Docsity
Log inSign up
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search Store documents

The best documents sold by students who completed their studies

Search through all study resources
Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

University Rankings

Discover the best universities in your country according to Docsity users

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

From our blog

Exams and Study
Go to the blog

Reproductive System and Breast Disorders: Assessment and Nursing Management, Lecture notes of Nursing

State Fair Community CollegeNursing

An overview of the structures and functions of the male and female reproductive systems, assessment techniques for reproductive system disorders, and nursing management for breast disorders. Topics include assessment of male and female reproductive systems, breast cancer screening and risk factors, benign breast disorders such as mastalgia and fibroadenoma, and nipple discharge. The document also covers breast cancer diagnosis, treatment options, and nursing interventions.

What you will learn

  • What are the primary roles of the male reproductive system?
  • What are the common benign breast disorders and their treatments?
  • What are the risk factors for breast cancer?
  • What is the importance of accurate and unbiased information about sexuality and age in assessing reproductive systems?
  • What are the screening guidelines for breast cancer?

Typology: Lecture notes

2019/2020

Uploaded on 03/26/2020

yodo1-15
yodo1-15 🇺🇸

9 documents

1 / 16

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
Lewis: Medical-Surgical Nursing, 9th Edition
Chapter 51
Nursing Assessment: Reproductive System
KEY POINTS
STRUCTURES AND FUNCTIONS OF MALE AND FEMALE REPRODUCTIVE SYSTEMS
•The primary roles of male reproductive system are production and transportation of
sperm, deposition of sperm in female reproductive tract, and secretion of hormones.
•The major gonadal hormone of men is testosterone, which is produced by interstitial cells
within the testes. Testosterone is responsible for development and maintenance of secondary sex
characteristics and spermatogenesis.
•The primary roles of female reproductive system are production of ova, secretion of
hormones, and protection and facilitation of the development of the fetus in a pregnant female.
•The hypothalamus, pituitary gland, and gonads secrete numerous hormones that regulate
the processes of ovulation, spermatogenesis, fertilization, and formation and function of
secondary sex characteristics.
•In women, follicle-stimulating hormone (FSH) production by the anterior pituitary
stimulates growth and maturity of ovarian follicles. Mature follicle produces estrogen, which in
turn suppresses the release of FSH. In men, FSH stimulates seminiferous tubules to produce
sperm.
•In women, luteinizing hormone (LH) from the anterior pituitary contributes to ovulation
by stimulating follicles to complete maturation and undergo ovulation. In men, LH is responsible
for the production of testosterone.
•Estrogen and progesterone are produced by the ovaries.
•oEstrogen is essential to the development and maintenance of secondary sex
characteristics, proliferative phase of menstrual cycle immediately after menstruation,
and pregnancy uterine changes.
•oProgesterone is also involved in body changes of pregnancy.
•Menarche is the first episode of menstrual bleeding, indicating that a female has reached
puberty. This usually occurs at 12 to 13 years of age, but may range from 9 to 16 years of age.
•The major functions of ovaries are ovulation and secretion of hormones. These functions
are accomplished during the menstrual cycle.
oThe length of the menstrual cycle generally ranges from 20 to 40 days. It is
mediated by the hormonal activity of the hypothalamus, pituitary gland, and ovaries.
oIf fertilization occurs, high levels of estrogen and progesterone continue to be
secreted because of continued activity of corpus luteum from stimulation by human
chorionic gonadotropin (hCG).
oIf fertilization does not take place, menstruation occurs because of a decrease in
estrogen production and progesterone.
•Menopause is the physiologic cessation of menses associated with declining ovarian
function. It is usually considered complete after 1 year of amenorrhea.
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff

Partial preview of the text

Download Reproductive System and Breast Disorders: Assessment and Nursing Management and more Lecture notes Nursing in PDF only on Docsity!

Lewis: Medical-Surgical Nursing, 9 th^ Edition

Chapter 51 Nursing Assessment: Reproductive System KEY POINTS STRUCTURES AND FUNCTIONS OF MALE AND FEMALE REPRODUCTIVE SYSTEMS

  •  The primary roles of male reproductive system are production and transportation of sperm, deposition of sperm in female reproductive tract, and secretion of hormones.
  •  The major gonadal hormone of men is testosterone, which is produced by interstitial cells within the testes. Testosterone is responsible for development and maintenance of secondary sex characteristics and spermatogenesis.
  •  The primary roles of female reproductive system are production of ova, secretion of hormones, and protection and facilitation of the development of the fetus in a pregnant female.
  •  The hypothalamus, pituitary gland, and gonads secrete numerous hormones that regulate the processes of ovulation, spermatogenesis, fertilization, and formation and function of secondary sex characteristics.
  •  In women, follicle-stimulating hormone (FSH) production by the anterior pituitary stimulates growth and maturity of ovarian follicles. Mature follicle produces estrogen, which in turn suppresses the release of FSH. In men, FSH stimulates seminiferous tubules to produce sperm.
  •  In women, luteinizing hormone (LH) from the anterior pituitary contributes to ovulation by stimulating follicles to complete maturation and undergo ovulation. In men, LH is responsible for the production of testosterone.
  •  Estrogen and progesterone are produced by the ovaries.
    • o Estrogen is essential to the development and maintenance of secondary sex characteristics, proliferative phase of menstrual cycle immediately after menstruation, and pregnancy uterine changes.
    • o Progesterone is also involved in body changes of pregnancy.
  • Menarche is the first episode of menstrual bleeding, indicating that a female has reached puberty. This usually occurs at 12 to 13 years of age, but may range from 9 to 16 years of age. -  The major functions of ovaries are ovulation and secretion of hormones. These functions are accomplished during the menstrual cycle. o The length of the menstrual cycle generally ranges from 20 to 40 days. It is mediated by the hormonal activity of the hypothalamus, pituitary gland, and ovaries. o If fertilization occurs, high levels of estrogen and progesterone continue to be secreted because of continued activity of corpus luteum from stimulation by human chorionic gonadotropin (hCG). o If fertilization does not take place, menstruation occurs because of a decrease in estrogen production and progesterone.
  • Menopause is the physiologic cessation of menses associated with declining ovarian function. It is usually considered complete after 1 year of amenorrhea.
  •  The sexual response is a complex interplay of psychologic and physiologic phenomena influenced by a number of variables, including daily stress, illness, and crisis. - o Changes that occur during sexual excitement are similar for men and women. - o Sexual response can be described in terms of the excitement, plateau, orgasmic, and resolution phases. GERONTOLOGIC CONSIDERATIONS: EFFECTS OF AGING ON REPRODUCTIVE SYSTEM
  •  In women, aging changes include a reduction in circulating estrogen along with an increase in androgens in postmenopausal women. These changes are associated with breast and genital atrophy, reduction in bone mass, and increased rate of atherosclerosis.
  •  Aging changes in men include an increase in prostate size, decreased testosterone level and sperm production, decreased scrotum muscle tone, and size and firmness of the testicles. Erectile dysfunction and sexual dysfunction can occur as a result of these changes. ASSESSMENT OF MALE AND FEMALE REPRODUCTIVE SYSTEMS
  •  You have an important role in providing accurate and unbiased information about sexuality and age. Emphasize normalcy of sexual activity in older adults.
  •  Reproduction and sexual issues are often considered extremely personal and private.
  • o A professional demeanor is important when taking a reproductive or sexual history.
  • o Be sensitive, ask gender-neutral questions, and maintain awareness of patient’s culture and beliefs.
  • o It is helpful to begin with the least sensitive information (e.g., menstrual history) before asking questions about more sensitive issues such as sexual practices or sexually transmitted infections.
  •  Women should have a complete menstrual, obstetric, and gynecologic history taken, including oral contraceptive use.
  • o Question the patient regarding current health status and presence of any acute or chronic health problems as problems in other body systems often relate to problems with the reproductive system.
  • o Detailed history data are used to detect gynecologic concerns.
  •  Physical examinations involve the following:
  • o Examining male external genitalia: inspection and palpation of pubis, penis, scrotum and testes, inguinal region and spermatic cord, anus, and prostate.
  • o Examining female: begins with inspection and palpation of breasts and then proceeds to abdomen and external genitalia including mons pubis , labia majora, labia minora, perineum, and anal region.
  • o Pelvic and bimanual examinations are considered advanced skills. DIAGNOSTIC STUDIES OF REPRODUCTIVE SYSTEMS
  •  Serum hCG is used to diagnose pregnancy.
  •  Prolactin assay is used for patients with amenorrhea.
  •  Serum progesterone and estradiol can help in ovarian function assessment, particularly for amenorrhea.
  •  Hormonal blood studies are essential for a fertility workup.
  •  Several tumor antigens are measured to assist in detecting and monitoring the effectiveness of therapy for reproductive system malignancies.

