Chapter 46 Assessment and Management of Female Physiologic Processes

Copyright © 2008 Lippincott Williams & Wilkins.

Chapter 46 Assessment and Management of Female Physiologic Processes

Chapter 46 Assessment and Management of Female Physiologic Processes


Women’s Health Women’s Health

• Evolving area of health care

• Role of the nurse

• Emphasis on health promotion


Review of Anatomy and FunctionReview of Anatomy and Function

• Function of the female reproductive system

• Ovulation and the menstrual cycle

• Significant hormones and hormonal changes

– Estrogens

– Progesterone

– Androgens

– Follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

• Perimenopause and menopause


External Female GenitaliaExternal Female Genitalia


Internal Female Reproductive StructuresInternal Female Reproductive Structures


Menstrual CycleMenstrual Cycle


Health History and Sexual AssessmentHealth History and Sexual Assessment

• Menstrual history and history of pregnancies

• History of exposure to medications

• Pain with menses or intercourse

• Vaginal discharge, odor, or itching

• Urinary and bowel function

• Sexual history, including sexual or physical abuse

• History of STDs, surgeries, or procedures

• Chronic illness or disabilities that affect health/self-care

• Family and genetic history


Sexual AssessmentSexual Assessment

• Include subjective and objective data.

• Purpose is to obtain information to picture a woman’s sexuality and sexual practices to promote sexual health.

• May move from less sensitive areas of general health history/assessment to more sensitive areas

• Ask for permission to discuss these issues.

• Do not assume sexual preferences.

• Asking the patient to label herself as married, single, etc. may be interpreted as inappropriate; asking about current meaningful relationships may be less offensive.

• PLISST model


Domestic ViolenceDomestic Violence

• A broad term that includes child abuse, elder abuse, and the abuse of women and men

• Abuse can be:

– Emotional

– Physical

– Sexual

– Economic

• Asking about abuse is part of a comprehensive assessment.See Chart 46-3

• Reporting abuse and guidelinesSee Chart 46-2


Diagnostic Examinations and TestsDiagnostic Examinations and Tests

• Pelvic examination

• Pap smear

• Colposcopy and cervical biopsy

• Cryotherapy and laser therapy

• Cone biopsy and loop electrosurgical excision (LEEP)

• Endometrial biopsy

• Dilation and curettage

• Laparoscopy (pelvic peritoneoscopy) and hysteroscopy


Speculum Examination of the Vagina and CervixSpeculum Examination of the Vagina and Cervix


Bimanual Examination of the PelvisBimanual Examination of the Pelvis


Use of Ayre Spatula to Obtain Cervical Secretions for CytologyUse of Ayre Spatula to Obtain Cervical Secretions for Cytology


LaparoscopyLaparoscopy


Menstrual DisordersMenstrual Disorders

• Premenstrual syndrome

• Dysmenorrhea

• Amenorrhea

• Abnormal uterine bleeding

– Menorrhagia

– Metrorrhagia

– Postmenopausal bleeding


Nursing Care of the Patient with Premenopausal Syndrome (PMS)Nursing Care of the Patient with Premenopausal Syndrome (PMS)

• Assessment: health history, nutritional history, recording of symptoms

• Assess for potential for violence, suicide or uncontrollable behavior, and refer appropriately.

• Identification of patient goals: improved coping, reduction of anxiety, improved relationships

• Interventions and patient teaching

– Social support, counseling, and stress reduction

– Diet and exercise

– Medications


MenopauseMenopause

• Permanent physiologic cessation of menses associated with declining ovarian function

• Changes in menstruation

• Clinical manifestations

• Psychological considerations

• Medical management: HRT; risks and benefits

• Alternative therapy for hot flashes


Nursing Teaching for the Patient Approaching MenopauseNursing Teaching for the Patient Approaching Menopause• View as natural life change, a new phase with potential

for growth and new activities.

• Promote general good health, including diet and exercise.

• Note that fatigue and stress may worsen hot flashes.

• Nutrition: decrease fat and calories and increase calcium, whole grains, fiber, fruit, and vegetables. Calcium and vitamin D supplementation may be helpful.

• Address sexual activity and prevention or management of common problems.

• See Chart 46-8


ContraceptionContraception

• Each year more than half of all pregnancies are unintended.

• Nurses can assist by providing women with information and support women in making contraceptive choices.


