REPRODUCTIVE DISORDERS OF RICHARDS, FILAMER

The Reproductive The Reproductive SystemSystem

(DISORDERS)(DISORDERS)

GROUP 5GROUP 5

BSN III RICHARDSBSN III RICHARDS

IntroductionIntroductionAt its most basic level, reproduction is the At its most basic level, reproduction is the

process by which a single cell duplicates its process by which a single cell duplicates its genetic material. Reproduction is also the genetic material. Reproduction is also the process by which our genetic material is passed process by which our genetic material is passed on from one generation to the next.on from one generation to the next.

This process requires a special kind of This process requires a special kind of cellular reproduction that produces special cells, cellular reproduction that produces special cells, the sperm from the male and the egg from the the sperm from the male and the egg from the female. These join in the process of fertilization female. These join in the process of fertilization to produce a fertilized egg or zygote.to produce a fertilized egg or zygote.

The Male Reproductive SystemThe Male Reproductive System- The primary sex organs of the male The primary sex organs of the male

reproductive system are the reproductive system are the TESTESTESTES or or male gonads. These organs produce male gonads. These organs produce sperm and the male sex hormones. Other sperm and the male sex hormones. Other organs also include;organs also include;

Scrotum – supports the testes.Scrotum – supports the testes. Penis – engorged with blood during Penis – engorged with blood during

arousal.arousal. Testes – produces sperm cells.Testes – produces sperm cells.

The Female Reproductive SystemThe Female Reproductive System

- The primary sex organs of the female The primary sex organs of the female reproductive system are the ovaries or the female reproductive system are the ovaries or the female gonads. These organs produce eggs or OVA, as gonads. These organs produce eggs or OVA, as exocrine glands and endocrine glands produce exocrine glands and endocrine glands produce the female sex hormones the female sex hormones estrogenestrogen and and progesteroneprogesterone. Other organs include;. Other organs include;

Fallopian TubeFallopian Tube UterusUterus VaginaVagina External GenitaliaExternal Genitalia

Reproductive DisordersReproductive Disorders

PHIMOSISPHIMOSIS

-- The abnormal tightness of the The abnormal tightness of the foreskin. Occurs when penile foreskin is foreskin. Occurs when penile foreskin is constricted at the opening, making constricted at the opening, making retraction difficult or impossible.retraction difficult or impossible.

It is not usually painful, but it can lead It is not usually painful, but it can lead to obstructive uropathy if it is severe to obstructive uropathy if it is severe enough.enough.

ETIOLOGYETIOLOGY

Result of inflammation or local trauma.Result of inflammation or local trauma.

Uncircumcised adult maleUncircumcised adult male

CongenitalCongenital

DiagnosticsDiagnostics

Pre :Pre :

cleanse the penis thoroughly, retract the cleanse the penis thoroughly, retract the foreskin for proper cleaning.foreskin for proper cleaning.

Intra :Intra :

assist in the procedure such as assist in the procedure such as circumcision.circumcision.

Post:Post:

provide proper dressing for the woundprovide proper dressing for the wound

ComplicationsComplications

Painful erectionPainful erection

Difficulty in urinatingDifficulty in urinating

Balanitis – inflammation of the penis head Balanitis – inflammation of the penis head (glans)(glans)

Paraphimosis - is a condition where there is Paraphimosis - is a condition where there is constriction in the glans penis by a foreskin. constriction in the glans penis by a foreskin.

Nursing DiagnosisNursing DiagnosisI.I. Pain related to surgery. – a variety of unpleasant Pain related to surgery. – a variety of unpleasant

sensation that the patient experienced after surgerysensation that the patient experienced after surgery

II.II. Self-esteem disturbance related to alteration in body Self-esteem disturbance related to alteration in body image. – patient will have negative feeling of himself image. – patient will have negative feeling of himself due to his illness.due to his illness.

III.III. Knowledge deficit related to alteration in body image. Knowledge deficit related to alteration in body image. – patient will have questions about what has done to – patient will have questions about what has done to him after surgery.him after surgery.

IV.IV. Urethral trauma secondary to surgery. – patient will Urethral trauma secondary to surgery. – patient will have a difficulty in urinating after his surgery.have a difficulty in urinating after his surgery.

V.V. High risk for Fluid volume deficit. – post operative High risk for Fluid volume deficit. – post operative hemorrhage.hemorrhage.

Medical and Surgical InterventionsMedical and Surgical Interventions

Medical:Medical:- Control infection with local treatment of Control infection with local treatment of

antimicrobial drugs.antimicrobial drugs.

