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Reproductive disorder by professor khan
1.
Slide 1Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Shree sahjanandinstitute of nursing, Reproductive Disorder Presented by Mr. AKRAM KHAN M.S.N. (HOD) ASST. PROFESSOR SSIN, BHAVNAGAR
2.
Slide 2Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Overview of Anatomy and Physiology • Male reproductive system Testes Ductal system • Epididymis • Ductus deferens (vas deferens) • Ejaculatory duct and urethra Accessory glands • Seminal vesicles • Prostate gland • Cowper’s glands Urethra and penis Sperm
3.
Slide 3Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-1 Longitudinal section of the male pelvis showing the location of the male reproductive organs. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
4.
Slide 4Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-2 Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell (ovum) surrounded by sperm at time of fertilization (right). (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
5.
Slide 5Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Overview of Anatomy and Physiology • Female reproductive system Ovaries Fallopian tubes Uterus Vagina External genitalia Accessory glands • Skene’s glands • Bartholin’s glands Perineum Mammary glands (breasts)
6.
Slide 6Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-3 Longitudinal section of the female pelvis showing the location of the female reproductive organs. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
7.
Slide 7Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-4 Sectioned view of the uterus showing relationship to the ovaries and vagina. (From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
8.
Slide 8Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-6 Lateral view of the breast (sagittal section). (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
9.
Slide 9Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-7 Mammalian ovary showing successive stages of ovarian (graafian) follicle and ovum development. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
10.
Slide 10Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-14 A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast. (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.)
11.
Slide 11Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Human Sexuality • Sexual identity The sense of being feminine or masculine • Influences on sexual health Overall wellness includes sexual health, and sexuality should be part of the health care program • Illness and sexuality Illness may cause changes in a patient’s self-concept and result in an inability to function sexually
12.
Slide 12Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Laboratory and Diagnostic Examinations • Diagnostic tests for the female Colposcopy; culdoscopy; laparoscopy Papanicolaou (Pap) smear Biopsies: Breast, cervical, endometrial Conization; dilation and curettage Cultures and smears Schiller’s iodine test Hysterograms Mammography; pelvic ultrasonography Tubal insufflation (Rubin’s test) Human chorionic gonadotropin; serum CA-125
13.
Slide 13Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Laboratory and Diagnostic Examinations • Diagnostic tests for the male Testicular biopsy Semen analysis Prostatic smears Cystoscopy Rectal digital exam Prostate specific antigen (PSA)
14.
Slide 14Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Menarche The beginning of menses Follows breast development by 2 to 2½ years Average age range is between 9 and 17 years Cycle length ranges from 24 to 32 days The average flow lasts 3 to 5 days The average flow is 35 mL/cycle
15.
Slide 15Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Amenorrhea Etiology/pathophysiology • Absent or suppressed menstrual flow Clinical manifestations/assessment • No menstrual flow for at least 3 months Medical management/nursing interventions • Based on underlying cause • Hormone replacement may be necessary
16.
Slide 16Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Dysmenorrhea Etiology/pathophysiology • Uterine pain with menstruation Clinical manifestations/assessment • Breast tenderness; headache • Abdominal distention; nausea and vomiting • Vertigo • Palpitations • Excessive perspiration • Colicky, cyclic pain; dull pain in the lower pelvis The Reproductive Cycle
17.
Slide 17Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Dysmenorrhea (continued) Medical management/nursing interventions • Exercise • Nutritious foods, high in fiber • Heat to pelvic area • Mild analgesics • Prostaglandin inhibitors
18.
Slide 18Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Abnormal uterine bleeding Menorrhagia • Excessive bleeding during the regular menstrual flow • Causes: Endocrine disorders; inflammatory disturbances; uterine tumors Metrorrhagia • Uterine bleeding between regular menstrual periods or after menopause • May indicate cancer or benign tumors of the uterus
19.