fever. Ultrasound-guided drainage of the abscess or surgical incision and drainage are necessary followed by antibiotic therapy.

  • Fibrocystic changes is a common benign condition characterized by changes in breast tissue, including development of excess fibrous tissue, hyperplasia of epithelial lining of mammary ducts, proliferation of mammary ducts, and cyst formation. o Changes produce pain by nerve irritation from edema in connective tissue and by fibrosis from nerve pinching. o Treatment may include use of good support bra, dietary therapy (low-salt diet), restriction of methylxanthines (e.g., coffee, chocolate), vitamin E therapy, analgesics, danazol, diuretics, hormone therapy, and antiestrogen therapy.
  • Fibroadenoma is a common cause of benign breast lumps. They may be due to increased estrogen sensitivity in localized area of breast. Treatment includes observation, surgical excision, or cryoablation_._ NIPPLE DISCHARGE
  •  Nipple discharge may occur spontaneously, as a result of nipple manipulation; may be idiopathic; or may be associated with a number of benign and malignant disorders as well as systemic diseases.
  •  In most cases, nipple discharge is not related to malignancy. Common benign causes include ductal ectasia and intraductal papilloma.
  •  The treatment depends on identification of the cause. GYNECOMASTIA IN MEN
  • Gynecomastia , a transient, noninflammatory enlargement of one or both breasts in men, is usually a benign condition but may signal hormonal problems or drug effects.
  •  Senescent gynecomastia occurs in many older men, likely caused by an elevation in plasma estrogen. No treatment is needed since it generally regresses within 6 to 12 months. BREAST CANCER
  •  Breast cancer is the most common malignancy in American women except for skin cancer and the second most common cause of cancer death.
  •  A number of factors are thought to be related to breast cancer, including a family history, environmental factors, genetics, early menarche and late menopause, and age 60 or over. Most women who develop breast cancer have no identifiable risk factors.
  •  Noninvasive breast cancers include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).
  • o DCIS tends to be unilateral. If left untreated, it may progress to invasive breast cancer.
  •  LCIS is a risk factor for developing breast cancer, but it is not known to be a premalignant lesion. No treatment is necessary for LCIS. Inflammatory breast cancer is the most malignant form of all breast cancers.
  • o The skin of the breast looks red, feels warm, and has a thickened appearance described as resembling an orange peel (peau d’orange).
  • o Metastatic risk is high. Neoadjuvant chemotherapy, radiation therapy, and hormone therapy are key therapies. If there is a good response to these therapies, surgery may follow.
  • Paget’s disease is a rare breast malignancy characterized by a persistent lesion of the nipple and areola with or without a palpable mass. Local treatment may include lumpectomy and radiation or mastectomy.
  •  Breast cancer presents as a lump or mammographic abnormality in the breast, most often in upper, outer quadrant of breast. - o If palpable, breast cancer is usually hard and may be irregularly shaped, poorly delineated, nonmobile, and nontender. - o Nipple discharge may also be present.
  •  In addition to tumor stage and grade, other tests useful in predicting risk of recurrence or metastatic breast disease include axillary lymph node status, tumor size, estrogen and progesterone receptor status, HER-2 status, multigene assays, and cell growth rate tests.
  •  Patients with breast cancer should discuss all treatment options with their health care provider, including local excision, breast-conserving surgery (lumpectomy), mastectomy with breast reconstruction, radiation therapy, chemotherapy, and/or hormonal and biologic therapy. - o Common options for early-stage breast cancer include breast-conserving surgery with radiation therapy and modified radical mastectomy with or without reconstruction. - o Breast-conserving surgery (lumpectomy) involves removal of entire tumor along with a margin of normal tissue. - o A modified radical mastectomy includes removal of breast and axillary lymph nodes, but it preserves pectoralis major muscle.
  •  Radiation therapy is usually delivered over 5 to 6 weeks to the entire breast, ending with a boost to the tumor bed over 1 week. Brachytherapy (internal radiation), which is a type of accelerated partial-breast radiation, may be given for early-stage breast cancer.