Surgical:Surgical:

- Circumcision- Circumcision

Levels of CareLevels of CarePromotive :Promotive :

-provide teachings to parents about the -provide teachings to parents about the disadvantages of being uncircumciseddisadvantages of being uncircumcised

Preventive :Preventive :

-advise clients for early circumcision-advise clients for early circumcision

Rehabilitative :Rehabilitative :

-provide proper wound dressing to the -provide proper wound dressing to the circumcised peniscircumcised penis

HYPOSPADIAHYPOSPADIA

-- a developmental anomaly in which the a developmental anomaly in which the male urethra opens on the under side of the male urethra opens on the under side of the penis. Midlinepenis. Midline

of the urethral foldsof the urethral folds

is incomplete sois incomplete so

that urethral meatusthat urethral meatus

opens on the opens on the

urethral side of penis.urethral side of penis.

EtiologyEtiology Single-gene defectSingle-gene defect

Chromosomal abnormalitiesChromosomal abnormalities

Maternal progestational drug ingestion in Maternal progestational drug ingestion in early pregnancyearly pregnancy

DiagnosisDiagnosis

- - Hypospadias is usually diagnosed Hypospadias is usually diagnosed during the physical examination of a during the physical examination of a newborn. A test that may be useful if newborn. A test that may be useful if hypospadias is suspected is an excretory hypospadias is suspected is an excretory urogram. This test uses urogram. This test uses X-rays to provide to provide pictures of the urinary tract.pictures of the urinary tract.


complications are more likely to occur in complications are more likely to occur in older children and adults. These include:older children and adults. These include:

Narrowing of the urethraNarrowing of the urethra

BleedingBleeding

InfectionInfection

Curvature of the penisCurvature of the penis

Nursing DiagnosisNursing DiagnosisI. Acute pain related to surgery. - a variety of unpleasant I. Acute pain related to surgery. - a variety of unpleasant

sensation that the patient experienced after surgerysensation that the patient experienced after surgery

II. Body image disturbance related to alteration in body II. Body image disturbance related to alteration in body structure.structure.

III. Fear related to developmental concerns with body III. Fear related to developmental concerns with body integrity. – patient may experience fear caused by integrity. – patient may experience fear caused by awareness of pain or danger concerning body awareness of pain or danger concerning body function.function.

IV. Altered patterns of urinary elimination related to surgical IV. Altered patterns of urinary elimination related to surgical repair. – patient may experience incontinent of passing repair. – patient may experience incontinent of passing urine due to surgery.urine due to surgery.

V. High risk for fluid volume deficit. – post operative V. High risk for fluid volume deficit. – post operative hemorhhage.hemorhhage.

Medical and Surgical InterventionsMedical and Surgical Interventions- Hypospadias/epispadias is sometimes treated with Hypospadias/epispadias is sometimes treated with

surgery to correct the placement of the urethral opening, surgery to correct the placement of the urethral opening, usually during the first year of life. usually during the first year of life.

There are several different types of surgery, which There are several different types of surgery, which may include repositioning of the urethra, correcting the may include repositioning of the urethra, correcting the placement of the urethral opening in the head of the placement of the urethral opening in the head of the penis, and reconstructing the skin of the area around the penis, and reconstructing the skin of the area around the urethral opening. urethral opening.

Because the foreskin may be needed for surgical Because the foreskin may be needed for surgical repair, a baby with hypospadia should not be repair, a baby with hypospadia should not be circumcised..

Levels of CareLevels of Care

Preventive :Preventive :

-advice parents of male child to have their -advice parents of male child to have their son checked for early detectionson checked for early detection

Rehabilitative :Rehabilitative :

-assist client in recovery and changes in -assist client in recovery and changes in urinationurination

EPISPADIAEPISPADIA

- A congenital absence of the uper wall of - A congenital absence of the uper wall of the urethra, ocuring in both sexes but the urethra, ocuring in both sexes but commonly in males.commonly in males.

EtiologyEtiology Acro-pectoro-renal field defect - A very rare genetic syndrome Acro-pectoro-renal field defect - A very rare genetic syndrome

characterized by abnormalities of the genital and urinary systems as characterized by abnormalities of the genital and urinary systems as well as the absence of chest muscles at birthwell as the absence of chest muscles at birth

Acrofacial dysostosis Catania form - One of a group of disorders Acrofacial dysostosis Catania form - One of a group of disorders characterized by defective limb and facial development.characterized by defective limb and facial development.

BEEC- A rare syndrome characterized by a birth defect where the BEEC- A rare syndrome characterized by a birth defect where the bladder is inside out and protrudes from the lower abdominal wall. bladder is inside out and protrudes from the lower abdominal wall. The urethra and genitals are also abnormally formed.The urethra and genitals are also abnormally formed.

