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Chapter053 Presentation Transcript

  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 53: Caring for Clients with Disorders of the Female Reproductive System Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Premenstrual Syndrome (PMS) • Occurs 7 to 10 days before menstruation • Unknown cause, possible hormonal connection; Physical and emotional symptoms • Signs and symptoms: Weight gain; Headache; Pain; Irritability; Personality changes; Anxiety • Menstrual diary aid in diagnosis • Treatment: Depends on symptom severity; Healthful lifestyle changes; Hormonal therapy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Question Is the following statement true or false? The cause of PMS is hormones. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Answer False. The cause of PMS is unknown. Proposals suggest a connection with excess estrogen, deficient progesterone (or both), glandular dysregulation, or effects of reproductive hormones on brain chemicals. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Dysmenorrhea • Painful menstruation; Idiopathic; Primary, secondary • Symptoms: Low abdominal pain; Cramping • Treatment: Non-narcotic analgesics; Heat Figure 53-2 Knee–chest position Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Various Menstrual Disorders • Amenorrhea: Absence of Menstrual Flow • Oligomenorrhea: Infrequent Menses – Causes: Endocrine imbalances; Stress; Poor nutrition – Associated conditions: Polycystic ovarian syndrome; Premature ovarian failure • Menorrhagia: Menstruation longer than 7 days – Causes: Endocrine, coagulation disorders – Medical, surgical management: NSAIDs; Hormones; Endometrial ablation; Uterine balloon therapy; Photodynamic therapy Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Uterine Balloon Therapy Left: Insertion of the catheter Right: Infusion and heating of fluid within the balloon Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Question Is the following statement true or false? Menorrhagia is a disorder where menstruation lasts longer than 7 days. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Answer True. Menorrhagia is a disorder where menstruation lasts longer than 7 days, which can be caused by endocrine disorders, coagulation disorders, or can be a symptom of a more serious condition. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Metrorrhagia • Unexpected, Irregular Bleeding – Intermenstrual or postcoital bleeding – Causes • Pituitary or ovarian stimulation • Uterine malignancies and cervical irritation • Breakthrough bleeding with HRT Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Menopause • Cessation of Menstrual Cycle: Physiologic, surgical menopause – Climacteric and postmenopausal period • Pathophysiology and Etiology: Diminishing ovarian function; Reduction in hormones; Hypothalamic-pituitary stimulation • Signs and Symptoms: Menstrual irregularities; Vasomotor disturbances • Medical Management: HRT; Antidepressants; Biphosphonates; Symptomatic relief • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Vaginitis • Vaginal Inflammation – Pathophysiology and Etiology: Chemical or mechanical irritants; Pathogenic microorganisms; Predisposing factors • Assessment Findings: Symptoms: Abnormal vaginal discharge, itching, burning, and redness • Medical Management: Anti-infective agents; Treatment of sexual partner; Symptomatic relief measures • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Cervicitis • Inflammation of the Cervix • Pathophysiology and Etiology: Trauma of gynecologic procedures; Chronic cervicitis may lead to infertility • Assessment Findings: History of spotting, unusual bleeding; Dyspareunia; Unhealthy vaginal discharge • Medical Management: Antibiotics; Douching; Electrocautery; Conization • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 14. Pelvic Inflammatory Disease • Infection of pelvic organs except uterus • Pathophysiology and Etiology: Microorganisms entering through cervix • Assessment Findings: Malodorous vaginal discharge; Severe abdominal, pelvic pain; Fever; Menorrhagia; Dysmenorrhea • Medical Management: Hospitalization; Rest; Symptomatic relief measures; Emergency surgery for pelvic abscess • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Toxic Shock Syndrome • Septic Shock; Life-threatening systemic reaction • Pathophysiology and Etiology: Virulent bacteria production with no immunological defense – Superabsorbent tampons; Internal contraceptives • Signs and Symptoms: Sudden onset of high