  •  Radiation therapy may be used for breast cancer as a primary treatment to prevent local breast recurrences after breast-conserving surgery, adjuvant treatment following mastectomy to prevent local and nodal recurrences, and palliative treatment for pain caused by local recurrence and metastases.
  •  If there is evidence of systemic disease, chemotherapy may be given either before surgery (neoadjuvant) or after surgery (adjuvant) but before radiation therapy.
  •  Hormonal therapy blocks the source of estrogen, thus promoting tumor regression.
  •  Nursing interventions at time of breast cancer diagnosis include providing information and resources to support informed decision making and coping.
  •  The woman with breast-conserving surgery often has an uncomplicated postoperative course with only a moderate amount of pain. If an axillary lymph node dissection or mastectomy is done, drains are often left in place.
  •  Postoperative pain and discomfort are minimized by administering analgesics on a regular schedule or as needed, before exercise or activity. The use of intermittent ice (unless contraindicated with reconstructive surgery) and warm water in the shower may provide relief.
  •  Lymphedema can occur because of surgical excision or radiation of lymph nodes. Symptoms are heaviness, pain, impaired motor function in the arm, and numbness and paresthesia of the fingers as a result of swelling in the affected arm, hand, or breast. MAMMOPLASTY
  • Mammoplasty is a surgical change in size or shape of the breast. It may be done electively for cosmetic purposes to either augment or reduce the size of breasts or to reconstruct the breast after mastectomy.
  •  Breast reconstructive surgery may be done simultaneously with a mastectomy (immediate) or some time afterward (delayed) to achieve symmetry and to restore or preserve body image.
  •  Women with gonorrhea are often asymptomatic or have minor symptoms that are often overlooked. A few women may complain of vaginal discharge, dysuria, or frequency of urination.
  •  Complications of gonorrhea in men are prostatitis, urethral strictures, and sterility from orchitis or epididymitis.
  •  Because women with gonorrhea who are asymptomatic seldom seek treatment, complications are more common in women and include pelvic inflammatory disease (PID), Bartholin’s abscess, ectopic pregnancy, and infertility.
  •  Typical clinical manifestations of gonorrhea, combined with a positive finding in a Gram-stained smear of the purulent discharge from the penis, give an almost certain diagnosis in men. A culture must be performed to confirm the diagnosis in women.
  •  The most common treatment for gonorrhea is a single intramuscular (IM) dose of ceftriaxone (Rocephin). Patients with coexisting syphilis are likely to be cured by the same drugs used for gonorrhea.
  •  All sexual contacts of patients with gonorrhea must be evaluated and treated to prevent reinfection after resumption of sexual relations. SYPHILIS
  • Syphilis is caused by Treponema pallidum, a spirochete that enters the body through very small breaks in skin or mucous membranes.
  •  In addition to sexual contact, syphilis may be spread through contact with infectious lesions and sharing of needles among IV drug users.
  •  If syphilis is not treated, specific stages are characteristic of disease progression. o In the primary stage, chancres appear. During this time, draining of microorganisms into lymph nodes causes regional lymphadenopathy. Genital ulcers may also be present. o Without treatment, syphilis progresses to a secondary (systemic) stage. Manifestations include flulike symptoms of fever, sore throat, headaches, fatigue, and generalized adenopathy. o The third stage is the most severe stage. Manifestations include gummas, aneurysms, heart valve insufficiency, heart failure, and general paresis.  Syphilis is commonly diagnosed by a serologic test. Benzathine penicillin G (Bicillin) or aqueous procaine penicillin G remains the treatment for all stages of syphilis. CHLAMYDIAL INFECTIONS
  • Chlamydial infections are the most commonly reported STI in the United States.
  •  They are caused by Chlamydia trachomatis, a gram-negative bacterium that is transmitted during vaginal, anal, or oral sex.
  •  Chlamydial infections are associated with gonococcal infections, which makes clinical differentiation difficult. In men, urethritis, epididymitis, and proctitis may occur in both diseases. In women, bartholinitis, cervicitis, and salpingitis can occur in both diseases. Therefore both Chlamydia and gonorrhea are usually treated concurrently.
  •  Complications from chlamydial infections in men result in epididymitis with possible infertility and reactive arthritis. Complications in women may result in PID, which can lead to chronic pelvic pain and infertility.
