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FEMALE REPRODUCTIVE DISORDERS Chapters 39 &40 By Angie Lawson RN, BSN A&P Review Internal Structures Ovaries Fallopian tubes Uterus Vagina External Structures Breast Labia major & Labia minora Clitoris Baselines History Breast assessment Teach self exam Diagnostic tests

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a p review
A&P Review
  • Internal Structures
    • Ovaries
    • Fallopian tubes
    • Uterus
    • Vagina
  • External Structures
    • Breast
    • Labia major & Labia minora
    • Clitoris
female assessment
Baselines

History

Breast assessment

Teach self exam

Diagnostic tests

Mammograms/ultrasounds

MRI’s

Biopsy

Hormonal tests

Pelvic exam

Bimanual palpation

Cytology

Swabs & smears

Sonography

Radiographic procedures

Endoscopic exams

Female Assessment
breast disorders
Breast Disorders
  • Cyclic breast discomfort
    • Swelling tenderness & pain due to hormonal mediated changes
  • Fibrocystic Breast Disease
    • Signs & Symptoms – may have no S/S, tenderness or pain, multiple lumps, S/S most notable just menstruation
mastitis
Mastitis
  • Signs & Symptoms
    • Fever, malaise, breast tenderness, pain, redness, breast edema, firm and hard, nipple may crack and axillary lymph nodes enlarge
    • Tx with Antibiotics
breast cancer prevention
Breast Cancer Prevention
  • Long-term Follow-up Therapy
  • Bilateral Prophylactic Mastectomy
  • Chemoprevention with Tamoxifen
breast cancer
Breast Cancer
  • Signs & Symptoms
    • Painless mass, bloody nipple discharge, dimpling of the skin, retraction of the nipple, peau d’orange appearance
metastatic breast cancer
Metastatic Breast Cancer
  • Signs & Symptoms
    • Pain in the new site, pathogenic fractures (if bone involved)
cosmetic breast procedures
Cosmetic Breast Procedures
  • Mammoplasty
  • Reduction & Mastopexy
  • Breast Augmentation
  • Breast Reconstruction
    • Artificial implants
    • Autogenous tissue
menstruation disorders
Menstruation Disorders
  • Dysmenorrhea
    • Painful menstruation – not pathological
  • Premenstrual Syndrome (PMS)
    • Water retention, headaches, discomfort, changes affect, concentration and coordination
endometriosis
Signs & Symptoms

Severe dysmenorrhea

Copius menstrual bleeding

Pain on defecation

Dypareunia

Endometriosis
menopause
Menopause
  • Change of life
  • Signs and Symptoms
    • Hot flashes
    • Sweats
    • Sleep disturbances
    • Irritability
    • Vaginal dryness
    • Diminished libido
  • Hormone Replacement Therapy (HRT)
vaginitis
Vaginitis
  • Gardnerella Vaginalis
  • Trichomonas Vaginalis
  • Candida Albicans
  • Signs & Symptoms
    • Itching, Burning, Redness, Swelling
  • Medicines
    • Flagyl, Gynelotrimin, Monistat, Gantrisin
toxic shock syndrome tss
Toxic Shock Syndrome(TSS)
  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Clostridium sordellii
  • Signs & Symptoms
    • High fever, chills, tenderness, diarrhea, hypotension, hyperemia, disorientation, headache
  • Treatments
    • IV fluids, IV oxacillin, nafcillin, methicillin, dopamine, dobutamine, O2
cervicitis
Cervicitis
  • Steptococci
  • Staphylococci
  • Gonorrhea
  • Chlamydia
  • Signs & Symptoms
    • Maybe no S&S, Vaginal discharge, Spotting, Painful intercourse
  • Treatments
    • Systemic antibiotics, douches, electrocautery, conization
pelvic inflammatory disease pid
Pelvic Inflammatory Disease(PID)
  • Gonococci
  • C. Trachomatis
  • Signs & Symptoms
    • Malodorous discharge, backache, severe/aching abdominal/pelvic pain, fever, nausea, vomiting, menorrhagia, dysmenorrhea
  • Treatments
    • Parenteral/oral antibiotics, IV fluids, antipyretics
uterine displacement
Uterine Displacement
  • Signs & Symptoms
    • Backache
    • Dysmenorrhea
    • Dyspareunia
pelvic organ prolapse
Pelvic Organ Prolapse
  • Signs & Symptoms
    • Stress incontinence, cystitis, constipation, backache, pelvic pain, “feeling that something is dropping out”
fertility disorders
Fertility Disorders
  • Both male and female should be examined
  • In vitro fertilization – brings sperm and ova together outside the body
  • Offer a listening ear but do not give advice
reproductive life planning
Reproductive Life Planning
  • Oral contraceptives
  • Contraceptive implants
  • Depot medications
  • Estrogen-progestogen contraceptive ring
  • Transdermal contraceptive patch
  • Barrier methods
  • Spermicides
  • IUD’s
  • Natural Family Planning
  • Sterilization
pregnancy termination
Pregnancy Termination
  • Reasons
    • Ectopic pregnancy
    • Prenatal abnormalities
  • Methods
    • Chemical
      • morning after pill
      • RU-486
  • Mechanical
    • Vacuum aspiration
    • D&C
uterine leiomyoma fibroid tumors
Uterine Leiomyoma(Fibroid Tumors)
  • Signs & Symptoms
    • Menorrhagia, pressure, dysmenorrhea, anemia & malaise
ovarian cysts
Ovarian Cysts
  • Signs & Symptoms
    • Pressure, backache, menstrual irregularities, pain, breast atrophy, sterility, & hirsutism
vaginal cancer
Vaginal Cancer
  • Signs & Symptoms
    • Abnormal bleeding, dyspareunia & visual lesions