Chromosome 4 ring syndrome - rare chromosomal disorder where the Chromosome 4 ring syndrome - rare chromosomal disorder where the ends of chromosome 4 have been deleted and the two broken ends ends of chromosome 4 have been deleted and the two broken ends have rejoined to form a ring shape resulting in a range of symptoms have rejoined to form a ring shape resulting in a range of symptoms determined by the size and location of the genetic deletion.determined by the size and location of the genetic deletion.

Exstrophy of the bladder- Exstrophy of the bladder: A rare congenital Exstrophy of the bladder- Exstrophy of the bladder: A rare congenital malformation the bladder is inside out and is protrudes through the malformation the bladder is inside out and is protrudes through the wall of the abdomen.wall of the abdomen.

DiagnosisDiagnosis

Epispadias is usually diagnosed Epispadias is usually diagnosed during the physical examination of a during the physical examination of a newborn. A test that may be useful if newborn. A test that may be useful if epispadias is suspected is an excretory epispadias is suspected is an excretory urogram. This test uses urogram. This test uses X-rays to provide to provide pictures of the urinary tract.pictures of the urinary tract.

ComplicationComplication

Urinary tract malformationUrinary tract malformation

Nursing DiagnosisNursing Diagnosis

I. Acute pain related to surgery. - a variety of unpleasant I. Acute pain related to surgery. - a variety of unpleasant sensation that the patient experienced after surgerysensation that the patient experienced after surgery

II. Body image disturbance related to alteration in body II. Body image disturbance related to alteration in body structure.structure.

III. Fear related to developmental concerns with body III. Fear related to developmental concerns with body integrity. – patient may experience fear caused by integrity. – patient may experience fear caused by awareness of pain or danger concerning body function.awareness of pain or danger concerning body function.

IV. Altered patterns of urinary elimination related to surgical IV. Altered patterns of urinary elimination related to surgical repair. – patient may experience incontinent of passing repair. – patient may experience incontinent of passing urine due to surgery.urine due to surgery.

V. High risk for fluid volume deficit. – post operative V. High risk for fluid volume deficit. – post operative hemorhhage.hemorhhage.

CRYPTORCHIDISMCRYPTORCHIDISM

or undescended testicles. Occurs or undescended testicles. Occurs when one or both of the testicles fail to when one or both of the testicles fail to move down into the scrotal sac.move down into the scrotal sac.

EtiologyEtiology

Hormonal factors (testosterone deficiency)Hormonal factors (testosterone deficiency)

Prenatal exposure to diethylstilbesterolPrenatal exposure to diethylstilbesterol

Prematurity (premature neonates are most commonly Prematurity (premature neonates are most commonly affected because testes normally descend into the affected because testes normally descend into the scrotum around 28 weeks gestation.scrotum around 28 weeks gestation.

Mechanical interference with the passage of the testes Mechanical interference with the passage of the testes into the scrotum.into the scrotum.

Deficiency of gonadotropinDeficiency of gonadotropin


Laparoscopy – useful in locating intra-abdominal Laparoscopy – useful in locating intra-abdominal testes or cord structures entering the inguinal testes or cord structures entering the inguinal canalcanal

UltrasonographyUltrasonography

CT scanCT scan

MRI (magnetic resonance imaging)MRI (magnetic resonance imaging)


Testicular cancerTesticular cancer

Male infertilityMale infertility

Groin massGroin mass

Testosterone level is lowTestosterone level is low


Body image disturbance related to Body image disturbance related to perceived body image changesperceived body image changes

Anxiety related to intensive diagnostic and Anxiety related to intensive diagnostic and surgical proceduressurgical procedures

Knowledge deficit related to new condition Knowledge deficit related to new condition Pain related to invasive procedurePain related to invasive procedure Fear related to anticipation of painFear related to anticipation of pain


Orchiopexy - is a surgery to move an Orchiopexy - is a surgery to move an undescended testicle into the scrotum and undescended testicle into the scrotum and permanently fix it there. It is performed by permanently fix it there. It is performed by a pediatric urologist or surgeon on boys a pediatric urologist or surgeon on boys with cryptorchidism, typically before they with cryptorchidism, typically before they reach the age of two.reach the age of two.

