Menstrual dysfunctionstudent concepts_2e_ch19_lecture_ex4 (1) (2)

Sexuality Module Overview

• Focus on the concept of sexuality in nursing, addressing menstrual dysfunction.

Menstrual Dysfunction (Exemplar 19.4)

General Overview

• Normal menses involves minor discomfort:

  • Breast tenderness

  • Cramping

  • Low back pain

  • Mood swings

• Some women experience more severe menstrual dysfunction:

  • Pain

  • Bleeding

  • Both

Pathophysiology, Etiology, and Clinical Manifestations

Dysmenorrhea

• Definition: Pain associated with menstruation.

• Primary Dysmenorrhea:

  • Symptoms include pelvic pain radiating to the groin, low backaches, diarrhea, headaches, and anorexia.

  • Begins within the first 3-4 periods after menarche and is recurrent with ovulatory cycles during teens and 20s.

  • Pain tends to decrease over time, often lessening after childbirth.

• Secondary Dysmenorrhea:

  • Related to uterine pathologies (e.g., endometriosis, tumors, cysts, pelvic adhesions, PID, cervical stenosis, leiomyoma, adenomyosis).

Types of Dysfunctional Uterine Bleeding (DUB)

• Amenorrhea: Absence of menses.

• Oligomenorrhea: Scant menses.

• Menorrhagia: Excessive, prolonged bleeding.

• Metrorrhagia: Bleeding between periods.

• Menometrorrhagia: Irregular and excessive bleeding.

• Postmenopausal Bleeding: Associated with potential complications.

Risk Factors for DUB

• Stress

• Extreme weight changes

• Use of oral contraceptives and IUC devices

• Often related to hormonal imbalances.

Collaboration and Management

• Aim: Identify underlying cause, restore functional capacity, and manage pain.

• History and Assessment:

  • Rule out organic causes.

• Treatments for DUB:

  • Identify and treat underlying diseases or hormonal disorders.

  • Encourage clients to keep a diary of menstrual patterns.

Diagnostic Tests

Objectives

• Identify:

  • Structural abnormalities

  • Hormonal imbalances

  • Pathological conditions

Procedures

• Pelvic Examination:

  • Pap test

  • Cervical & vaginal cultures

• Imaging:

  • Ultrasound of pelvis/vagina

  • CT scan, MRI

• Laboratory Tests:

  • Pregnancy test

  • FSH, LH, progesterone levels

  • Estradiol levels

  • Thyroid function tests

  • CBC, Coagulation studies

Advanced Diagnostics

• Laparoscopy: Diagnose defects and blockages.

• Hysteroscopy.

• Endometrial biopsy.

• Endocrine studies.

Pharmacologic Therapy

• Common medications include:

  • Combined oral contraceptives

  • NSAIDs

  • Diuretics

  • SSRIs

  • Hormonal agents

  • Mirena (IUD)

  • IV conjugated estrogen

  • Oral iron supplement.

Non-pharmacologic Therapy

• Alternative options:

  • Rose hips for dysmenorrhea.

  • Fish oil plus B12 for prostaglandin metabolism.

  • Vitamin E and magnesium.

  • Importance of exercise, rest, stress management, and nutrition.

Surgical Interventions

• Therapeutic D&C:

  • Cervical canal dilation, uterine wall scraping.

• Endometrial Ablation:

  • Permanent destruction of the endometrial layer.

• Hysterectomy Types:

  • Abdominal hysterectomy

  • Vaginal hysterectomy

• Nursing care considerations for patients undergoing hysterectomy.

Nursing Process

Focus Areas

• Control manifestations.

• Provide education:

  • Physiology of the menstrual cycle.

  • Self-care methods adjusted to underlying causes.

Data Collection

• Nursing History:

  • Last menstrual period, open communication, both subjective and objective data.

• Physical Examination: Essential for comprehensive assessment.

Nursing Problems and Diagnosis

For Dysmenorrhea

• Nursing problems may include acute pain and ineffective coping.

For DUB

• Common nursing problems include:

  • Anxiety

  • Risk for ineffective perfusion (blood loss related)

  • Fatigue due to blood loss

  • Sexual Dysfunction (NANDA-I ©2012) guidelines followed.

Planning by RN

• Goals may include:

  • Reduced pain/discomfort

  • Increased comfort and rest

  • Enhanced iron-rich food intake

  • Comfort discussing sexual dysfunction

  • Identifying coping strategies

  • Maintaining a symptom journal.

Implementation

Pain Relief Strategies

• Teach effective pharmacologic/non-pharmacologic self-care methods:

  • Use of heat, relaxation, and exercise.

Anxiety Relief

• Discuss test results:

  • Provide information on causes, treatments, risks, and prognosis.

  • Evaluate coping strategies and support systems.

Promoting Sexual Function

• Information on sexual activity during menstruation.

• Opportunities for clients to express concerns about sexual functioning.

• Advise on lifestyle alterations and encourage rest periods;

• Discuss alternative methods for sexual expression.

Evaluation

Expected Outcomes

• Clients report:

  • Less pain, allowing ADLs

  • Reduced anxiety

  • Less fatigue

  • Return to baseline menstruation

  • Capability to participate in sexual activities without symptoms.