Slide 19Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Premenstrual syndrome (PMS) Etiology/pathophysiology • Believed to be related to the neuroendocrine events occurring within the anterior pituitary gland Clinical manifestations/assessment • Irritability, lethargy, and fatigue • Sleep disturbances; depression • Headache; backache; breast tenderness • Vertigo • Abdominal distention • Acne
20.
Slide 20Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Premenstrual syndrome (PMS) (continued) Medical management/nursing interventions • Pharmacological management Analgesics; diuretics; progesterone • Dietary recommendations 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
21.
Slide 21Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Menopause Etiology/pathophysiology • The normal decline of ovarian function resulting from the aging process • 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
22.
Slide 22Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Menopause Clinical manifestations/assessment • 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
23.
Slide 23Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Menopause (continued) Medical management/nursing interventions • Estrogen therapy Premarin Provera • Calcium supplements
24.
Slide 24Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Male climacteric Etiology/pathophysiology • Gradual decrease of testosterone levels and seminal fluid production; 55 to 70 years of age Clinical manifestations/assessment • Decreased erections; decreased seminal fluid • Enlarged prostate gland; decreased muscle tone • Loss or thinning of hair Medical management/nursing interventions • Emotional support; treatment for impotence
25.
Slide 25Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Erectile dysfunction Etiology/pathophysiology • Inability of an adult man to achieve penile erection • Types Functional Anatomical Atonic Medical management/nursing interventions • Remove cause if possible • Treat diseases • Viagra • Mechanical devices: penile prosthesis
26.
Slide 26Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. The Reproductive Cycle • Infertility Etiology/pathophysiology • Inability to conceive after 1 year of sexual intercourse without birth control Medical management/nursing interventions • Depends on the cause • Hormone therapy • Repair occlusion • Intrauterine insemination • In vitro fertilization
27.
Slide 27Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Infections of the Female Reproductive Tract • Simple vaginitis Etiology/pathophysiology • Common vaginal infection • Causative organisms: E. coli; staphylococcal; streptococcal; T. vaginalis; C. albicans; Gardnerella Clinical manifestations/assessment • Inflammation of the vagina • Yellow, white, or grayish white, curd-like discharge • Pruritus and vaginal burning
28.
Slide 28Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Simple vaginitis (continued) Medical management/nursing interventions • Douching • Vaginal suppositories, ointments, and creams Organism-specific • Sitz baths • Abstain from sexual intercourse during treatment • Treat partner if necessary Infections of the Female Reproductive Tract
29.
Slide 29Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cervicitis Etiology/pathophysiology • Infection of the cervix Clinical manifestations/assessment • Backache • Whitish exudate • Menstrual irregularities Medical management/nursing interventions • Vaginal suppositories, ointments, and creams; organism-specific Infections of the Female Reproductive Tract
30.
Slide 30Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Pelvic inflammatory disease (PID) Etiology/pathophysiology • Any acute, subacute, recurrent, or chronic infection of the cervix, uterus, fallopian tubes, and ovaries that has extended to the connective tissues • Most common causative organisms Gonorrhea; streptococcus; staphylococcus; Chlamydia; tubercle bacilli • High risk: Surgical and examination procedures; sexual intercourse (especially with multiple partners); pregnancy Infections of the Female Reproductive Tract
31.
Slide 31Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Pelvic inflammatory disease (PID) (continued) Clinical manifestations/assessment • Fever and chills • Severe abdominal pain • Malaise • Nausea and vomiting • Malodorous purulent vaginal exudate Medical management/nursing interventions • Antibiotics; analgesics • Bed rest Infections of the Female Reproductive Tract
32.
Slide 32Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Toxic shock syndrome Etiology/pathophysiology • Acute bacterial infection caused by Staphylococcus aureus • Usually occurs in women who are menstruating and using tampons Infections of the Female Reproductive Tract
33.
