Reproductive System. Zoya Minasyan , RN, MSN-EDU. Benign Prostate Hyperplasia. Enlargement of prostate gland resulting from increase in number of epithelial cells and stromal tissue Enlargement gradually compresses urethra. Partial or complete obstruction
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ZoyaMinasyan, RN, MSN-EDU
Benign prostatic hyperplasia. The enlarged prostate compresses the urethra.
History and PE
DRE ( digital rectal exam), prostate can be palpated by DRE.
Urinalysis with culture( presence of infection).
PSA level (Prostate-specific antigen is a protein produced by cells of the prostate gland).
Serum creatinine (for renal insufficiency)
TRUS scan(trans rectal ultrasound) for the size of prostate.
Uroflometry (volume of urine expelled from the bladder per second)
Cystoscopy for internal visualiziation of the urethra and bladder.
Focus: early detection and treatment
Yearly physical exam and DRE for men over 50
Educate patients that alcohol, caffeine, and cold and cough meds can increase symptoms.
Instruct patient with obstructive symptoms to urinate every 2 to 3 hours and when first feeling urge.
Teach for adequate fluid intake. Use aseptic technique when using urinary catheter.
Administer antibiotics preoperatively.
Postop bladder irrigation to remove blood clots and ensure drainage or urine
Teach Kegel exercises.
Observe patient for signs of infection.
Stool softeners to prevent straining
Is a malignant tumor of the prostate gland
One out of five men will develop at some point during there life
Early stages are asymptomatic and later on symptoms of BPH
Pain that radiate down to the hips or legs plus urinary symptoms may indicate metastasis
Hypospadias: urethral meatus is located on the ventral surface of the penis
Epispadias: an opening of the urethra on the dorsal surface
Phimosis: tightness or constriction of the foreskin around the head of the penis
Paraphimosis: tightness of the foreskin resulting in inability to pull it forward
Priapism: painfull erection lasting >6hour caused by obstruction of the venous outflow in the penis
Peyronie’s disease: curved penis caused by plaque formation in one of the corpora cavernosa
Epididymitis: inflammation caused by infection trauma, urinary reflux
Orchitis: inflammation of testes; painful, tender and swollen
Cryptochidism: un-descended testes into the scrotal sac before birth
Hydrocele: fluid filled mass results from lymphatic mallfunction
Spermatocele: sperm containing painless cyst of the epidiydimis
Varicocele: dilation of the veins that drain the testes
Testicular torsion: twisting of the spermatic cord that supplies blood to the testes and epididymis
Erectile dysfunction: ED caused by DM, vascular disease, decreased hormones, trauma, stress, depression,
Vasectomy: bilateral surgical ligation or resection of the vas deferens. Done in 15-30 min, local anesthesia
Andropause: decline in androgen with aging, decreased level of testosterone
STDs are diseases that can be transmitted during intimate sexual contact.
Most prevalent communicable diseases in the US.
Most cases occur in adolescents and young adults.
- STDs in infants and children usually indicate sexual abuse and should be reported. The nurse is legally responsible to report suspected cases of child abuse.
Syphilis ( TreponemaPallidum)
Chlamydia ( Chlamydia Trachomatis)
Trichomoniasis ( TrichomonasVaginales)
Candidiasis ( Candida Albicans)
Herpes Type 2 (herpes Simplex Virus 2)
HPV ( Human Papilloma Virus)
HIV and AIDS ( Human Immunodeficiency Virus)
Deficient Knowledge related to
Anxiety related to
Anticipatory grieving related to
Use a non judgmental approach. Be straightforward when taking history.
All information is strictly confidential. Obtain a complete sexual history.
Develop teaching Plan include:
Sign and symptom of STDs.
Mode of transmission of STDs
Reminder that sexual contact should be avoided with anyone while infected.
Concise written instruction about treatment; request a return verbalization of these instructions to ensure the client has heard the instructions and understands them.
Encourage client to provide information regarding all sexual contacts.
Report incidents of STDs to appropriate health agencies and departments.
Instruct women of childbearing age about risk to a newborn:
a. Gonorrheal conjuctivitis
b. Neonatal herpes
c. Congenital syphilis
d. Oral candidiasis
Teach safer sex
Safer sex behavior include:
a. Reduce the number of sexual contacts.
b. Avoid sex with those who have multiple partners.
c. Examine genital area and avoid sexual contact if
anything abnormal is present.
d. Wash hands and genital area before and after
e. Use a latex condom as a barrier.
f. Use water based lubricants rather than oil based lubricants.
g. Avoid douching before and after sexual contact: douching increase the risk for infections because the body’s normal defenses are reduced or destroyed.
h. Seek attention from health care provider immediately if symptoms occur.
Complications of STD’s
Pelvic Inflammatory Disease (PID)
Cancer (associated with HPV)
Fetal and infant death
AIDS has a set of complications much broader than the other STD’s
Profuse, purulent drainage in a patient with gonorrhea.