Methods of ContraceptionMethods of Contraception

• Abstinence and natural methods

• Sterilization

• Tubal ligation

• Vasectomy

• Intrauterine device (IUD)

• Hormonal contraception

• Mechanical barriers


Hormonal ContraceptionHormonal Contraception

• Benefits and risks

• Adverse reactions

• Contraindications

• Hormone types

– Estrogen and progestin

– Progestin only

• Patient education related to hormonal contraceptives


Combination Progestin OnlyCombination Progestin Only

• Oral pills

• Vaginal ring

• Transdermal patch

• Oral pills or mini-pills

• “Plan B”

• Injection

• Levonorgestrel- releasing intrauterine system


Barrier MethodsBarrier Methods

• Diaphragm

• Cervical cap

• Contraceptive sponge

• Female and male condoms

• Note: assess for latex allergy!

Spermicides: nonoxynol-9 and octoxynol


Female CondomFemale Condom


Emergency ContraceptionEmergency Contraception

• Hormonal methods

– Plan B: progestin

– Dose of oral contraceptive (i.e., levonorgestrel and ethinyl estradiol) given and repeated in 12 hours

• Postcoital IUD insertion

• Timing of emergency contraception

• Nursing support, teaching, and counseling


AbortionAbortion

• Spontaneous abortion

• Habitual abortion

• Medical management

• Nursing support of the patient

• Grief process and dysfunctional grief


Elective AbortionElective Abortion

• Pre-abortion counseling

• Pelvic examination and laboratory tests

• Use of RhoGAM for Rh-negative patient

• Types of elective abortions

• Patient teaching, including instructions for follow-up care and information on contraception


InfertilityInfertility

• A couple’s inability to achieve a pregnancy after 1 year of unprotected intercourse

• Primary infertility refers to a couple who have never had a child.

• Secondary infertility means at least one conception has occurred but the couple cannot achieve a pregnancy.


Pathophysiology of InfertilityPathophysiology of Infertility

• Ovarian and ovulation factors

• Tubal factors

• Uterine factors

• Semen factors

• Other male factors


Management of InfertilityManagement of Infertility

• Pharmacologic therapySee Chart 46-16

– Potential for multiple pregnancies

– Ovarian hyperstimulation syndrome (OHSS)

• Artificial insemination

• In vitro fertilization

• Other technologies


Ectopic PregnancyEctopic Pregnancy• A leading cause of pregnancy-related death in the first

trimester

• Causes include salpingitis, peritubal adhesions, structural abnormalities of the fallopian tube, previous ectopic pregnancy, previous tubal surgery, tumors, IUD, progestin-only contraception, and pelvic inflammatory disease (PID)

• Clinical manifestations

– Delay in menses, slight bleeding, vague soreness or sharp colicky pain, GI symptoms, dizziness, lightheadedness

– With tube rupture: agonizing pain, dizziness, faintness, N/V, progression to shock

– Later: generalized abdominal pain that radiates to shoulder


Sites of Ectopic PregnancySites of Ectopic Pregnancy


Note:Note:

• All women need to be educated about early treatment and seek care if a period does not seem normal or if they have pain or pain and a suspected pregnancy.

• Fatal hemorrhage may occur with ruptured ectopic pregnancy if treatment is delayed.

• Women who have had an ectopic pregnancy are at increased risk for recurrent ectopic pregnancy and require teaching regarding early signs and symptoms.


Nursing Process: The Care of the Patient with Ectopic Pregnancies- DiagnosesNursing Process: The Care of the Patient with Ectopic Pregnancies- Diagnoses

• Acute pain

• Anticipatory grieving

• Deficient knowledge


Collaborative Problems/Potential ComplicationsCollaborative Problems/Potential Complications

• Hemorrhage

• Hemorrhagic shock


Nursing Process: Care of the Patient with Ectopic Pregnancy: PlanningNursing Process: Care of the Patient with Ectopic Pregnancy: Planning

• Major goals include relief of pain, acceptance and resolution of grief and pregnancy loss, increased knowledge about ectopic pregnancy and its treatment and outcome, and absence of complications.


InterventionsInterventions

• Supporting the grief process

– Listen and provide support.

– If appropriate, the partner should participate in the process.

– Referral for counseling as needed

• Management of complications

– Continuous/frequent monitoring of VS, LOC, amount of bleeding, I&O, laboratory values

– Bed rest

Chapter 46 Assessment and Management of Female Physiologic Processes

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Transcript of Chapter 46 Assessment and Management of Female Physiologic Processes