Levels of CareLevels of CarePreventive :Preventive :

-provide information on causes and the -provide information on causes and the possible effect on reproduction possible effect on reproduction

Curative :Curative :

-antimicrobial therapy-antimicrobial therapy

-warm moist soaks and used to relieved -warm moist soaks and used to relieved discomfort and help reduce swellingdiscomfort and help reduce swelling

-circumcission-circumcission

HYDROCELEHYDROCELE

Collection of fluid between the Collection of fluid between the visceral and parietal layers of the tunica visceral and parietal layers of the tunica vaginalis of the testicles or along the vaginalis of the testicles or along the spermatic cord.spermatic cord.

Most common form of Most common form of

scrotal swellingscrotal swelling

Two Types of HydroceleTwo Types of Hydrocele Communicating Hydrocele (Infants)Communicating Hydrocele (Infants)

1. Incomplete obliteration of processus vaginalis 1. Incomplete obliteration of processus vaginalis

2. Open communication between peritoneum and tunica2. Open communication between peritoneum and tunica

3. Closes spontaneously in the first year of life 3. Closes spontaneously in the first year of life

Non-Communicating Hydrocele (Adults)Non-Communicating Hydrocele (Adults)1. Imbalance in secretion vs absorption of tunica 1. Imbalance in secretion vs absorption of tunica

2. Results from inflammatory reaction2. Results from inflammatory reaction a. injurya. injury

b. infectionb. infection

c. Testicular Tumorc. Testicular Tumor

EtiologyEtiology

Congenital malformationCongenital malformation

Trauma of the testes or epididymisTrauma of the testes or epididymis

Infection of the testesInfection of the testes

Testicular tumorTesticular tumor

PathophysiologyPathophysiology A communicating hydrocele, a congenital A communicating hydrocele, a congenital

condition, occurs because of patency between condition, occurs because of patency between the scrotal sac and peritoneal cavity, which the scrotal sac and peritoneal cavity, which allows peritoneal fluids to collect in the scrotum. allows peritoneal fluids to collect in the scrotum.

In non-communicating hydrocele, fluids In non-communicating hydrocele, fluids accumulate because of infection, trauma, tumor, accumulate because of infection, trauma, tumor, an imbalance between the secreting and an imbalance between the secreting and absorptive capacities of scrotal tissue, or an absorptive capacities of scrotal tissue, or an obstruction of lymphatic or venous drainage in obstruction of lymphatic or venous drainage in the spermatic cord.the spermatic cord.


Transllumination of the scrotum – shining Transllumination of the scrotum – shining a light through the scrotum for the purpose a light through the scrotum for the purpose of visualizing the internal structures.of visualizing the internal structures.

Ultrasonography – determine whether the Ultrasonography – determine whether the mass is solid or cystic and whether the mass is solid or cystic and whether the testicle is normal.testicle is normal.


Epididymitis – is a medical condition in which Epididymitis – is a medical condition in which there is inflammation of the epididymis (a curved there is inflammation of the epididymis (a curved structure at the back of the testicle in which structure at the back of the testicle in which sperm matures and is stored). sperm matures and is stored).

Testicular Atrophy - is a medical condition in Testicular Atrophy - is a medical condition in which the male reproductive organs (the testes, which the male reproductive organs (the testes, which in humans are located in the scrotum) which in humans are located in the scrotum) diminish in size and may be accompanied by diminish in size and may be accompanied by loss of function. loss of function.

Nursing DiagnosisNursing DiagnosisI. High risk for dysfunction related to excision of tunica I. High risk for dysfunction related to excision of tunica

vaginalis.- may lose sexual urges due to surgery.vaginalis.- may lose sexual urges due to surgery.

II. Pain related to swelling. – pain that is experienced by II. Pain related to swelling. – pain that is experienced by the patient after surgery.the patient after surgery.

III. Impaired skin integrity related to surgery. – incisions III. Impaired skin integrity related to surgery. – incisions made during surgery.made during surgery.

IV. High risk for infection related to fluid accumulation. – IV. High risk for infection related to fluid accumulation. – fluid that is collected at the scrotal sac may cause fluid that is collected at the scrotal sac may cause infection.infection.

V. Anxiety related to intrusive diagnostic and surgical V. Anxiety related to intrusive diagnostic and surgical test and procedure. – patient may feel very anxious test and procedure. – patient may feel very anxious about the procedures that will be done to him.about the procedures that will be done to him.


Medical:Medical:

usually no treatment for congenital usually no treatment for congenital hydrocele, condition commonly resolves hydrocele, condition commonly resolves spontaneously by age 1.spontaneously by age 1.

Surgical:Surgical:

aspiration of fluid and injection of aspiration of fluid and injection of sclerosing drug into the scrotal sac for a sclerosing drug into the scrotal sac for a tense hydrocele that impedes blood tense hydrocele that impedes blood circulation or cause pain.circulation or cause pain.