Slide 33Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Toxic shock syndrome (continued) Clinical manifestations/assessment • Usually occurs between days 2 and 4 of the menstrual period • Flu-like symptoms; sore throat; headache • Red macular palmar or diffuse rash • Decreased urinary output; BUN elevated • Pulmonary edema Medical management/nursing interventions • Antibiotics; IV fluid therapy; oxygen Infections of the Female Reproductive Tract
34.
Slide 34Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Reproductive System • Endometriosis Etiology/pathophysiology • Endometrial tissue appears outside the uterus • The tissue responds to the normal stimulation of the ovaries; bleeds each month Clinical manifestations/assessment • Lower abdominal and pelvic pain • May radiate to lower back, legs, and groin Medical management/nursing interventions • Antiovulatory medications; pregnancy • Laparoscopy; total hysterectomy
35.
Slide 35Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-9 Common sites of endometriosis.
36.
Slide 36Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Vaginal fistula Etiology/pathophysiology • Abnormal opening between the vagina and another organ Clinical manifestations/assessment • Urine and/or feces being expelled from vagina Medical management/nursing interventions • Oral or parenteral antibiotics • Diet: high protein; increase vitamin C • Surgery: Repair fistula; urinary or fecal diversion Disorders of the Female Reproductive System
37.
Slide 37Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-10 Types of fistulas that may develop in the vagina and uterus. (From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3rd ed.]. St. Louis: Mosby.)
38.
Slide 38Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Displaced uterus Etiology/pathophysiology • Congenital • Childbirth • Backward displacement Retroversion Retroflexion Disorders of the Female Reproductive System
39.
Slide 39Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Displaced uterus (continued) Clinical manifestations/assessment • Backache • Muscle strain • Leukorrheal discharge • Heaviness in the pelvic area Medical management/nursing interventions • Pessary • Uterine suspension Disorders of the Female Reproductive System
40.
Slide 40Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Uterine prolapse Etiology/pathophysiology • Prolapse of the uterus through the pelvic floor and vaginal opening Clinical manifestations/assessment • Fullness in vaginal area • Backache • Bowel or bladder problems • Protrusion of cervix and vaginal walls in perineal area Disorders of the Female Reproductive System
41.
Slide 41Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-11 Uterine prolapse. (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination. [5th ed.]. St. Louis: Mosby.)
42.
Slide 42Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Uterine prolapse (continued) Medical management/nursing interventions • Pessary • Surgery Vaginal hysterectomy Anteroposterior colporrhaphy Disorders of the Female Reproductive System
43.
Slide 43Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cystocele and rectocele Etiology/pathophysiology • Cystocele Displacement of the bladder into the vagina • Rectocele Rectum moves toward posterior vaginal wall Disorders of the Female Reproductive System
44.
Slide 44Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-12 A, Cystocele. B, Rectocele. (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.)
45.
Slide 45Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cystocele and rectocele (continued) Clinical manifestations/assessment • Cystocele Urinary urgency, frequency, and incontinence; pelvic pressure • Rectocele Constipation; rectal pressure; hemorrhoids Medical management/nursing interventions • Surgical repair Anteroposterior colporrhaphy; bladder suspension Disorders of the Female Reproductive System
46.
Slide 46Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Leiomyomas of the uterus (fibroids, myomas) Etiology/pathophysiology • Arise from the muscle tissue of the uterus • Stimulated by ovarian hormones Clinical manifestations/assessment • Pelvic pressure; pain; backache • Dysmenorrhea; menorrhagia • Constipation; urinary symptoms Medical management/nursing interventions • Surgery: Myomectomy; hysterectomy Disorders of the Female Reproductive System
47.
Slide 47Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-13 Leiomyomas. (Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak’s gynecologic and obstetric pathology. [6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the biologic basis for disease in adults and children. [4th ed.]. St. Louis: Mosby.)
48.
Slide 48Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Ovarian cysts Etiology/pathophysiology • Benign tumors that arise from dermoid cells of the ovary Clinical manifestations/assessment • May be no symptoms • Palpable on examination • Disturbance of menstruation • Pelvic heaviness; pain Medical management/nursing interventions • Ovarian cystectomy Disorders of the Female Reproductive System
49.
