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Reproductive Health

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    1. Reproductive Health Ricci Chapters 4-9

    3. Cause of Discomfort/Primary Dysmenorrhea Pain during menses Role of prostaglandin Interventions Oral contraceptives Diet- Vitamins Rest exercise Heat Anti-prostaglandin

    4. Secondary Dysmenorrhea Define- pain with menses after menses well established. Etiology: reproductive tract pathology Assess- reproductive hx Interventions: DX and treat cause

    5. Abnormal Bleeding Amenorrhea- lack of menses Menorrhagia- excessive bleeding- 5 days Metrorrhagia- bleeding between cycles Oligomenorrhea-infrequent periods Polymenorrhea-too frequent Menometrorrhagia-irregular with heavy flow Risk for anemia- causes-hormones, fibroids, weight

    6. Dysfunctional Uterine Bleeding Extremes of reproductive years Progesterone- estrogen imbalance Tx- hormones, OC,NSAIDS IUD Nursing- Education, information, if untreated can lead to infertility

    7. PMS Exact etiology unknown Thought to be: Hormonal imbalance Nutritional deficiency Prostaglandin excess Serotonin

    8. Symptoms of Syndrome DX takes 3-5 months Physical symptoms include: fluid retention-weight gain-H/A- backache-N/V- diarrhea-constipation- craving- sleep disturbance Emotional- Mood changes-hostility- depression-labile-anxiety- lethargy Resolves with onset of menses

    9. Endometriosis Endometrial tissue outside of endometrium Hormonal changes cause bleeding and inflammation, scarring S/S- pain, bleeding, painful intercourse. Tx- remove tissue, OC Nursing- explain tests, pain management

    10. Infertility Definition unable to conceive after 1 yr Female - blocked tubes, endometriosis, 40% of cases attributed to women Dx-hystosalpingography Tx- surgery medications Male- sperm problems, 40% attributed to male DX- semen analysis Tx- artificial insemination- donor

    11. Health promotion Related to Infertility Physiological Psychological- self esteem, scheduled intercourse, expense Sociocultural expectations Developmental expectations Spiritual- grieving

    12. Behavioral Contraception Abstinence- other activities beside intercourse Fertility awareness-know cycle and S/S of fertility BBT-post ovulation increase in temp,temp before rising Sympothermal- BBT,cervical mucosa+ positioning

    13. Behavioral Contraception Coitus Interuptus-withdraw before ejaculation. First few drops of sperm have high concentration of sperm Lactation Amenorrhea-prolactin inhibits gonadatropin Effectiveness depends on exclusivity of BF

    14. Barrier Methods Condoms-placed correctly, STI protection Diaphragm- covers cervix Must be refitted for weight loss or gain Cervical cap-smaller, insert 12 hours before intercourse Sponge- no protection against STI

    15. Hormonal Contraceptive Oral-combination of estrogen or progestin Suppresses FSH- LH makes mucosa hostile Take at same time each day Contraindicated- women over 35 & smokers Can take for up to 3 months Report to HCP if side effects occur

    16. Hormonal Contraceptives Lunelle injection- once a month Depo provera-progesterone every 12 weeks Vaginal Ring-place for 3 weeks Norplant-implantable- last 5 years, same S/E as the pill IUD- endometrium hostile to implantation Emergency Contraception- within 72 hrs

    17. Permanent Sterilization Tubal ligation- dissect piece of fallopian tube Trancervically- coil blocks fallopian tube Vasectomy-cut vas defrens Need 2 ejaculates with no sperm Use alternative form of birth control

    18. Termination of Pregnancy Physiological Surgical vs. medical Mode of termination dependent upon gestation Psychological tasks of the trimester Informed consent Legal parameters Age Religious ethical

    19. Nursing Considerations Cost Will both use Religion- Culture Medical History Reproductive History Consent

    20. Menopause Ovaries decrease production of estrogen Cessation of menses before menopause Peri menopausal 3-5 years Average age is 51 Estrogen produced by fat replaced by estrone

    21. Characteristics of Menopause Physiologic Hot flashes-CV-osteoporosis-skin-urogenital changes Psychological- empty nest-new beginning- not hot flashes------power surges

    22. Physiological Changes R/T Menopause Osteoporosis- bone loss related to aging Risk factors- familial hx, steroids, smoking, lack of exercise Nursing-Increase calcium (1200mg), exercise, eval for height change Cardiovascular- loose protection of estrogen Nursing- Promote healthy lifestyle

    23. Interventions Estrogen replacement at risk for Ca Hormonal replacement at risk for breast Ca Calcium- 1200mg-1500mg Natural sources of estrogen

    24. STI Vulvovaginal candidiasis-change in flora Nsg-hygiene, cotton underwear, douching Trichamonis-bacterial Nsg-condoms, do not share towels BV-alteration in flora Nsg- treat partner for reoccurrence

    25. STI Chlamydia-men/women asympomatic Nsg- treat both, no intercourse until TOC Genital Herpes-itching/burning lesion Nsg-need C/S for outbreak Syphilis-progressive -at risk for HIV Nsg- RPR, VDRL,Pen G

    26. Pelvic Inflammatory Disease Bacterial infection of pelvic organs Leading cause of infertility S/S-cramping, painful intercourse, temp, bleeding, foul smelling discharge Nsg- assess for sexual activity, risk for infection, STI, full course ABX

    27. HIV World wide epidemic Women of color at risk Dx based upon CD4 count less than 200 Antiviral decrease of transmission to newborn Nsg- understand illness, stay on meds, help with side effects

    28. STI HPV- genital warts, most common viral infection Some strains=95% relationship with cervical ca Nsg- can have removed, virus remains Hep A/B-viral infection Nsg- safe sex, immunizations Scabies/ lice- tx with OTC meds

    29. Breast Disorders Fibrocystic breast- common benign tumor S/S- lumpy, pain tenderness Nsg-Diet changes, analgesic Fibroadenoma-moveable cyst, benign Nsg- mammogram, biopsy Intraductal papilloma- may be cancerous S/S- discharge from nipple Nsg-excision to r/o ca.

