Chapter 47

1. Chapter 47 Female Reproductive Disorders

2. Learning Objectives • List data to be collected when assessing the female reproductive system. • Describe the nursing interventions for women who are undergoing diagnostic tests and procedures for reproductive system disorders. • Identify the nursing interventions associated with douche, cauterization, heat therapy, and topical medications used to treat disorders of the female reproductive system. • Explain the pathophysiology, signs and symptoms, complications, diagnostic procedures, and medical or surgical treatment for selected disorders of the female reproductive system.{AU: This bullet should wrap sooner on right margin.} • Assist in developing a nursing care plan for patients with common disorders of the female reproductive system. • Describe the nursing interventions for the patient who is menopausal.

3. Anatomy and Physiology of the Female Reproductive System External genitalia Mons pubis Labia majora Labia minora Clitoris Pudendum Bartholin’s glands Skene’s glands

4. Anatomy and Physiology of the Female Reproductive System Internal genitalia Vagina Uterus Fallopian tubes Ovaries Breasts

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8. Anatomy and Physiology of the Female Reproductive System Menstrual cycle Consists of ovarian cycle and uterine cycle Menstruation: passage through the vagina of a mixture of blood and other fluids and tissue formed in the lining of the uterus to receive the fertilized ovum The length of the menstrual cycle averages 28 to 30 days, but it may be 21 to 40 days; affected by stress, physical activity, and illness

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10. Health History Chief complaint and history of present illness If existing problem, include related signs and symptoms and onset, frequency, and effect on normal functioning Past medical history: menstrual history Age when menstruation began, date of onset of last period, usual number of days between, amount of flow, number of days of flow per period, use of tampons Menopause: age when menstruation ceased as well as whether menopause occurred naturally or resulted from surgery, chemotherapy, or radiation therapy

11. Health History Past medical history: obstetric-gynecologic Term and preterm births, living children, abortions Blood type, Rh factor, rubella or rubella immunization Infections and sexually transmitted infections, cysts and tumors, structural and functional abnormalities, infertility, and stress incontinence Family history Diabetes mellitus, cancer, complications of pregnancy, multiple pregnancies, genetic disorders, or congenital anomalies

12. Health History Review of systems Symptoms and prescribed or self-selected treatments Commonly reported symptoms are pain, itching, burning, vaginal bleeding between periods or after menopause, heavy or prolonged bleeding with periods, vaginal discharge, urinary frequency/urgency Functional assessment Includes a diet history, use of dietary supplements including calcium and iron, exercise pattern, sexual history, occupational exposure to potential teratogens, and effects of symptoms on usual activities

13. Physical Examination Measure vital signs, height, and weight Skin color, texture, and moisture noted. Breasts should be examined for dimpling and abnormal skin texture Abdomen inspected for distention and palpated for tenderness. The legs are inspected for swelling and palpated for tenderness Assesses the external genitalia for lesions, lumps, swelling, and discharge Vagina and uterine cervix are inspected for lesions, growths, discharge, and redness Vagina, abdomen, and rectum palpated for abnormalities

14. Diagnostic Tests and Procedures Pelvic examination Smears and cultures Endometrial and cervical biopsies Culdoscopy Laparoscopy Dilation and curettage Mammography Breast self-examination Breast biopsy

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20. Therapeutic Measures Douching Cauterization Application of heat Topical medications Surgical procedures Abdominal Vaginal Laparoscopic

21. Disorders of the Female Reproductive System

22. Uterine Bleeding Disorders Pathophysiology Metrorrhagia Bleeding or spotting between menstrual periods Menorrhagia Menstrual periods with profuse or prolonged bleeding Amenorrhea The absence of menses

23. Uterine Bleeding Disorders Etiology and risk factors Symptoms of underlying factors, rather than being specific definable conditions in themselves Causes: hormonal dysfunction, benign and malignant tumors, coagulation disorders, systemic diseases, use of some contraceptives, endometrial hyperplasia, inflammatory processes, and systemic diseases Causes of amenorrhea include pregnancy; excessive weight loss, physical activity, or stress; pituitary, hypothalamic, thyroid, or adrenal disorders; ovarian failure; and uterine abnormalities