Slide 49Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the Female Reproductive Tract • Cancer of the cervix Etiology/pathophysiology • Squamous cell carcinoma • Carcinoma in situ • If untreated, invades the vagina, pelvic wall, bladder, rectum, and regional lymph nodes • High risk Sexually active during teens Multiple sexual partners Multiple births Chronic cervical infections
50.
Slide 50Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cancer of the cervix (continued) Clinical manifestations/assessment • Few symptoms in early stages • Leukorrhea • Irregular vaginal bleeding; spotting • Advanced Pain in the back, upper thighs, and legs Cancer of the Female Reproductive Tract
51.
Slide 51Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cancer of the cervix (continued) Medical management/nursing interventions • Carcinoma in situ Removal of the affected area • Early carcinoma Hysterectomy Intracavitary radiation • Advanced carcinoma Radical hysterectomy with pelvic lymph node dissection Cancer of the Female Reproductive Tract
52.
Slide 52Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cancer of the endometrium Etiology/pathophysiology • Adenocarcinoma of the uterus Clinical manifestations/assessment • Postmenopausal bleeding (50% will have cancer) • Abdominal pressure; pelvic fullness Medical management/nursing interventions • Surgery: total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) • Radiation; chemotherapy Cancer of the Female Reproductive Tract
53.
Slide 53Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cancer of the ovary Etiology/pathophysiology • Fourth most common cause of cancer death in women • High risk: infertile; anovulatory; nulliparous; habitual aborters; high-fat diet; exposure to industrial chemicals Cancer of the Female Reproductive Tract
54.
Slide 54Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cancer of the ovary (continued) Clinical manifestations/assessment • Early Vague abdominal discomfort Flatulence; mild gastric disturbance • Advanced Enlarged abdominal girth Flatulence; constipation Urinary frequency Nausea and vomiting Weight loss Cancer of the Female Reproductive Tract
55.
Slide 55Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Cancer of the ovary (continued) Medical management/nursing interventions • Surgery TAH-BSO and omentectomy • Radiation and/or chemotherapy Cancer of the Female Reproductive Tract
56.
Slide 56Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Hysterectomy • Total hysterectomy Removal of the uterus including the cervix • TAH-BSO Removal of the uterus, fallopian tubes, and ovaries • Radical hysterectomy TAH-BSO with removal of the pelvic lymph nodes • Vaginal hysterectomy The uterus is removed through the vagina • Abdominal hysterectomy Abdominal incision is made to perform procedure
57.
Slide 57Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast • Fibrocystic breast condition Etiology/pathophysiology • Hyperplasia and cystic formation in mammary ducts Clinical manifestations/assessment • Cysts are soft, well-differentiated, tender, and freely moveable; often bilateral and multiple Medical management/nursing interventions • Eliminate methylxanthines • Danazol (danocrine); vitamin E
58.
Slide 58Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast • Acute mastitis Etiology/pathophysiology • Acute bacterial infection of the breast Clinical manifestations/assessment • Breasts are tender, inflamed, and engorged Medical management/nursing interventions • Keep breasts clean • Application of warm packs • Support: Well-fitting bra • Systemic antibiotics
59.
Slide 59Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast • Chronic mastitis Etiology/pathophysiology • Fibrosis and cysts in the breast Clinical manifestations/assessment • Tender, painful, and palpable cysts • Usually unilateral Medical management/nursing interventions • Same as for acute mastitis
60.
Slide 60Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast • Breast cancer Etiology/pathophysiology • Unknown cause; usually adenocarcinoma Clinical manifestations/assessment • Small, solitary, irregular-shaped, firm, non-tender, and non-mobile tumor • Change in skin color • Puckering or dimpling of tissue • Nipple discharge; retraction of nipple • Axillary tenderness
61.
