Genital Urinary System

Female Reproductive System

Brunner and Suddarth’s Medical Surgical Nursing

Text: Ch. 46-48

Behavioral Objectives:• Review the anatomy and physiology of the female GU systems• Describe the physical assessment of the female GU systems• Discuss the application of the nursing process as it relates to patients with

disorders of the female GU system• Describe etiology, pathophysiology, clinical manifestations, nursing management

and patient education for the following female GU disorders:– Vaginitis– Pelvic inflammatory disease (PID)– Endometriosis

• Discuss incidence, prevention & tx of the pts with CA of the GU system• Discuss the nursing interventions in pre and post-operative care of patients

undergoing the following surgeries– Hysterectomy– Mastectomy

Anatomy Review: Breast

• Female breast development– 10-16 yrs

• Tail of Spence– Into axillary area

• Cooper’s ligament• 12-20 lobes• Nipple• Areola

Anatomy Review Internal Reproductive Structures

Vagina– Mucus membrane– Posterior to bladder &

urethra– Anterior to rectum– Anterior & posterior

walls touch – Upper vagina

surrounds cervix • Inferior uterus

Anatomy Review Internal Reproductive Structures

Uterus• Pear-shaped

– Muscular• Size

– ?– Variable

• # pg

Anatomy Review Internal Reproductive Structures

• Location– Posterior to bladder

• Ligaments

Uterus

• Two parts of the uterus– Cervix

• Projects into the Vagina

– Fundus• Body of the uterus

• Endometrium:– Lining of the uterus

Anatomy Review Internal Reproductive Structures

Ovaries• Connected to uterus by

the fallopian tubes• Contains

– 1000’s of ova @ birth• Ova / Ovum

– Egg cells (immature) – Ova – plural– Ovum - Singular

Physiology Review

Ovulation• Definition

– Discharge of a mature ovum from the ovary

Start

Physiology Review

Ovulation• Follicular Stage

– Ovum enlarges cyst (graafian follicle) – Reaches the surface (of the ovary)

– Ovum is discharged• Ovulation

Physiology ReviewAfter Ovulations

• Ovum • Fallopian tube • Uterus• IF is meets a

spermatozoon – Union & conception– Location of

fertilization?

Physiology Review After ovulation

• Ovum cyst – Corpus luteum– Stays in the ovary

• Produces progesterone • Prepares the uterus for

the fertilized ovum

The Menstrual Cycle

• 2 system control menstruation process

– Reproductive – Endocrine

Hormones

The Menstrual Cycle

• Ovaries – Estrogen – Progesterone

The Menstrual Cycle

Pituitary gland• FSH

– Stim. Ovaries – to secrete estrogen

• LH – Ovulation– Stim. Progesterone

The Menstrual Cycle

• Cyclic pattern – Changes in the

endometrium and menstruation

– 28 day cycle

Follicular PhaseEstrogen IncreasingProgesterone LowFSH High decreasingLH Low increasingOvaries Growth of follicleEndometrium Proliferation of superficial layerDay(s) 5 - 13

OvulationEstrogen HighProgesterone LowFSH LowLH HighOvaries OvulationEndometrium Continued growthDay(s) 14

Luteal PhaseEstrogen Drops then increasesProgesterone IncreasingFSH LowLH HighOvaries Active corpus luteumEndometrium Highly vascular & thickDay(s) 15 - 25

Premenstrual PhaseEstrogen DecreasingProgesterone DecreasingFSH IncreasingLH DecreasingOvaries Degeneration of corpus luteumEndometrium Vasoconstriction, degenerationDay(s) 26 - 28

Menstrual PhaseEstrogen LowProgesterone NoneFSH IncreasingLH LowOvaries follicular development beginsEndometrium Degeneration and shedding of

superficial layerDay(s) 1-5

Menopausal Period

• End of reproductive capacity

• Age 45 – 52 yrs• Menstruation ceases

– No periods for > 1 year

Menopausal Period

• Ovaries not active – _?__ estrogen–

• Reproductive organs size

• No ova mature

Physical assessment

Health history• Menstrual hx

– Menarche• Beginning of

menstruation– Length– Amount – Cramps/pain ?

• Hx of pregnancies

• Medication history– Hormone therapy– Hormonal

contraceptives– Fertility treatment

Assessment: History & Clinical Manifestations

• Pain– Dysmenorrhea– Dyspareunia

• Hx vaginal discharge– Odor– Itching

• Hx urinary functions• Hx B&B control

Assessment: History & Clinical Manifestations

• Sexual history• History of sexual or physical abuse• History of surgery• History of chronic illness or disability• History of genetic disorders

• Physical Exam• Breast

– Frequency:• Monthly

Breast Exam – Assessment

• Palpable masses• Skin changes• Pain• Swelling• Redness• Nipple changes• Self exam

Abnormal breast findings

• Erythema– Benign local infection or – Superficial neoplasm

• Prominent venous pattern– blood supply required by tumor

• Edema & pitting– Neoplasm blocking the lymphatic drainage tubes

• Orange-peel appearance / Peau D’orange (edema)– Advanced breast cancer

• Nipple inversion– If new requires evaluation

• Signs of dimpling, creasing, changes in contour

• Breast Cancer Mass - palpate– Single mass– One breast– Firm, hard, embedded in surrounding tissue– Non-tender

Mammography

• Duration– 15 minutes

• Recommended frequency – Annually– > age 40

Physical Assessment

• Pelvic– Frequency

• Annual– Initial

• > age 18 • sexually active

– breast– pelvic

• Positioning– Supine lithotomy

position

Physical Assessment

• Inspection– Inspects external

genitilia– Speculum examination

• Vaginal canal• Cervix

Physical Assessment

• Pap smear– Tissue sample of cervix

– Purpose:

• Dx Cervical Ca

– No douche before visit

Physical Assessment

• Bimanual palpation– Cervical palpation– Uterine palpation

• Colposcopy– Portable microscope– Obtain sample