JBorrero 10/08
Stressors of the Female and Male
Reproductive Systems
NUR240
Endometriosis
• Endometriosis is usually a benign problem of endometrial tissue implantation outside the uterine cavity.
• Manifestations include pain, dyspareunia, painful defecation, sacral backache, hypermenorrhea, and infertility.
• Erythrocyte sedimentation rate and white blood cell count rule out pelvic inflammatory disease.
• Laparoscopy is the key diagnostic procedure.
Collaborative Management
• Nonsurgical management includes hormone manipulation.
• Surgical management includes:– D&C- Dilation and curettage– Laser or balloon endometrial ablation– Hysterectomy
Uterine Prolapse
• Stages of uterine prolapse are described by the degree of descent of the uterus.
• Dyspareunia, backache, pressure in the pelvis, bowel or bladder problems
• Pessaries
• Surgery
Cystocele
• Protrusion of the bladder through the vaginal wall due to weakened pelvic structures
• Difficulty in emptying bladder, urinary frequency and urgency, urinary tract infection, stress urinary incontinence
• Kegel exercises
• Surgery
Rectocele
• Protrusion of the rectum through a weakened vaginal wall
• Constipation, hemorrhoids, fecal impaction, feelings of rectal or vaginal fullness
• High-fiber diet, stool softeners, laxatives
• Surgery
Fistulas
• Abnormal openings between two adjacent organs or structures
• Etiology
• S&S
• Nonsurgical treatment
• Surgical treatment
Bartholin Cyst
• Obstruction of the duct of the Bartholin’s gland
• Simple incision and drainage
• Marsupialization (formation of a pouch)
• Postoperative care
Uterine Tumors
Nonmalignant:
Fibroids or Leiomyomas
Malignant:
Endometrial Cancer
• Endometrial cancer is a reproductive cancer, of which adenocarcinoma is the most common type.
• The main symptom is postmenopausal bleeding.
Endometrial Cancer Dx Tests
• Diagnostic assessment includes the following tests:– CA-125 tumor marker– Chest x-ray– Barium enema– CT of the pelvis– Liver and bone scans– Functional dilation and curettage (D&C)
TX: Radiation Therapy
• External and internal
• Teletherapy
• Brachytherapy
• Intracavitary radiation
Surgical Management
• Total abdominal hysterectomy and bilateral salpingo-oophorectomy
• Radical hysterectomy with bilateral pelvic lymph node dissection for stage II cancer
Cervical Cancer• Common reproductive cancer among
women in the U.S.• Disorder is a progression: from totally
normal cervical cells to premalignant changes in appearance of cervical cells (dysplasia), to changes in function, ultimately to transformation to cancer
• HPV- Human papillomavirus• Gardasil Vaccine- 3 doses• Carcinoma in situ• Preinvasive or invasive
Clinical Manifestations
• Client often asymptomatic• Classic symptom: painless vaginal
bleeding• Watery, blood-tinged vaginal discharge
that may become dark and foul-smelling as the disease progresses
• Leg pain• Flank pain • Unexplained weight loss, pelvic pain,
dysuria, hematuria, rectal bleeding, chest pain and cough
Diagnostic Assessment
• Pap smear
• Colposcopic examination
• Endocervical curettage
Nonsurgical Management
• Local ablation of using the loop electrosurgical excision procedure
• Laser therapy
• Cryotherapy
• Radiation therapy
• Chemotherapy
• Conization
Surgical Management
• Clinical staging performed before surgery to establish extent of the disease
• Simple hysterectomy
• Radical hysterectomy
• Pelvic exenteration
Postoperative Care
• Early stages of recovery, assess for:– Hemorrhage and shock– Pulmonary complications– Fluid and electrolyte imbalances– Renal or urinary complications– Pain
Postoperative Care
• Later stages of recovery, assess for:– Deep vein thrombosis– Pulmonary emboli– Paralytic ileus– Wound infections– Wound dehiscence– Wound evisceration– Pain
Ovarian Cancer
• Most common type—serous adenocarcinoma
• Vague abdominal discomfort, dyspepsia, indigestion, gas, and distention
• Ovarian antibody CA-125, ultrasound, intravenous pyelography, barium enema, upper gastrointestinal radiographic series to rule out tumors
Management
NONSURGICAL
• Chemotherapy with agents such as cisplatin, carboplatin, and paclitaxel
• Radiation therapy
Management
SURGICAL
• Total abdominal hysterectomy and bilateral salpingo-oophorectomy
• Staging
• Second-look procedure usually after 1 year of chemotherapy
Assessment
• Urinary pattern, frequency, nocturia, and other symptoms of bladder neck obstruction
• Lower urinary tract symptoms• Hesitancy, intermittency, reduced force
and size of urinary stream, a sensation of incomplete bladder emptying, and postvoid dribbling
• Hematuria
Laboratory Assessment
• Urinalysis
• Complete blood count
• Blood urea nitrogen and creatinine levels
• Prostate-specific antigen
• DRE
• C&S
Drug Therapy
• Finasteride ( Proscar) to shrink the prostate gland and improve urinary flow
• Terazosin hydrochloride (Hytrin)
• Doxazosin mesylate (Cardura)
• Tamsulosin hydrochloride (Flomax)
• Estrogens and androgens
Surgical Procedures
• Transurethral resection of the prostate AKA TURP
• Suprapubic prostatectomy
• Retropubic prostatectomy
• Perineal prostatectomy
Continuous Bladder IrrigationCBI
• Goal: To maintain clear urine flow• Three-way urinary catheter with a 30- to
45-mL retention balloon through the urethra into the bladder
• Traction via taping to client’s abdomen or thigh
• Uncomfortable urge to void continuously
• Antispasmodic medications
Postcatheterization Care
• Client feels burning on urination as well as some urinary frequency, dribbling, and leakage.
• Symptoms are normal and will subside.
• Monitor fluid intake.
Prostate Cancer
• Most common invasive cancer among men in the U.S.
• One of the slowest growing malignancies; metastasizes in a predictable pattern
• First symptoms related to bladder neck obstruction
• Hormonal dependent
Prostate Cancer: Dx
• Digital rectal examination
• Prostate-specific antigen (PSA)
• Biopsy necessary to confirm suspected prostatic cancer
Surgical Treatment: Radical Prostatectomy
Post op Care:• Caring for wound drains• Preventing emboli• Preventing pulmonary complications• Antibiotics• Analgesics• Laxative and stool softener• Indwelling urinary catheter• Antispasmotic
Complications
• Urinary incontinence
• Erectile dysfunction
Nonsurgical Management
• Radiation therapy
• Hormonal therapy
• Chemotherapy
• Targeted therapy
Testicular Cancer
• Although uncommon, this cancer is the most common malignancy in men 15 to 35 years of age.
• With early detection by testicular self-examination and treatment with combination chemotherapy, testicular cancer can be cured.
Diagnostics
• Alpha-fetoprotein
• Beta subunit of hCG
• Ultrasound
• Computed tomography
• Magnetic resonance imaging
• Lymphangiograms
Risk for Sexual Dysfunction
Oligospermia, azoospermia
Interventions include:– Health teaching about reproduction,
fertility, and sexuality– Sperm storage– Other reproductive options
Potential for Metastasis
• Interventions include:– Surgical management– Preoperative care– Operative procedures: radical
retroperitoneal lymph node dissection, orchiectomy
– Post op care : Pain, Immobilty, Wound/Drain Care
Nonsurgical Management
• Chemotherapy
• Radiation therapy
• Stem cell transplantation
Top Related