    30. Breast Disorders Mammary duct ectasia-inflammation of duct Common in women with children, have not breast feed S/S- discharge, pain, puritis Nsg- take ABX, warm compress

    31. Breast Cancer Hereditary component Usually over 50- under 50 aggressive Ca Upper outer quadrant Family hx- prolonged exposure to estrogen-nullipara-early menarche- late menopause- HRT-ERT- breast d/o-obesity- alcohol

    32. Detection Breast self exam- one week past menses Ab. Finding- lump dimpling-vein-nipple discharge or retraction Mammogram- biopsy Baseline at 40 1-2 years 40-50 Yearly past 50 Earlier if family hx

    33. Cancer Staging Stage 1- less than 2cm and in breast only Stage 2- less than 5cm, mobile lymph node- not attached Stage 3-greater than 5 cm/ fixed lymph/ local extension Stage 4- distant metastases

    34. Treatment Options Surgical Radical vs. partial Lumpectomy Chemotherapy Radiation Hormonal suppression Immunotherapy

    35. Nursing- Mastectomy Preoperative- Discuss tx options Support decision Reduce fear- improve coping Postoperative Pain control Maintain skin integrity Self care Coping Sexual adjustment Prevent lymph edema Promote screening and prevention

    36. Types of Prolapse Cystocele-posterior bladder protrudes towards ant wall of vagina Rectocele-rectum sags into post. Wall of vagina Enterocele- Sm. intestine bulges posterior wall of vagina Uterine prolapse- through pelvic floor and out vagina

    37. Risk Factors Children Gravity Atrophy Weak muscles Lifting, coughing, straining can exacerbate

    38. Nursing Assess degree of discomfort Degree of incontinence Diet and lifestyle-Kegels, straining,fiber, weight, girdle, no lifting Pessary- can support structures Surgical-colporrhaphy-hysterectomy

    39. Incontinence Embarrassing, reluctance to discuss, can cause emotional problems Cause- weakness in pelvic floor- aging Urge-urgency, frequency, nocturia Stress- coughing, laughing, exertion Tx- Kegels, anticholinergic,estrogen lifestyle changes

    40. Polyps/Fibroids Appear on reproductive organs-benign Will remove with forceps or laser Fibroids- masses inside uterus Pain, pressure, bleeding, infertility Tx- hormones, myomectomy, hysterectomy

    41. Female Reproductive Surgeries Hysterectomy- vaginal vs. abdominal Laproscopic- visualize abdominally remove through vagina Abdominal more trauma and longer recovery

    42. Nursing Care Nursing Diagnosis Pre-op- pain, deep breath, and cough Give information, loss of childbearing Post operative interventions Pelvic rest, no lifting, S/S of infection, rest, good diet

    43. Cysts Follicular cyst-failure of ovarian follicle to rupture Corpus luteum-failure of C.L to degenerate Theca Lutein-high levels of hCG Polycystic ovaries-hyperandrogenism, insulin resistance, hirsituism, infertile OC to suppress androgen, restore reproductive fx

    44. Reproductive Cancers Cervical- most preventable-Pap smear R/T-HPV, early intercourse, multiple partners, STI, HIV Coploscopy- stained cells sent for biopsy Cone biopsy-remove precancerous cells LEEP-heated or electrical current Laser

    45. Endometrial Cancer Most caught early- post menopausal bleeding Risk factors- nulliparity, obesity, infertility Dx- biopsy-UTZ Tx- hysterectomy, ovaries and tubes Need follow-up chance or reoccurence

    46. Ovarian Bad outcomes due to late diagnosis Risk factors-nulliparity, late menarche and menopause, obesity Postmenopasusal cyst- must evaluate Tx- hysterectomy Nursing is primary prevention-early symptoms

    47. Vaginal/Vulvar Rare slow developing Risk factors-HPV, HIV, age S/S- painful intercourse, discharge, pain Tx- laser, radiation, hysterectomy Vulvar-ext genitalia Risk factor- HPV, smoking, age Tx-laser, cryo, may need skin graft

    48. Violence Not always physical Abusers are from all SES Violence is learned and perpetuated Children develop mistrust of world

    49. Phases of Violence Tension building- unresolved issues Violence-physical and emotional abuse Reconciliation-apologetic Types of abuse Mental-threatening, demeaning, controlling Physical- hitting, grabbing Sexual- forced sex

    50. Violence During Pregnancy Can escalate during pregnancy Should screen during PNC and ER Spouse may feel threatened She is vulnerable More likely to have mental health issues

    51. Sexual Violence May be under reported Sexual violence is about power and control Person abused more likely to abused again Incest- forced by family members Aquaintance rape- under reported, feel guilty

    52. Female Genital Mutilation Female circumsicion- practiced in other countries Leave opening for urine and menstrual flow May need reconstructive surgery

    53. Violence Human trafficking-mostly children, sold into prostitution, porn PTSD-re-experience event, flashbacks, avoidance

    54. Nursing Evaluate for injuries Is partners behavior suspicious Use non-judgmental approach Educate Support decisions Use community resources Help to develop coping skills Help to break cycle of violence