  •  DNA amplification tests are the most sensitive diagnostic methods available to detect chlamydial infections.
  •  Chlamydial infections respond to treatment with doxycycline (Vibramycin) or azithromycin (Zithromax). GENITAL HERPES
  • Genital herpes is caused by herpes simplex virus.
  •  The virus enters through mucous membranes or breaks in skin during contact with an infected person.
  •  In general, HSV type 1 (HSV-1) causes infection above the waist, involving gingivae, dermis, upper respiratory tract, and central nervous system.
  •  HSV type 2 (HSV-2) most commonly infects the genital tract and perineum (locations below waist).
  •  In a primary (initial) episode of genital herpes the patient may complain of burning or tingling at the site of inoculation. Multiple small, vesicular lesions may appear on penis, scrotum, vulva, perineum, perianal region, vagina, or cervix.
  •  Recurrent genital herpes occurs in 50% to 80% of individuals. Symptoms of recurrent episodes are less severe, and lesions usually heal within 8 to 12 days.
  •  The diagnosis of genital herpes is confirmed through isolation of the virus from active lesions by means of tissue culture.
  •  Three antiviral agents are available for treatment: acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). These drugs inhibit herpetic viral replication and are prescribed for primary and recurrent infections. GENITAL WARTS
  • Genital warts are caused by the human papillomavirus (HPV). There are over 100 types of papillomaviruses, and about 40 of these affect the genital tract.
  •  Most individuals who have HPV infection do not know that they are infected because symptoms are often not present.
  •  Some HPV types appear to be harmless and self-limiting, whereas others are linked to cervical, vulvar, and vaginal cancer in women and penile and anorectal cancer in men.
  •  Genital warts are discrete single or multiple papillary growths that are white to gray and pink-flesh colored. They may grow and coalesce to form large, cauliflower-like masses.
  •  In men, warts may occur on the penis and scrotum, around the anus, or in the urethra. In women, warts may be located on the vulva, vagina, or cervix and in the perianal area.
  •  Diagnosis of genital warts can be made on the basis of the gross appearance of lesions.
  •  Treatment consists of chemical or ablative methods. Because genital warts are difficult to treat and treatment does not destroy the virus, recurrences and reinfection are possible, and careful long-term follow-up is advised.
  •  Vaccines are available to protect against HPV types 6, 11, 16, and 18 (Gardasil) and HPV types 16 and 18 (Cervarix). NURSING MANAGEMENT: SEXUALLY TRANSMITTED INFECTIONS
  •  Be prepared to discuss decreasing exposure to STIs with all patients, not only those who are perceived to be at risk.
  •  “Safe” sex practices include abstinence, monogamy with the uninfected partner, Safe” sex practices include abstinence, monogamy with the uninfected partner, avoidance of certain high-risk sexual practices, and use of condoms and other barriers to limit contact with potentially infectious body fluids or lesions. -  Actively encourage communities to provide better education about STIs for their citizens. Teenagers have a high incidence of infection and should be a prime target for such educational programs.
  • Dysmenorrhea is abdominal cramping pain or discomfort associated with menstrual flow. Nausea, diarrhea, headache, and fatigue may accompany pain. - o Primary dysmenorrhea is caused by an excess of prostaglandin F 2 α (PGF 2 α) and/or an increased sensitivity to it. - o Secondary dysmenorrhea is acquired after adolescence. Pelvic causes include endometriosis, chronic pelvic inflammatory disease, and uterine fibroids.
  •  Treatment for primary dysmenorrhea includes heat, exercise, and drug therapy. Treatment for secondary dysmenorrhea depends on the cause. A primary nursing responsibility is teaching regarding the treatment of dysmenorrhea. ABNORMAL VAGINAL BLEEDING
  •  Abnormal vaginal or uterine bleeding is a common gynecologic concern and is caused by dysfunction of hypothalamic-pituitary-ovarian axis, infection, and stressful changes in lifestyle.
  •  The various types of irregular bleeding—oligomenorrhea, menorrhagia, metrorrhagia, and menometrorrhagia—are characterized by different patterns and associated symptoms. -  Treatment varies depending on the cause but can include drug therapy and surgery. ECTOPIC PREGNANCY
  •  An ectopic pregnancy is the implantation of the fertilized ovum anywhere outside the uterine cavity.