Promotive: Promotive:

-provide health education -provide health education

Preventive:Preventive:

-thorough physical examination annually-thorough physical examination annually

Rehabilitative:Rehabilitative:

-apply ice packs-apply ice packs

VARICOCELEVARICOCELE

- a mass of dilated and tortuous - a mass of dilated and tortuous varicose veins in the spermatic cord. varicose veins in the spermatic cord. Classically Classically

described as a described as a

““Bag of worms”Bag of worms”

EtiologyEtiology

Incompetent or congenitally absent valves Incompetent or congenitally absent valves in the spermatic veinsin the spermatic veins

Tumor or thrombus obstructing the inferior Tumor or thrombus obstructing the inferior vena cava (unilateral [left-sided] vena cava (unilateral [left-sided] varicocele)varicocele)

PathophysiologyPathophysiology

Because of a valvular disorder in the spermatic Because of a valvular disorder in the spermatic vein, blood pools in the pampiniform plexus of vein, blood pools in the pampiniform plexus of veins that drain each testis rather than flowing veins that drain each testis rather than flowing into the venous systeminto the venous system

One function of the pampiniform plexus is to One function of the pampiniform plexus is to keep the testis slightly cooler than body keep the testis slightly cooler than body temperaturetemperature

Testicular atrophy may also occur because of Testicular atrophy may also occur because of reduce blood flowreduce blood flow

DiagnosticsDiagnostics Physical examination allows palpation of the Physical examination allows palpation of the

“bag of worms” when the patient is upright“bag of worms” when the patient is upright

Real-time ultrasonographyReal-time ultrasonography

Radioisotope scanningRadioisotope scanning

Spermatic venographySpermatic venography

ScrotopenographyScrotopenography


InfertilityInfertility

HydroceleHydrocele

Metastasis from a renal tumor leading to Metastasis from a renal tumor leading to sudden development of varicocele in an sudden development of varicocele in an older man (late sign)older man (late sign)


High risk sexual dysfunction related to High risk sexual dysfunction related to injury to excision of tunica vaginalisinjury to excision of tunica vaginalis

Pain related to swellingPain related to swelling Impaired skin integrity related to surgical Impaired skin integrity related to surgical

repairrepairHigh risk for infection related to fluid High risk for infection related to fluid

accumulationaccumulationAnxiety related to intusive diagnostic Anxiety related to intusive diagnostic

surgical test and proceduresurgical test and procedure


Medical:Medical:

Conservative treatment with a scrotal Conservative treatment with a scrotal support to relieve discomfort (jockstrap)support to relieve discomfort (jockstrap)

Surgical:Surgical:

Surgical ligation or sclerosis using a Surgical ligation or sclerosis using a percutaneous transvenous catheter under percutaneous transvenous catheter under flouroscopic guidanceflouroscopic guidance

Levels of care Levels of care Promotive: Promotive: -provide health education -provide health education

Preventive:Preventive: -thorough physical examination annually-thorough physical examination annually -retograde venogram will confirm the diagnosis-retograde venogram will confirm the diagnosis

Curative:Curative: -scrotal support which relieves any associated -scrotal support which relieves any associated

discomfortdiscomfort - surgery (varicosilectomy)- surgery (varicosilectomy)

PROSTATE CANCERPROSTATE CANCER

Slow-growing, most common neoplasm in Slow-growing, most common neoplasm in men older than age 50men older than age 50

Commonly forms as adrenocarcinomaCommonly forms as adrenocarcinomaUsually originatesUsually originates

in posteriorin posterior

prostate glandprostate gland

EtiologyEtiology

Exact cause unknownExact cause unknownRisk factorsRisk factors

-older than age 40-older than age 40

-infection-infection

-vasectomy-vasectomy

-Family history-Family history

-heavy metal exposure-heavy metal exposure

PATHOPHYSIOLOGYPATHOPHYSIOLOGY

Difficulty initiating urinary stream, Difficulty initiating urinary stream, dribbling, urine retention, and unexplained dribbling, urine retention, and unexplained cystitis due to obstruction of urinary tract cystitis due to obstruction of urinary tract by tumorby tumor

Hematuria due to infiltration of bladder Hematuria due to infiltration of bladder tumortumor