Endocervicalgonorrhea. Cervical redness and edema with discharge.
Skin lesions with disseminated gonococcal infection. A, On the hand. B, On the fifth toe.
All sexual contacts of patients must be evaluated and treated.
Patient should be counseled to abstain from sexual intercourse and alcohol during treatment.
Reexamine if symptoms persist after treatment.
Chlamydialepididymitis. Red, swollen scrotum.
Caused by herpes simplex virus (HSV)
Enters through mucous membranes or breaks in the skin during contact with infected persons
HSV reproduces inside cell and spreads to surrounding cells.
Virus enters peripheral or autonomic nerve endings.
Ascends to sensory or autonomic nerve ganglion, where it is dormant
Recurrence when virus descends to initial site of infection
Persists for life
Unrupturedvesicles of herpes simplex virus type 2 (HSV-2). A,Vulvar area. B,Perianal area.
C, Penile herpes simplex, ulcerative stage.
Autoinoculation of herpes simplex virus (HSV) to the lips.
Genital warts. A, Severe vulvular warts. B,Perineal wart. C, Multiple genital warts of the
Risk for infection
Ineffective health maintenance
Discuss practices with all patients.
Teach to inspect partner’s genitals.
Some protection if void immediately after intercourse; wash genitalia and adjacent areas with soap and water
Proper use of condoms
Avoiding sexual contact with HIV-infected persons
Compassion and respect
Locating and examining all contacts of person with STD for testing and treatment
Counseling to verbalize feelings
Explaining side effects, need for treatment adherence, and follow-ups
Emphasize hygiene (hand washing, bathing).
Avoid synthetic materials in undergarments.
Abstinence during treatment period, condoms afterward
Avoid oral-genital contact.
When caring for a patient with a sexually transmitted disease, it is important that the nurse teach the patient to:
1. Advise all sexual partners of the need for treatment.
2. Use a condom for sexual intercourse during treatment.
3. Engage in monogamous relationships to prevent reinfection.
4. Wash the genitalia before sexual intercourse to prevent disease transmission.
The nurse teaches the patient with genital herpes about the use of:
1. Acyclovir ointment.
2. Oral acyclovir (Zovirax).
3. Human papillomavirus vaccine.
4. Podofilox (Condylox) topical gel.
Pelvic inflammatory disease. Acute infection of the fallopian tubes and ovaries. The tubes and
ovaries have become an inflamed mass attached to the uterus. A tubo-ovarian abscess is also present.
The rectovaginal septum is the connective tissue that separates the rectum (bowel) from the vagina.
Defects in the rectovaginal septum can result in a rectocele.
The rectovaginal septum is attached at its upper portion to the cervix and the lower portion to the perineum.
The perineum is the space between the vaginal opening and the anus.
A rectocele occurs when a break in the septum allows the rectum to push into the vaginal area.
Risk Factors for Cystocele
Risk Factors for Rectocele
Cystocele : Anterior colporrhaphy – This uses a vaginal approach, the pelvic muscles are tightened.
Rectocele: Posterior colporrhapy– Using a vaginal perineal approach, the pelvic muscles are tightened.
Anterior Posterior Repair if surgery for both Cystocele and Rectocele is indicated.
1. Avoid traumatic vaginal childbirth – early and adequate episiotomy.
An episiotomy is a surgical incision made in the area between the vagina and anus (perineum). This is done during the last stages of labor and delivery to expand the opening of the vagina to prevent tearing during the delivery of the baby.
2. Inform the client about measures to prevent atrophic vaginitisand of the advantage of prevention.
Atrophic vaginitis (also known as vaginal atrophy or urogenital atrophy) is an inflammation of the vagina (and the outer urinary tract) due to the thinning and shrinking of the tissues, as well as decreased lubrication. This is all due to a lack of the reproductive hormone estrogen.
The most common cause of vaginal atrophy is the decrease in estrogen which happens naturally during perimenopausal, and increasingly so in post-menopausal stage. However this condition can sometimes be caused by other circumstances. .
3. To loose weight if obese.
4. To eat high-fiber diet and drink adequate fluids to prevent constipation.
Kegel exercises – tightened pelvic muscles for a count of 10, relax slowly for a count of 10 repeat in sequences of 15 in lying down, sitting, and standing position.
Kegel exercises are said to be good for treating vaginal prolapse and preventing uterine prolapsein women and for treating prostate pain and swelling resulting from benign prostatic hyperplasia(BPH) and prostatitis in men.
2. Estrogen Therapy – to prevent uterine atrophy and atrophic vaginitis.
Inform client of client’s risk from complication of
hormone therapy. E.g. cardiovascular or embolic
Monitor for s/e of estrogen therapy e.g. water retention, headaches.
3. Weight loss and changes in diet.
4. Vaginal Pessary– removable rubber, plastic or silicon device inserted into the vagina to provide support and block protrusion into vagina.