  •  Any blockage of the tube or reduction of tubal peristalsis that impedes or delays the zygote passing to the uterine cavity can result in tubal implantation.
  •  Risk factors include a history of pelvic inflammatory disease, prior ectopic pregnancy, current progestin-releasing intrauterine device (IUD), progestin-only birth control failure, and prior pelvic or tubal surgery.
  •  Eventually the tube ruptures, resulting in the classic acute peritoneal symptoms of abdominal/pelvic pain, missed menses, and irregular vaginal bleeding.
  •  Treatment is usually surgery. PERIMENOPAUSE AND POSTMENOPAUSE
  • Menopause is the physiologic cessation of menses associated with declining ovarian function. It is usually considered complete after 1 year of amenorrhea. The average age at which menopause occurs is 51 years.
  •  Ovarian changes start the cascade of events that result in menopause.
  •  Premenopausal symptoms include hot flashes, irregular vaginal bleeding, fat redistribution, and a tendency to gain weight.
  •  Treatment might include hormone replacement, drug therapy, and alternative therapies. CONDITIONS OF VULVA, VAGINA, AND CERVIX
  •  Infection and inflammation of vagina, cervix, and vulva commonly occur when natural defenses of the acid vaginal secretions (maintained by sufficient estrogen levels) and presence of Lactobacillus are disrupted.
  •  Abnormal vaginal discharge and reddened vulvar lesions are often noted with itching and dysuria.
  •  Treatment includes antibiotics and antifungal preparations. PELVIC INFLAMMATORY DISEASE
  • Pelvic inflammatory disease (PID) is an infectious condition of pelvic cavity that may involve infection of fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic peritoneum (peritonitis). PID is often the result of untreated cervicitis.
  •  The main symptom is constant lower abdominal pain. Purulent discharge, fever, chills, and irregular menses may also occur.
  •  Long-term complications include ectopic pregnancy, infertility, and chronic pelvic pain.
  •  PID is usually treated with antibiotics. ENDOMETRIOSIS
  • Endometriosis is the presence of normal endometrial tissue in sites outside endometrial cavity.
  •  The etiology of endometriosis is poorly understood. One theory is retrograde menstrual flow through the fallopian tubes carrying viable endometrial tissues into the pelvis.
  •  Symptoms are secondary dysmenorrhea, infertility, pelvic pain, dyspareunia, and irregular bleeding.
  •  Treatment depends on the woman’s age, parity, symptoms, and extent of disease.
  •  Drug therapy reduces symptoms, with surgery offering a potential cure. BENIGN TUMORS OF THE FEMALE REPRODUCTIVE SYSTEM Leiomyomas
  • Leiomyomas (uterine fibroids) are benign smooth-muscle tumors that occur within the uterus. They are the most common tumor of the female genital tract.
  •  Although most women do not have symptoms, symptoms may include abnormal uterine bleeding and pain.
  •  Treatment depends on size of tumor and may include surgery. Miscellaneous Problems
  • Cervical polyps are bright-cherry red, soft pedunculated lesions. They are generally asymptomatic but are prone to infection. Surgical excision is the preferred treatment.
  • Follicle and corpus luteum cysts commonly occur in the ovary during the reproductive years. Surgery may be indicated for large, persistent masses.
  • Polycystic ovary syndrome is a chronic disorder in which many benign cysts form on the ovaries. It is a common cause of infertility and is associated with dysfunctional bleeding, hirsutism, and acne. Treatment includes drug therapy. Surgery may be indicated depending on parity. CERVICAL CANCER
  •  Noninvasive cervical cancer (in situ) is about four times more common than invasive cervical cancer.
  •  There is a strong relationship between sexual exposure to papillomavirus (HPV) and dysplasia. A vaccine can protect against cervical cancer due to two types of HPV.
  •  The finding of an abnormal Pap test indicates need for follow-up.
  •  Early cervical cancer is generally asymptomatic, but leukorrhea and intermenstrual bleeding eventually occur.
  •  Invasive disease is treated with surgery, radiation, and chemotherapy. ENDOMETRIAL CANCER
  •  The major risk factor of endometrial cancer is unopposed estrogen.
  •  It is the most common gynecologic malignancy and has a low mortality rate, since most cases are diagnosed early.
  •  The first sign of endometrial cancer is abnormal uterine bleeding, usually in postmenopausal women.
  •  Treatment is total hysterectomy and bilateral salpingo-oophorectomy with lymph node biopsies. Radiation and chemotherapy may also be given.