fever, chills, myalgia, N/V, diarrhea, hypotension, disorientation, headache • Medical Management: IV fluid administration; IV ATB therapy; Adrenergics • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 16. Endometriosis • Pathophysiology and Etiology: Not clearly understood – Ectopic tissue responds to hormones – Result in adhesions, sterility • Assessment Findings: Severe dysmenorrhea; Copious menstrual bleeding; Chocolate cyst formation • Medical, Surgical Management: Natural or surgical menopause; Cyst removal • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Vaginal Fistulas • Unnatural Opening Between Structures – Different types • Pathophysiology and Etiology: CA; Surgical injury; Radiation therapy; Congenital anomaly; Ulcerative colitis • Assessment Findings: Leakage of urine or stool through vagina • Medical, Surgical Management: Surgery; Symptomatic relief measures • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 18. Pelvic Organ Prolapse • Cystocele; Rectocele • Pathophysiology and Etiology: Weakness in muscles, fascia; Urinary, bowel alterations; Irritation of protruding cervix • Signs and Symptoms: Stress incontinence (cystocele); Cystitis; Constipation (rectocele); “Something is dropping out” (uterovaginal prolapse) • Medical, Surgical Management: Pessary; Kegel exercises; Transvaginal repairs • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 19. Question Is the following statement true or false? Is it common to use a pessary as treatment for a rectocele. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Answer False. Is it common to use a pessary as treatment for a cystocele. Cleaning the pessary biweekly is important to avoid serious complications. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Uterine Displacement • Retroversion, Retroflection – May cause infertility • Anteversion, Anteflexion • Pathophysiology and Etiology: Positional displacement ; Congenital, PID, Endometriosis • Assessment Findings: Backache; Dyspareunia; Dysmenorrhea; • Medical, Surgical Management: Pessary; Kneechest position • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Uterine Leiomyoma • Benign growth of smooth muscle, fibrous connective tissue; Most common in pelvis; AKA fibroid tumors • Pathophysiology and Etiology: Growth stimulated by estrogen; Slow growth; Various sites • Assessment Findings: Menorrhagia; Anemia; Dysmenorrhea • Medical, Surgical Management: D & C; Myomectomy; Hysterectomy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Cervical, Endometrial Cancer • Cervical CA: 2nd most common female reproductive CA • Pathophysiology and Etiology: Age (>50 y.o.); DES exposure; High-risk sexual activity; HPV; Smoking; Pelvic radiation • Signs and Symptoms: Bleeding; Pain; Pressure on bladder • Medical, Surgical Management: Depends on tumor staging; Hysterectomy; Chemotherapy • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Ovarian Cysts, Benign Ovarian Tumors • Pathophysiology and Etiology: Unknown; Endocrine dysfunction implicated • Different Types – Affect menstruation, fertility • Assessment Findings: Menstrual irregularities, pain; Lower abdomen discomfort; Backache • Medical, Surgical Management: Range from no treatment to BCPs to surgery • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Ovarian Cancer • Leading cause of death from gynecologic malignancies • Pathophysiology and Etiology: Hereditary; Nulliparous women; Other types of female reproductive CAs • Signs and Symptoms: Vague abdominal discomfort; Urinary frequency – Later: Ascites; Weight loss; Severe pain • Medical, Surgical Management: Various surgeries, including oophorectomy, etc. • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 26. Vaginal Cancer • Pathophysiology and Etiology: HPV infection; Nonhygienic pessary use; DES exposure • Signs and Symptoms: Abnormal vaginal bleeding; Dyspareunia • Medical, Surgical Management: Based upon tumor extent; Laser photovaporization treatments; Total vaginectomy; Radiotherapy – Complications • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. Vulvular Cancer • Pathophysiology and Etiology: Relatively rare; Usually in women > 60 y.o.; Increasing in HPV, herpes – Highly curable • Signs and Symptoms: Pruritus, genital burning; White, raised labial patches; Bloody discharge; Enlarged lymph nodes; Vulvular ulceration; Mass development • Medical, Surgical Management: Vulvectomy; Laser photovaporization • Nursing Management Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 28. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins