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Stressors of the Female and Male Reproductive Systems. NUR240. Endometriosis. Endometriosis is usually a benign problem of endometrial tissue implantation outside the uterine cavity.

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Stressors of the female and male reproductive systems

Stressors of the Female and Male Reproductive Systems

NUR240

JBorrero 10/08


Endometriosis
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
Collaborative Management

  • Nonsurgical management includes hormone manipulation.

  • Surgical management includes:

    • D&C- Dilation and curettage

    • Laser or balloon endometrial ablation

    • Hysterectomy


Uterine prolapse
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
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
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
Fistulas

  • Abnormal openings between two adjacent organs or structures

  • Etiology

  • S&S

  • Nonsurgical treatment

  • Surgical treatment


Bartholin cyst
Bartholin Cyst

  • Obstruction of the duct of the Bartholin’s gland

  • Simple incision and drainage

  • Marsupialization (formation of a pouch)

  • Postoperative care


Uterine tumors
Uterine Tumors

Nonmalignant:

Fibroids or Leiomyomas

Malignant:


Endometrial cancer
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
Endometrial CancerDx 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
TX: Radiation Therapy

  • External and internal

  • Teletherapy

  • Brachytherapy

  • Intracavitary radiation


Surgical management
Surgical Management

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy

  • Radical hysterectomy with bilateral pelvic lymph node dissection for stage II cancer


Cervical 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
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
Diagnostic Assessment

  • Pap smear

  • Colposcopic examination

  • Endocervical curettage


Nonsurgical management
Nonsurgical Management

  • Local ablation of using the loop electrosurgical excision procedure

  • Laser therapy

  • Cryotherapy

  • Radiation therapy

  • Chemotherapy

  • Conization


Surgical management1
Surgical Management

  • Clinical staging performed before surgery to establish extent of the disease

  • Simple hysterectomy

  • Radical hysterectomy

  • Pelvic exenteration


Postoperative care
Postoperative Care

  • Early stages of recovery, assess for:

    • Hemorrhage and shock

    • Pulmonary complications

    • Fluid and electrolyte imbalances

    • Renal or urinary complications

    • Pain


Postoperative care1
Postoperative Care

  • Later stages of recovery, assess for:

    • Deep vein thrombosis

    • Pulmonary emboli

    • Paralytic ileus

    • Wound infections

    • Wound dehiscence

    • Wound evisceration

    • Pain


Ovarian cancer
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
Management

NONSURGICAL

  • Chemotherapy with agents such as cisplatin, carboplatin, and paclitaxel

  • Radiation therapy


Management1
Management

SURGICAL

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy

  • Staging

  • Second-look procedure usually after 1 year of chemotherapy


Assessment
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
Laboratory Assessment

  • Urinalysis

  • Complete blood count

  • Blood urea nitrogen and creatinine levels

  • Prostate-specific antigen

  • DRE

  • C&S


Drug therapy
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
Surgical Procedures

  • Transurethral resection of the prostate AKA TURP

  • Suprapubic prostatectomy

  • Retropubic prostatectomy

  • Perineal prostatectomy


Continuous bladder irrigation cbi
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
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
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
Prostate Cancer: Dx

  • Digital rectal examination

  • Prostate-specific antigen (PSA)

  • Biopsy necessary to confirm suspected prostatic cancer


Surgical treatment radical prostatectomy
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
Complications

  • Urinary incontinence

  • Erectile dysfunction


Nonsurgical management1
Nonsurgical Management

  • Radiation therapy

  • Hormonal therapy

  • Chemotherapy

  • Targeted therapy


Testicular cancer
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
Diagnostics

  • Alpha-fetoprotein

  • Beta subunit of hCG

  • Ultrasound

  • Computed tomography

  • Magnetic resonance imaging

  • Lymphangiograms


Risk for sexual dysfunction
Risk for Sexual Dysfunction

Oligospermia, azoospermia

Interventions include:

  • Health teaching about reproduction, fertility, and sexuality

  • Sperm storage

  • Other reproductive options


Potential for metastasis
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 management2
Nonsurgical Management

  • Chemotherapy

  • Radiation therapy

  • Stem cell transplantation


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