-  Therapy depends on degree of prolapse and can include strengthening exercises and a pessary. SEXUAL ASSAULT

  • Sexual assault is the forcible perpetration of a sexual act on a person without his or her consent. It can include sodomy, forced vaginal or anal intercourse, oral copulation, and assault with a foreign object.
  •  Physical injuries may include bruising and lacerations to perineum, hymen, vulva, vagina, cervix, and anus.
  •  Feelings of humiliation, degradation, embarrassment, anger, self-blame, and fear of another assault are commonly expressed.
  •  Ensuring the woman’s emotional and physical safety is the highest priority.
  •  Follow-up physical and psychologic care is essential.

Lewis: Medical-Surgical Nursing, 9 th^ Edition

Chapter 55 Nursing Management: Male Reproductive Problems KEY POINTS BENIGN PROSTATIC HYPERPLASIA

-Benign prostatic hyperplasia (BPH) is prostate gland enlargement caused by increased epithelial cells and stromal tissue. BPH results from endocrine changes associated with the aging process.

  •  The compression of the urethra leads to clinical symptoms including decrease in caliber and force of the urinary stream, difficulty in initiating voiding, intermittency, and dribbling.
  •  Conservative and initial treatment for some men who have little to no symptoms is active surveillance or watchful waiting. Drug therapy with 5α-reductase inhibitors and α-adrenergic blockers may also be used.
  •  Minimally invasive therapies that destroy prostatic tissue include lasers, radiowaves, ultrasound, microwaves, and electrical current.
  •  Invasive treatment of symptomatic BPH involves prostate resection or ablation. The gold standard of treatment is a transurethral resection of the prostate (TURP). o Care in the immediate postoperative period revolves around preventing complications, restoring urinary control, and for the patient to have satisfying sexual expression. o You have an important role in discharge teaching. Instructions include catheter care, managing urinary control, preventing constipation, observing for infection, and counseling regarding sexual functioning.

