Nursing of Adults with Medical & Surgical Conditions

1. Nursing of Adultswith Medical & Surgical Conditions Reproductive Disorders

2. Amenorrhea • Etiology/Pathophysiology • Absent or suppressed menstrual flow • Primary • Menarche has not occurred by age 18 years • Secondary • Menarche has occurred but ceased for at least 3 months

3. Amenorrhea • Frequent, vigorous exercise • Depression • Anorexia or bulimia • Normal • Before puberty • After menopause • During pregnancy • Hormonal abnormalities • Surgical interventions • Hysterectomy

4. Amenorrhea • Signs & Symptoms • No menstrual flow for at least 3 months

5. Amenorrhea • Treatment • Based on underlying cause • Hormone replacement may be necessary

6. Dysmenorrhea • Etiology/Pathophysiology • Uterine pain with menstruation • Primary • Not associated with pelvic disorders • Usually disappears with pregnancy or by the woman’s late 20’s • Secondary • Caused by organic disease • PID • Endometriosis • Usually over 20 years of age

7. Dysmenorrhea • Signs & Symptoms • Breast tenderness • Abdominal distention • Nausea and vomiting • Headache • Vertigo • Palpitations • Excessive perspiration • Colicky and cyclic pain • Dull pain in the lower pelvis

8. Dysmenorrhea • Treatment • Exercise • Nutritious foods, high in fiber • Heat to pelvic area • Mild analgesics • Prostaglandin inhibitors • Ibuprofin (Motrin) • Naproxen (Anaprox)

9. Abnormal Uterine Bleeding • Menorrhagia • Excessive bleeding at the time of the regular menstrual flow • Endocrine disorders • Inflammatory disdurbances • Uterine tumors • Metrorrhagia • Uterine bleeding between regular menstrual periods or after menopause • May indicate cancer or benign tumors of the uterus

10. Premenstrual Syndrome (PMS) • Etiology/Pathophysiology • Related to the neuroendocrine events occurring within the anterior pituitary gland • Occurs 7-10 days prior to the menstrual period • Subsides within the first 3 days after the onset of menstrual flow

11. Premenstrual Syndrome (PMS) • Signs & Symptoms • Irritability • Lethargy & Fatigue • Sleep disturbances • Depression • Headache • Vertigo • Backache • Breast tenderness • Abdominal distention • Acne • Paresthesia of hands and feet

12. Premenstrual Syndrome (PMS) • Treatment • Analgesics • Diuretics • Progesterone • Diet • High in complex carbohydrates • Moderate in protein • Low in refined sugar and sodium • Limit caffeine, chocolate, and alcohol • Reduce or eliminate smoking • Exercise • Adequate rest, sleep, and relaxation

13. Female Climacteric(menopause) • Etiology/Pathophysiology • The normal decline of ovarian functin resulting from the aging process • Begins between the ages of 35 and 60 years (average 51yrs) • May be induced by irradiation of the ovaries or surgical removal of both ovaries • Not considered complete until 1 year after the last menstrual period

14. Female Climacteric • Signs & Symptoms • Decrease in frequency, amount, and duration of the normal menstrual flow • Shrinkage of vulval structures • Shortening of the vagina • Dryness of the vaginal wall • Pelvic relaxation • Loss of skin turgor and elasticity • Increased subcutaneous fat • Decreased breast tissue • Thinning of hair • Osteoporosis

15. Female Climacteric(menopause) • Treatment • Estrogen therapy • Premarin • Provera • Calcium supplements

16. Male Climacteric • Etiology/Pathophysiology • Gradual decrease of testosterone levels and seminal fluid production • Occurs between the ages of 55 and 70

17. Male Climacteric • Signs & Symptoms • Decreased erections • Enlarged prostate gland • Decreased seminal fluid • Loss or thinning of hair • Decreased muscle tone

18. Male Climacteric • Treatment • Emotional support • Treatment for impotence

19. Impotence • Etiology/Pathophysiology • Inability of an adult man to achieve penile erection • Functional • Psychological • Anatomical • Physical defect of genital structures • Atonic • Disturbed neuromuscular function

20. Impotence • Treatment • Remove cause if possible • Medications • Illicit or abused substances • Alcohol, cocaine, nicotine • Treat diseases • DM, renal, heart and pulmonary diseases • Viagra • Mechnical devices • Penile prostesis

21. Penile Prosthesis

22. Infertility • Etiology/Pathophysiology • Inability to conceive after 1 year of sexual intercourse without birth control • Impaired sperm or ovum production • Occlusion in the reproductive system that prevents the sperm and ova from meeting • Infections of the reproductive tract • Primary • Never conceived • Secondary • Conceived but are now unable to do so • Females most fertile time is between the ages of 20 and 29

23. Infertility • Treatment • Depends on the cause • Hormone therapy • Repair occlusion • Intrauterine insemination • Partner or donor sperm • In vitro fertilization