Teach client how to insert, remove, and clean the device.
Monitor for possible bleeding or fistula formation.
A vaginal pessary is a removable device placed into the vagina. It is designed to support areas of pelvic organ prolapsed.
5. Provide a liquid diet followed by low – residue diet until normal bowel function returns.
6. Instruct client how to care for indwelling catheter at home.
7. Recommend to client to drink at least 2,000 ml of fluid daily, unless contraindicated.
8. Following removal of the catheter, instruct the client to void every 2-3 hour to prevent a full bladder and stress on stitches.
9. Teach the client how to perform client intermittent self-catheterization techniques in the event that client is unable to void.
10. Caution the client to avoid straining at defecation, sneezing, coughing, lifting, and prolonged sitting, walking, or standing following surgery.
11. Instruct the client to tighten and support pelvic muscles when coughing or sneezing.
12. Post-operative restrictions include avoidance of strenuous activity, weight lifting greater than 5 lbs. and sexual intercourse.
Residual urine in the bladder at risk for recurrent bladder infection and possibly kidney infections.
Dyspareunia (painful sexual intercourse) is a possible surgical complication due to surgical alteration of the orifice.
Cystocele and rectocele develop in older female clients usually following menopause.
Older clients tend to overuse laxatives and enemas for the relief of constipation.
Older adults are more susceptible to post-operataive complications.
Performing Kegel exercises and manipulating pessary maybe more difficult for older adults.
Occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus.
The uterus then descends into the vaginal canal.
affects postmenopausal women who've had one or more vaginal deliveries.
Damage to supportive tissues during pregnancy and childbirth.
Effects of gravity.
Loss of estrogen.
Repeated straining over the years which can weaken pelvic floor and lead to uterine prolapse.
Pregnancy and trauma incurred during childbirth, particularly with large babies or after a difficult labor and delivery.
Loss of muscle tone associated with aging
In rare circumstances, may be caused by a tumor in the pelvic cavity.
Genetics : Women of Northern European descent have a higher incidence of uterine prolapse than do women of Asian and African descent.
One or more pregnancies and vaginal births
Giving birth to a large baby
Frequent heavy lifting
Frequent straining during bowel movements
Genetic predisposition to weakness in connective tissue
Some conditions, such as obesity, chronic constipation and chronic obstructive pulmonary disorder (COPD), can place a strain on the muscles and connective tissue in the pelvis and may play a role in the development of uterine prolapse.
Sign and Symptoms:
Mild uterine prolapse client may experience no signs or symptoms.
Moderate to severe uterine prolapse
- Sensation of heaviness or pulling in pelvis
- Tissue protruding from your vagina
- Urinary difficulties, such as urine leakage or urine retention
- Trouble having a bowel movement
- Low back pain
- Feeling as if sitting on a small ball or as if something is falling out of vagina
- Sexual concerns
- Symptoms that are less in the morning and worsen as the day goes on.
A complete pelvic exam
-Client will be examined while lying down and while standing up. Your physician may ask client to bear down as if having a bowel movement to see how much that affects the degree of prolapse.
To check the strength of your pelvic muscles, client may also be instructed to contract them, as if you are stopping the stream of urine.
-Ultrasound or magnetic resonance imaging (MRI)
For mild uterine prolapse, treatment usually is not needed.
Options include using a supportive device (pessary) inserted into the vagina or having surgery to repair the prolapse.
Loosing weight, stopping smoking
Achieve and maintain a healthy weight, to
Perform Kegel exercises, to strengthen pelvic floor muscles.
Avoid heavy lifting and straining, to reduce abdominal pressure on supportive pelvic structures.
less pain after surgery, faster healing and a better cosmetic result.
Laparoscopic techniques — using smaller abdominal incisions, a lighted camera-type device (laparoscope) to guide the surgeon— offer a minimally invasive approach to abdominal surgery.
Balloon thermotherapy for treatment of menorrhagia. A, Balloon-tipped catheter is inserted into the
uterus through the vagina and cervix. B, The balloon is inflated with a sterile fluid that expands to fit the size
and shape of the uterus. The fluid is heated to 188° F (87° C) and maintained for 8 minutes while the uterine
lining is treated. C, Fluid is withdrawn from the balloon and the catheter is removed.
Menorragia-excessive or prolonged bleeding
Oligomenorrhia-long intervals between meses-more than 35 days
Metrorrhagia- irregular bleeding or bleeding between menses
Ectopic pregnancy occurring in the fallopian tube.
Laparoscopic treatment of ectopic pregnancy in the right fallopian tube.
Implantation of the fertilized ovum anywhere outside the uterine cavity
Can cause abdominal pain, vaginal bleeding, breast tenderness, GI disturbance
Mastalgia- breast pain
Mastitis- inflammatory condition
Fibroadenoma-benign breast lumps
Fibrocystic changes-benign condition caused by development of excess fibrous tissue and cyst formation