PROSTATE CANCER

Prostate cancer is an androgen-dependent carcinoma that is usually slow growing.  It is the most common cancer among men, excluding skin cancer.  The most common site for metastasis is the bone.  Risk factors include family history, age, and ethnicity.  Symptoms of prostate cancer are similar to those for BPH, including dysuria, hesitancy, dribbling, frequency, and urgency. Low back pain may accompany metastases.  Elevated levels of prostate-specific antigen (PSA) indicate prostatic pathology, although not necessarily prostate cancer.  Care of the patient depends on the stage of the cancer and health of the patient. There is more than one treatment possible for all stages. o Active surveillance is the conservative approach to management. It is also called “Safe” sex practices include abstinence, monogamy with the uninfected partner, watchful waiting.” o Invasive therapies include radical prostatectomy and cryosurgery. o Other treatments include radiation (external beam and brachytherapy) and drug therapy.

  •  Treatment side effects frequently include changes in sexual, bowel, and urinary functioning.
  •  Nursing care for the patient with prostate cancer revolves around the diagnoses of pain, urinary retention, impaired urinary elimination, sexual dysfunction, anxiety, and altered bowel elimination.
  •  Encourage patients to consult with their health care providers on the risks and benefits of routine prostate cancer screening. Annual prostate screening usually includes PSA and digital rectal examination. Screening can start at age 50 or younger if risk factors are present. PROSTATITIS
  •  The term prostatitis describes a group of inflammatory and noninflammatory conditions affecting the prostate gland.
  •  It includes acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis.
  •  Acute and chronic bacterial prostatitis result from organisms reaching the prostate gland by ascending from the urethra, descending from the bladder, and invasion via the bloodstream or the lymphatic channels.
  •  The etiology of chronic prostatitis/chronic pelvic pain syndrome is not known. Asymptomatic inflammatory prostatitis is usually diagnosed in individuals with no symptoms.
  •  Antibiotics are used for acute and chronic bacterial prostatitis. Antibiotic therapy is often ineffective for patients whose prostatitis is not due to bacteria.
  •  Patients with acute and chronic bacterial prostatitis experience a great amount of discomfort, which resolves as infection is treated. Pain management for chronic prostatitis/chronic pelvic pain syndrome is difficult since pain can persist for months.
  •  For bacterial conditions, encourage the patient to drink plenty of fluids and manage fever (if present). PROBLEMS OF THE PENIS
  • Phimosis is a tightness or constriction of the foreskin around the head of the penis making retraction difficult. It is caused by edema or inflammation of the foreskin, usually associated with poor hygiene techniques. Goal of treatment is to return the foreskin to its natural position over the glans penis through manual reduction.

-Erectile dysfunction (ED) is the inability to attain or maintain an erect penis that allows satisfactory sexual performance. It is estimated that 50% of men between ages 40 and 70 have at least some degree of ED. -  ED can result from a number of etiologic factors, with the most common cause being vascular. -  An inability to perform sexually can cause great distress. -  Goal of therapy is for the patient and his partner to achieve a satisfactory sexual relationship. Treatment for ED is based on the underlying cause. -  Many treatment options are available, including oral drugs, vacuum constriction devices, intraurethral devices, and implants. -  Sexual counseling is often recommended before and after treatment. ANDROPAUSE

  • Andropause is a gradual decline in androgen secretion that occurs in most men as they age. The main androgen reduced is testosterone. Factors that determine the rate of decline are not clearly known. Andropause is also called late onset hypogonadism and male menopause.
  •  Signs and symptoms associated with a lowered level of testosterone include loss of libido, fatigue, and erectile dysfunction. Long-term effects can include osteoporosis and decreased muscle mass and strength.
  •  The diagnosis is made after a complete physical examination. Serum total testosterone levels are obtained. Treatment consists of testosterone replacement therapy. INFERTILITY -  Male infertility can be caused by disorders of the hypothalamic-pituitary system or testes and abnormalities of the ejaculatory system. -  The first test for male infertility is a semen analysis. Additional tests include plasma testosterone, and serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) measurements. Sperm penetration ability studies may also be done. -  Treatment options include medication, lifestyle changes, in vitro fertilization, and corrective surgery.