24. Simple Vaginitis • Etiology/Pathophysiology • Common vaginal infection • Causitive organisms • E. coli • Staphylococcal • Streptococcal • T. vaginalis • C. albicans (yeast) • Gardnerella

25. Simple Vaginitis • Signs & Symptoms • Inflammation of the vagina • Yellow, white, or grayish white, curdlike discharge • Pruritus • Vaginal burning • T. vginalis • Profuse foamy exudate • C. albicans • Thick, cheeselike discharge • Bacterial • Milk-like discharge; foul odor

26. Simple Vaginitis • Treatment • Douching • Vaginal suppositories, ointments, and creams • Organism specific • Sitz baths • Abstain from sexual intercourse during treatment • Treat partner if necessary

27. Cervicitis • Etiology/Pathophysiology • Infection of the cervix • One of the most common diseases of the reproductive system • May be caused by vaginal infection, STD, childbirth or abortion

28. Cervicitis • Signs & Symptoms • Backache • Whitish exudate • Menstrual irregulatities

29. Cervicitis • Treatment • Vaginal suppositories, ointments, and creams • Organism specific

30. Pelvic Inflammatory Disease (PID) • Etiology/Pathophysiology • Any acute, subacute, recurrent or chronic infection of the cervix, uterus, fallopian tubes and overies that has extended to the connective tissues • Most common causative organisms • Gonorrhea • Streptococcus • Staphylococcus • Chlamydia • Tubercle bacilli

31. Pelvic Inflammatory Disease (PID) • Surgical and examination procedures • Sexual intercourse • Especially with multiple partners • Pregnancy

32. Pelvic Inflammatory Disease (PID) • Signs & Symptoms • Fever • Chills • Severe abdominal pain • Malaise • Nausea and vomiting • Malodorous purulent vaginal exudate

33. Pelvic Inflammatory Disease (PID) • Treatment • Antibiotics • IV or IM • Analgesics • Bedrest

34. Toxic Shock Syndrome • Etiology/Pathophysiology • Acute bacterial infection caused by Staphylococcus aureus • Usually occurs in women who are menstrujating and using tampons

35. Toxic Shock Syndrome • Signs & Symptoms • Usually occur between days 2 and 4 of the menstrual period • Flulike symptoms • Temperture up to 102 degrees • Vomiting • Diarrhea • Myalgia • Hypotension • Sore throat • Headache • Red macular palmar or diffuse rash

36. Toxic Shock Syndrome • Decreased urinary output • BUN elevated • Disorientation • Pulmonary edema • Inflammation of mucous membranes

37. Toxic Shock Syndrome • Treatment • Antibiotics • Bacterial specific • IV fluid therapy • Oxygen

38. Endometriosis • Etiology/Pathophysiology • Endometrial tissue appears outside the uterus • The tissue responds to the normal stimulation of the ovaries; bleeds each month • Most common in caucasian women 25 to 35 years old

39. Endometriosis • Signs & Symptoms • Lower abdominal pain • Pelvic pain • May radiate to lower back, legs, and groin • Most acute during menstruation and subside after menstruation

40. Endometriosis • Treatment • Antiovulatory medications • Suppress menstruation • Pregnancy • Laparoscopy • Remove endometrial cells and adhesions • Total hysterectomy

41. Vaginal Fistula • Etiology/Pathophysiology • Abnormal opening between two organs • Named for organs involved • Urethrovaginal fistula: between the urethra and vagina • Vesicovaginal fistula: between the bladder and vagina • Rectovaginal fistula: between the rectum ad the vagina • Vesicouterine fistula: between the bladder and the uterus • Vesicocervical fistula: between the bladder and the cervix • Perineovagina fistula: between the perineum and the vagina

42. Fistulas

43. Vaginal Fistula • Result from • Cancer • Radiation • Weakening of tissue by pregnancies • Surgical interventions

44. Vaginal Fistula • Signs & Symptoms • Urine and/or feces being expelled from vagina

45. Vaginal Fistula • Treatment • Oral or parenteral antibiotics • Diet • High protein • Increase Vitamin C • Surgery • Repair fistula • Urinary or fecal diversion

46. Displaced Uterus • Etiology/Pathophysiology • Congenital • Childbirth • Backward Displacement • Retroversion • Retroflexion • Forward Displacement • Anteversion • Anteflexion

48. Displaced Uterus • Signs & Symptoms • Backache • Muscle strain • Leukorrheal discharge • Heaviness in the pelvic area

49. Displaced Uterus • Treatment • Pessary • Rubber or plastic doughnut-shaped ring • Uterine Suspension

50. Uterine Prolapse • Etiology/Pathophysiology • Obstetrical trauma • Overstretching of the support system • Coughing, straining, and lifting heavy objects