.4\,\text{million units} IM) once for early; weekly ×3 for late latent.
   • Follow RPR/VDRL titers 6, 12 mo post-treatment to confirm four-fold decline.
   • Incorrect penicillin formulation (e.g., Pen-G procaine) = treatment failure.

Respiratory: Trach Suctioning (quick review)

• Pre-oxygenate 100\% for 30{-}60 sec.

• Closed vs open system; sterile technique for open.

• Insert catheter without suction, withdraw with intermittent suction \le 10\text{ sec}.

• Re-oxygenate, reassess breath sounds & SpO_2.

These bullet-point notes consolidate every major and minor concept, example, and clinical pearl spoken in the transcript so you have a complete study reference without revisiting the original lecture.