Stressors of the Female and Male Reproductive Systems

1. Stressors of the Female and Male Reproductive Systems NUR240 JBorrero 10/08

2. 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.

3. Collaborative Management • Nonsurgical management includes hormone manipulation. • Surgical management includes: • D&C- Dilation and curettage • Laser or balloon endometrial ablation • Hysterectomy

4. 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

5. 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

6. 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

7. Fistulas • Abnormal openings between two adjacent organs or structures • Etiology • S&S • Nonsurgical treatment • Surgical treatment

8. Bartholin Cyst • Obstruction of the duct of the Bartholin’s gland • Simple incision and drainage • Marsupialization (formation of a pouch) • Postoperative care

9. Uterine Tumors Nonmalignant: Fibroids or Leiomyomas Malignant:

10. Endometrial Cancer • Endometrial cancer is a reproductive cancer, of which adenocarcinoma is the most common type. • The main symptom is postmenopausal bleeding.

11. 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)

12. TX: Radiation Therapy • External and internal • Teletherapy • Brachytherapy • Intracavitary radiation

13. Surgical Management • Total abdominal hysterectomy and bilateral salpingo-oophorectomy • Radical hysterectomy with bilateral pelvic lymph node dissection for stage II cancer

14. 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

15. 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

16. Diagnostic Assessment • Pap smear • Colposcopic examination • Endocervical curettage

17. Nonsurgical Management • Local ablation of using the loop electrosurgical excision procedure • Laser therapy • Cryotherapy • Radiation therapy • Chemotherapy • Conization

18. Surgical Management • Clinical staging performed before surgery to establish extent of the disease • Simple hysterectomy • Radical hysterectomy • Pelvic exenteration

19. Postoperative Care • Early stages of recovery, assess for: • Hemorrhage and shock • Pulmonary complications • Fluid and electrolyte imbalances • Renal or urinary complications • Pain

20. Postoperative Care • Later stages of recovery, assess for: • Deep vein thrombosis • Pulmonary emboli • Paralytic ileus • Wound infections • Wound dehiscence • Wound evisceration • Pain

21. 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

22. Management NONSURGICAL • Chemotherapy with agents such as cisplatin, carboplatin, and paclitaxel • Radiation therapy

23. Management SURGICAL • Total abdominal hysterectomy and bilateral salpingo-oophorectomy • Staging • Second-look procedure usually after 1 year of chemotherapy

24. 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

25. Laboratory Assessment • Urinalysis • Complete blood count • Blood urea nitrogen and creatinine levels • Prostate-specific antigen • DRE • C&S

26. 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

27. Surgical Procedures • Transurethral resection of the prostate AKA TURP • Suprapubic prostatectomy • Retropubic prostatectomy • Perineal prostatectomy

28. 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

30. 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.

31. 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

32. Prostate Cancer: Dx • Digital rectal examination • Prostate-specific antigen (PSA) • Biopsy necessary to confirm suspected prostatic cancer

33. 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

34. Complications • Urinary incontinence • Erectile dysfunction

35. Nonsurgical Management • Radiation therapy • Hormonal therapy • Chemotherapy • Targeted therapy

36. 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.

37. Diagnostics • Alpha-fetoprotein • Beta subunit of hCG • Ultrasound • Computed tomography • Magnetic resonance imaging • Lymphangiograms

38. Risk for Sexual Dysfunction Oligospermia, azoospermia Interventions include: • Health teaching about reproduction, fertility, and sexuality • Sperm storage • Other reproductive options

39. 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

40. Nonsurgical Management • Chemotherapy • Radiation therapy • Stem cell transplantation