Back pain caused by metastasisBack pain caused by metastasis

Prostate CancerProstate Cancer

DiagnosticsDiagnostics Serum prostate-specific antigen level is elevatedSerum prostate-specific antigen level is elevated Transrectal prostatic ultrasonography shows Transrectal prostatic ultrasonography shows

prostate size and presence of abnormal growthsprostate size and presence of abnormal growths Bone scan and excretory urography detarmines Bone scan and excretory urography detarmines

extent of diseaseextent of disease MRI and CT scanning define extent of tumorMRI and CT scanning define extent of tumor Direct rectal examination reveals a small, hard Direct rectal examination reveals a small, hard

nodulenodule Blood testing reveals elevated serum acid Blood testing reveals elevated serum acid

phosphatase levelsphosphatase levels Biopsy confirms the cell typeBiopsy confirms the cell type


Spinal cord compressionSpinal cord compression

Deep vein thrombosisDeep vein thrombosis Pulmonary emboliPulmonary emboli

MyelophthisisMyelophthisis

deathdeath

Nursing DiagnosisNursing Diagnosis Altered pattern of urinary elimination related to Altered pattern of urinary elimination related to

malignant tissue-growth of tissue interferes malignant tissue-growth of tissue interferes bladder functionbladder function

High risk for fluid volume deficit (risk factor: Post High risk for fluid volume deficit (risk factor: Post operative hemorrhage)operative hemorrhage)

Pain related to surgical incisionPain related to surgical incision High risk for infection (risk factor: Surgical High risk for infection (risk factor: Surgical

resection, indwelling catheter and underlying resection, indwelling catheter and underlying malignancy)malignancy)

Knowledge deficit related to need for home Knowledge deficit related to need for home mangementmangement

Medical and Surgical InterventionsMedical and Surgical Interventions Medical Medical -hormone manipulation therapy as prescribed-hormone manipulation therapy as prescribed -administer luteinizing hormone-administer luteinizing hormone -radiation therapy to treat locally invasive -radiation therapy to treat locally invasive

lesionslesions -administration of chemotherapy incase of -administration of chemotherapy incase of

hormone resistant tumorshormone resistant tumors Surgical Surgical -Radical prostatectomy to remove prostate -Radical prostatectomy to remove prostate

gland and tumorgland and tumor -TURP to relieve obstruction-TURP to relieve obstruction -Orchiectomy to decrease androgen production-Orchiectomy to decrease androgen production

Levels of CareLevels of CarePromotive: Promotive: -health teaching concerning; the need for regular -health teaching concerning; the need for regular

physical xamination, certain drugs that may physical xamination, certain drugs that may produce further bladder problemsproduce further bladder problems

Preventive:Preventive: -routine physical examinations-routine physical examinations -diagnostic test such as urinalysis and BUN-diagnostic test such as urinalysis and BUNRehabilitative:Rehabilitative: -exercise to avoid prostatectomy urinary -exercise to avoid prostatectomy urinary

incontinenceincontinence -follow-up health care visits and physical -follow-up health care visits and physical

examinationsexaminations

Ovarian CancerOvarian Cancer

Malignancy arising from the ovaryMalignancy arising from the ovaryRapidly progressing Rapidly progressing

cancer that’scancer that’s

difficult to diagnosedifficult to diagnose

EtiologyEtiology

Exact cause unknownExact cause unknownRisk factorsRisk factors -infertility problems or nulliparity-infertility problems or nulliparity -celibacy-celibacy -exposure to asbestos and talc-exposure to asbestos and talc -history of breast or uterine cancer-history of breast or uterine cancer -family history of ovarian cancer-family history of ovarian cancer -diet high in satured fat-diet high in satured fat


Ovarian cancer spreads rapidly Ovarian cancer spreads rapidly intraperitoneally by local extension of intraperitoneally by local extension of surface seeding and, occasionally, through surface seeding and, occasionally, through the lymphatict and the bloodstreamthe lymphatict and the bloodstream

Metastasis to the ovary can originate as Metastasis to the ovary can originate as breast, colon, gastric, and pancreatic breast, colon, gastric, and pancreatic cancercancer

Ovarian cancerOvarian cancer


Exploratory laparotomyExploratory laparotomyAbdominal ultrasonographyAbdominal ultrasonographyMammographyMammographyAspiration of ascitic fluid reveals atypical Aspiration of ascitic fluid reveals atypical

cellscellsLaboratory tumor marker studies shows Laboratory tumor marker studies shows

abnormaities that may indicate abnormaities that may indicate complicationscomplications


Fluid and electrolyte imbalanceFluid and electrolyte imbalance

Leg edemaLeg edema

AscitesAscites

Intestinal obstructionIntestinal obstruction

Nursing DiagnosisNursing Diagnosis Pain related to increased abdominal pressure Pain related to increased abdominal pressure

caused by tumor or metastasize to abdominal caused by tumor or metastasize to abdominal structuresstructures