24. Uterine Bleeding Disorders Medical diagnosis and treatment Colposcopy, biopsy, and cauterization as well as laboratory analyses of blood components, hormone levels, and tissue specimens or smears provide diagnostic information Interventions Deficient Knowledge Anxiety

25. Vulvitis and Vaginitis Pathophysiology Vulvitis Inflammation of the vulva Vaginitis Local inflammatory response to various factors Etiology and risk factors Two most common causes: Candida albicans (fungus, or yeast infection) and Trichomonas vaginalis (protozoal infection) Signs and symptoms Include local swelling, redness, and itching

26. Vulvitis and Vaginitis Complications Ascending infection Medical diagnosis Based on symptoms and on inspection of the vulva and vagina

27. Vulvitis and Vaginitis Medical treatment Specific to the causative agent Topical antifungal creams, oral antiprotozoals or antibiotics, vaginal suppositories to reestablish normal vaginal flora, topical/systemic estrogen replacement therapy, improved diabetes control, and avoidance of offending chemical agents Symptoms managed with frequent cleansing with neutral agents; wearing cotton panties, cotton-crotched pantyhose, and nonconstricting clothing; and heat in the form of sitz baths and perineal irrigations

28. Bartholin’s Gland Abscess (Bartholinitis) Pathophysiology Edema and pus formation due to infectious microorganisms occlude the duct of the affected gland and form an abscess Etiology and risk factors Commonly cultured organisms include normal intestinal bacterial flora, Staphylococcus aureus, Streptococcus pneumoniae, Trichomonas vaginalis, Neisseria gonorrhoeae, and Mycoplasma hominis

29. Bartholin’s Gland Abscess (Bartholinitis) Signs and symptoms Perineal pain, fever, labial edema, chills, malaise, and purulent discharge Complications Systemic infection Medical diagnosis Visual inspection; culture and sensitivity

30. Bartholin’s Gland Abscess (Bartholinitis) Medical treatment Oral analgesics and moist heat in the form of frequent sitz baths or hot wet packs Surgical incision and drainage of the abscess Broad-spectrum antibiotics Nursing care Instruction to help patient comply with treatment Tactful instruction in basic perineal hygiene principles is in order if the evidence indicates that inappropriate or inadequate practices are being followed

31. Cervicitis Pathophysiology Inflammation of the cervix Etiology and risk factors Infectious organisms, scraping of cells for diagnostic tests, cryosurgery, use of vaginal tampons or medications, childbirth, decreased estrogen levels after menopause, and use of oral contraceptives Signs and symptoms Usually asymptomatic, although it may cause pain, visible vaginal discharge, bleeding, or dysuria Complications Pelvic inflammatory disease

32. Cervicitis Medical diagnosis and treatment Based on pelvic examination or results of Pap smear Treated with systemic or topical antimicrobial agents If related to menopause, topical or oral estrogen Nursing care Assisting with assessment procedures, patient support, and teaching the patient to carry out the prescribed treatment and posttreatment procedures

33. Mastitis Pathophysiology Infection-induced inflammation of breast tissue in the lactating woman Etiology and risk factors Staphylococcus aureus;Escherichia coli, streptococci Signs and symptoms Usually confined to one breast; may be asymptomatic except for tenderness and low-grade (and often unsuspected) fever Symptomatic mastitis: localized pain, fever, tachycardia, general malaise, and headache

34. Mastitis Complications Abscess formation Medical diagnosis and treatment Diagnosis based on presenting symptoms Culture and sensitivity Treatment based on symptoms alone and consists primarily of immediate and aggressive antibiotic therapy Symptoms managed by frequent emptying of the breast, heat, rest, and analgesics