Vulva Cancer

  • Signs & Symptoms
    • Pruritus, genital burning, bloody discharge, enlarged lymph nodes, ulceration and swelling of the vulva
cervical endometrial cancer
Cervical & Endometrial Cancer
  • Signs & Symptom
    • Spotting (esp. with intercourse), pain, pressure, & generalized wasting.
ovarian cancer
Ovarian Cancer
  • Signs & Symptoms
    • Vague lower abd. discomfort, urinary frequency & urgency, ascites, weight loss, severe pain, & GI symptoms.
gynecological surgeries
Gynecological Surgeries
  • Endoscopic
  • Hysterectomy
    • Removal of the uterus
  • Bilateral salpingooophorectomy
    • uterus and ovaries are removed
pharmacology
Pharmacology
  • Antineoplastics – cancer (pg 584-590)
    • Alkylating Drugs
      • Cyclophosphamide (cytoxan) - ovaries & breast
      • Melphalan (alkeran) – ovaries
      • Thiotepa (thioplex) – ovaries & breast
    • Antibiotics
      • Doxorubicin HCL (adriamycin, rubex) – breast & ovaries
      • Epirubicin (ellence) - breast
pharmacology cont
Pharmacology Cont:
  • Antineoplastics drugs cont:
    • Antimetabolites
      • Capecitabine (xeloda) – breast
      • Fluorouracil (5-FU) (adrucil) – breast
      • Methotrexate (rheumatrex) – breast
    • Mitotic inhibitors
      • Docetaxel (taxotere) – breast
      • Paclitaxel (taxol) – ovaries & breast
pharmacology cont30
Pharmacology Cont:
  • Hormones
    • Androgens
      • Testolactone (teslac) – metastatic breast cancer
    • Progestins
      • Medroxyprogesterone (depo-provera) – endometrial
      • Megestrol acetate (megace) – breast & endometrial
    • Antiestrogens
      • Tamoxifen (nolvadex) – breast
      • Toremifene citrate (fareston) – breast
pharmacology cont31
Pharmacology Cont:
  • Gonadotropin-releasing hormone analogs
    • Goserelin acetate (zoladex) – breast & uterine
  • Aromastase inhibitors
    • Anastrazole (arimidex) – advanced breast
    • Exemestane (aromasin) – advanced breast
    • Letrozole (femara) – advanced breast
  • Platinum coordination complex
    • Carboplatin (paraplatin) – ovaries
    • Cisplatin (platinol-AQ) - ovaries
pharmacology cont32
Pharmacology Cont:
  • Substituted urea
    • Hydroxyurea (droxia, hydrea) - ovaries
  • Cytoprotective agents
    • Amifostine (ethyol) – advanced ovaries
    • Dexrazonxane (zinecard) – metastatic breast
  • DNA topoisomerase inhibitors
    • Topotecan (hycamtin) – ovaries
  • Monoclonal antibodies
    • Trastuzumab (herceptin) - breast
pharmacology cont33
Pharmacology Cont:
  • Hormonal therapy ( pg 540 – 547)
    • Androgens
      • Treatment of cancer in women who are 1-5 years past menopause
      • Assess daily for signs of fluid and electrolyte imbalance & jaundice
    • Estrogens
      • The most potent estrogen is estradiol
      • Used to relieve moderate to relieve moderate to severe vasomotor symptoms of menopause ( flushing, sweating)
      • Other actions include fluid retention
pharmacology cont34
Pharmacology Cont:
  • Progestins
    • Provera, norethindrone
    • Used for amenorrhea, abnormal bleeding
    • Adverse reactions include breakthrough bleeding, amenorrhea, weight gain
    • If breakthrough bleeding occurs dosage might be to high
  • Combination products
    • Increases the risk of cardovascular side effects the like thromboembolism
    • Monitor for thromboembolic effects (homan’s sign)
pharmacology cont35
Pharmacology Cont:
      • Oral contraceptives is best taken with the evening meal or at hs
      • Miss one dose take 2 next day. If 2 missed take 2 the next 2 days.
  • Antifungals (pg 130)
    • Fluconazole (diflucan) – vaginal candidiasis
    • Butoconazole nitrate (femstat 3)
    • Clotrimazole (lotrimin)
    • Miconazole nitrate (monistat)
    • Nystatin
    • Terconazole (terazol)
    • Tioconazole (monistat, vagistat)
pharmacology cont36
Pharmacology Cont:
  • Metronidazole (flagyl)
    • Uses – vaginosis
    • Adverse reactions- nausea, anorexia, seizures, numbness