High risk for ineffective breathing pattern (risk High risk for ineffective breathing pattern (risk factor: presence of ascites)factor: presence of ascites)

High risk for altered nutrition (Risk factor: High risk for altered nutrition (Risk factor: cancer, poor appetite secondary to disease, side cancer, poor appetite secondary to disease, side effects of therapies)effects of therapies)

High risk for Impaired home management (risk High risk for Impaired home management (risk factor: inadequate support system)factor: inadequate support system)

High risk for sexual Dysfunction related to injury High risk for sexual Dysfunction related to injury to perineal nerves during injuryto perineal nerves during injury


MedicalMedical --STAGE I OVARIAN CANCER- STAGE I OVARIAN CANCER- irradiation or irradiation or

chemotherapy after surgerychemotherapy after surgery or systemic chemotherapy or systemic chemotherapy may be administered.may be administered.

- STAGE II OR HIGH-- STAGE II OR HIGH- typically received the same typically received the same treatment as those with stage I disease , with the treatment as those with stage I disease , with the inclusion of pelvic and possibly abdominal radiation.inclusion of pelvic and possibly abdominal radiation.

SurgicalSurgical -TAH-BSO or partial or compete omentectomy and -TAH-BSO or partial or compete omentectomy and

removal of all visible tumor.removal of all visible tumor.

Pre-operatively Nursing care managementPre-operatively Nursing care management - Evaluate the clients understanding of the proposed procedure and - Evaluate the clients understanding of the proposed procedure and

the changes it involves. the changes it involves. -Clients may be nutritionally compromised and may require -Clients may be nutritionally compromised and may require

nutritional therapy before surgerynutritional therapy before surgery Post-operatively nursing care managementPost-operatively nursing care management -Wound care and prevention of infection-Wound care and prevention of infection For clients receiving radiation therapyFor clients receiving radiation therapy -Provide education-Provide education -Minimize side effects-Minimize side effects For clients receiving chemotherapyFor clients receiving chemotherapy -Careful monitoring for potential adverse reactions and side effects -Careful monitoring for potential adverse reactions and side effects

is required during and even after completion of the infusion.is required during and even after completion of the infusion. -Review clients medical history to identify potential risk factors for -Review clients medical history to identify potential risk factors for

chemotherapy toxicity; such as impaired cardiac, pulmonary chemotherapy toxicity; such as impaired cardiac, pulmonary functionfunction

-Careful assess the severity and duration of side effects -Careful assess the severity and duration of side effects experienced since the previous cause of therapy.experienced since the previous cause of therapy.

-Abnormal laboratory values may indicate organ-specific toxicities of -Abnormal laboratory values may indicate organ-specific toxicities of chemotherapeutic agents.chemotherapeutic agents.


Primary PreventionPrimary PreventionInvolves measures to avoid or reduce exposure to Involves measures to avoid or reduce exposure to

carcinogenscarcinogensScreening programs help to identify high risk Screening programs help to identify high risk

populations and individualspopulations and individualsEarly detection involves finding a precancerous Early detection involves finding a precancerous

lesion or a cancer at its earliest most treatable stage lesion or a cancer at its earliest most treatable stage RehabilitationRehabilitation

Consist of limitation of disability and rehabilitation Consist of limitation of disability and rehabilitation An important opportunity for rehabilitation may be an An important opportunity for rehabilitation may be an exercise program to help a client counteract exercise program to help a client counteract chemotherapy related fatiguechemotherapy related fatigue

MYOMAMYOMA Disease characterizedDisease characterized by fibroid (benign tumors)by fibroid (benign tumors) in the uterusin the uterus• Most common benignMost common benign tumors in womentumors in women• composed of smoothcomposed of smooth cellscells• become malignant inbecome malignant in fewer than 0.1% of patientsfewer than 0.1% of patients

EtiologyEtiology

cause is unknowncause is unknown their growth seems to be related to their growth seems to be related to

estrogen stimulation because the fibroids estrogen stimulation because the fibroids often enlarged with pregnancy and shrink often enlarged with pregnancy and shrink with menopausewith menopause

begins as a simple proliferation of smooth begins as a simple proliferation of smooth muscle cellsmuscle cells


Fibroids vary greatly in size and usually Fibroids vary greatly in size and usually appear firm, sorrounded by a appear firm, sorrounded by a pseudocapsule composed of compressed pseudocapsule composed of compressed but otherwise normal uterine myometrium.but otherwise normal uterine myometrium.

The uterine cavity may become larger, The uterine cavity may become larger, increasing the endometrial surface area; increasing the endometrial surface area; this can cause increased uterine bleedingthis can cause increased uterine bleeding

IntramuralIntramural-found in the uterine wall, -found in the uterine wall, surrounded by myometrium.surrounded by myometrium.