35. Mastitis Interventions Risk for Injury Deficient Knowledge

36. Fibrocystic Changes Pathophysiology An exaggerated response to hormonal influences Excess fibrous tissue develops accompanied by overgrowth of the lining of the mammary ducts, proliferation of mammary ducts, and the formation of cysts

37. Fibrocystic Changes Etiology and risk factors Common among women who have never given birth, have had a spontaneous abortion, and early menarche and late menopause Signs and symptoms Smooth round lumps that are freely movable may be felt; sometimes milky yellow or green discharge from the nipple

38. Fibrocystic Changes Medical diagnosis and treatment Diagnosis based on the physical exam and health history. A mammogram or ultrasound may be used No specific cure for fibrocystic changes. Danazol reduces symptoms; decreases estrogen production Nursing care Instruct the patient in self-examination and to encourage scheduled professional

39. Pelvic Inflammatory Disease Pathophysiology Infection that may affect any or all structures in pelvic portion of reproductive tract and peritoneal cavity Etiology and risk factors Most PID cases from sexually transmitted organisms N. gonorrhoeae, Chlamydia trachomatis, and M. hominis Non-STI organisms also causative agents Staphylococcal, streptococcal, and other organisms

40. Pelvic Inflammatory Disease Signs and symptoms May be a silent infection with no symptoms Symptomatic PID: with either the gradual onset of dull, steady, low abdominal pain or the sudden onset of severe abdominal pain, chills, and fever Other symptoms: dysuria, irregular bleeding, a foul-smelling vaginal discharge that may cause inflammation and skin breakdown of the vulva, dyspareunia (pain during intercourse)

41. Pelvic Inflammatory Disease Complications Ectopic pregnancy, infertility, and chronic abdominal discomfort Infection of the entire peritoneal cavity (peritonitis) and systemic septic shock also are potential complications

42. Pelvic Inflammatory Disease Medical diagnosis Culture of the causative organism or organisms; sonography, laparoscopy, and culdocentesis Medical treatment Rest; application of heat via warm compresses, a heating pad, or sitz baths; and a regimen of analgesics and broad-spectrum antibiotics Interventions Acute Pain Impaired Skin Integrity Deficient Knowledge

43. Endometriosis Pathophysiology Endometrial cells deposited in the pelvic cavity implant on structures within the cavity They continue to respond to menstrual cycle hormonal stimulation Result is the periodically painful and potentially destructive condition

44. Endometriosis Etiology and risk factors Believed to occur in 10% of all women of reproductive age Incidence and severity are greatest in women with relatives who have endometriosis Signs and symptoms Dysmenorrhea; pain with defecation, dyspareunia, and abnormal bleeding

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46. Endometriosis Complications Constriction of pelvic structures by endometriosis-related adhesions Medical diagnosis Visualization and excision of endometrial implants; ultrasonography Medical treatment Nonsteroidal anti-inflammatory agents Gonadotropin-releasing hormone (GnRH) agonists or a synthetic androgenic steroid Surgical management

47. Endometriosis Nursing care The most significant nursing interventions are validating that the pain is real and providing information about pain relief measures Patient teaching based on treatment method selected and includes anticipatory guidance and treatment-specific instructions

48. Cysts A closed saclike structure that is lined with epithelium and that contains fluid, semisolid, or solid material Classified as neoplasms and may be benign or malignant; majority are benign See Table 47-3, p. 1054

49. Fibroid Tumors Pathophysiology Benign and common Fibroid tumors grow slowly during reproductive years but atrophy after onset of menopause Etiology and risk factors Exact cause unknown; widely thought that fibroids form and grow in response to stimulation by estrogen, primarily estradiol

50. Fibroid Tumors Signs and symptoms May be asymptomatic, but the most common symptoms are menstrual irregularities—menorrhagia and dysmenorrhea Complications Infertility, crowding and malpositioning of the fetus during pregnancy, degenerative changes from interruption of blood supply