SubmucosalSubmucosal-located directly under the -located directly under the endometrium, involving the endometrial endometrium, involving the endometrial cavitycavity

SubserosalSubserosal-found on the outer surface -found on the outer surface (under the serosa) of the uterus.(under the serosa) of the uterus.

Wandering or parasiticWandering or parasitic-a pedunculated -a pedunculated leiomyoma that twist on its pedicle, breaks leiomyoma that twist on its pedicle, breaks off,then attaches to other tissues, off,then attaches to other tissues, particularly the omentum.particularly the omentum.

IntraligamentaryIntraligamentary- implants on the pelvic - implants on the pelvic ligaments, may displace the uterus or ligaments, may displace the uterus or involve the uretersinvolve the ureters

CervicalCervical- occur infrequently and may - occur infrequently and may obstruct the cervical canal.obstruct the cervical canal.


Bimanual examinationBimanual examination

UtrasonographyUtrasonography

MRIMRI

Endometrial BiopsyEndometrial Biopsy

LaparoscopyLaparoscopy


Recurrent spontaneous abortionRecurrent spontaneous abortionPreterm laborPreterm laborAnemia secondary to excessive bleedingAnemia secondary to excessive bleedingBladder compressionBladder compression InfectionInfectionBowel obstructionBowel obstruction

Nursing DiagnosisNursing DiagnosisRisk for Dysfunctional Grieving- some Risk for Dysfunctional Grieving- some

women experience grief about their loss of women experience grief about their loss of the female reproductive organsthe female reproductive organs

Risk for Infection- patient has a foley Risk for Infection- patient has a foley catheter inserted during surgerycatheter inserted during surgery

Constipations- because of bowel Constipations- because of bowel manipulation during surgerymanipulation during surgery


MedicalMedical

-GnRH agonists-GnRH agonists

-NSAIDs-NSAIDsSurgicalSurgical

-Myomectomy-Myomectomy

-Hysterectomy-Hysterectomy

Pre-operative carePre-operative care

-reduce pain-reduce pain

-provide education-provide education

-explain surgery effects on menstruation, -explain surgery effects on menstruation, menopause, sexual activity and hormonal menopause, sexual activity and hormonal balancebalance

•Post-operative carePost-operative care

-Tell patient to report abnormal bleeding or -Tell patient to report abnormal bleeding or pelvic pain immediatelypelvic pain immediately

ReferencesReferences Medical-Surgical Nursing Pathophysiological Concepts 2Medical-Surgical Nursing Pathophysiological Concepts 2ndnd Edition 1991 Edition 1991

Patrick, Woods, Craven, Rokosky, BrunoPatrick, Woods, Craven, Rokosky, BrunoJB LIPPINCOTT COMPANYJB LIPPINCOTT COMPANY

Medical-Surgical Nursing Vol. 2 10Medical-Surgical Nursing Vol. 2 10thth Edition 2004 Edition 2004 Suzanne Smelter, Brenda G. BaneSuzanne Smelter, Brenda G. Bane

LIPPINCOTT WILLIAMS & WILKINSLIPPINCOTT WILLIAMS & WILKINS

Medical-Surgical Nursing 6Medical-Surgical Nursing 6thth Edition Vol. 1 and 2 Joyce M. Black, Jane Edition Vol. 1 and 2 Joyce M. Black, Jane Hokanson Hawks, Annabelle M. KeeneHokanson Hawks, Annabelle M. Keene

SAUNDERSSAUNDERS

Nursing Care Plans 3Nursing Care Plans 3rdrd Edition EditionGulanick, Klopp, Galanes, Gradishar, PuzasGulanick, Klopp, Galanes, Gradishar, PuzasMOSBYMOSBY

Internet ReferenceInternet Reference www.medline.comwww.medline.com www.wrongdiagnosis.comwww.wrongdiagnosis.com emedicine.medscape.comemedicine.medscape.com

GROUP 5GROUP 5

I.I. Dula, Cheene JaneDula, Cheene Jane

II.II. Forro, DelsheilaForro, Delsheila

III.III. Olivares, EmmilyOlivares, Emmily

IV.IV. Loresto, Mary AnnLoresto, Mary Ann

V.V. Dela Cruz, John EuxineDela Cruz, John Euxine

VI.VI. Barros, CherrieBarros, Cherrie

THANK YOU and GOD BLESS!!THANK YOU and GOD BLESS!!

REPRODUCTIVE DISORDERS OF RICHARDS, FILAMER

Health & Medicine

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