Slide 61Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Female Breast • Breast cancer (continued) Medical management/nursing interventions • Depends on the stage Radiation Chemotherapy Surgery o Lumpectomy o Mastectomy—simple, radical
62.
Slide 62Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Inflammatory Disorders of the Male Reproductive System • Prostatitis Etiology/pathophysiology • Acute or chronic infection of the prostate gland Clinical manifestations/assessment • Chills and fever • Dysuria; urgency and frequency of urination • Cloudy urine • Perineal fullness; lower back pain • Arthralgia; myalgia • Tenderness, edema, and firmness of the prostate
63.
Slide 63Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Prostatitis (continued) Medical management/nursing interventions • Antibiotics • Digital massage of the prostate • Sitz baths • Monitor I&O Inflammatory Disorders of the Male Reproductive System
64.
Slide 64Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. • Epididymitis Etiology/pathophysiology • Infection of the epididymis Clinical manifestations/assessment • Scrotal pain and edema • Pyuria; chills and fever Medical management/nursing interventions • Bed rest • Elevate scrotum; cold compresses • Antibiotics Inflammatory Disorders of the Male Reproductive System
65.
Slide 65Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of Male Genital Organs • Phimosis Etiology/pathophysiology • Prepuce is too small to allow retraction of the foreskin over the glans • Usually congenital; may be due to inflammation or disease Clinical manifestations/assessment • Infection of foreskin and glans penis • Occasionally causes obstruction of urine flow Medical management/nursing interventions • Circumcision
66.
Slide 66Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of the Male Genital Organs • Paraphimosis Etiology and pathophysiology • An edematous condition of the retracted uncircumcised foreskin preventing a normal return over the glans Medical management/nursing interventions • Warm compresses • Circumcision
67.
Slide 67Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of Male Genital Organs • Hydrocele Etiology/pathophysiology • Accumulation of fluid between the membranes of the testes Clinical manifestations/assessment • Enlargement of the scrotum; pain Medical management/nursing interventions • Aspiration of fluid • Surgical removal of testicular sac • Bed rest; elevate scrotum; cold compresses
68.
Slide 68Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Disorders of Male Genital Organs • Varicocele Etiology/pathophysiology • Dilation of scrotal veins causing obstruction and malfunction of circulation Clinical manifestations/assessment • Engorgement and elongation of the scrotum • Pulling sensation in scrotum; dull, aching pain Medical management/nursing interventions • Surgery: Removal of obstruction • Bed rest • Elevate scrotum; cold compresses
69.
Slide 69Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the Male Reproductive Tract • Cancer of the testis Etiology/pathophysiology • Cause unknown Clinical manifestations/assessment • Enlarged scrotum; feeling of heaviness • Firm, painless, smooth mass Medical management/nursing interventions • Radical inguinal orchiectomy • Radiation and/or chemotherapy • Teach testicular self-examination
70.
Slide 70Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer of the Male Reproductive Tract • Cancer of the penis Etiology/pathophysiology • Very rare Clinical manifestations/assessment • Painless, wart-like growth or ulceration, usually on the glans penis Medical management/nursing interventions • Surgery Removal of tissue Partial or total amputation of the penis Metastasis: Radical surgical procedures
71.
Slide 71Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Genital herpes (HSV) Etiology/pathophysiology • Infectious viral disease; usually acquired sexually Clinical manifestations/assessment • Fluid-filled vesicles • Eventually rupture and develop shallow, painful ulcers • Fever; malaise • Dysuria • Leukorrhea (female)
72.
Slide 72Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Figure 12-19 Herpes simplex virus type II in a male and female patient. (From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)
73.
Slide 73Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Genital herpes (HSV) (continued) Medical management/nursing interventions • No cure; treat symptoms • Acyclovir (Zovirax) • Sitz baths • Local anesthetic; analgesics • Keep lesions clean and dry • GOOD handwashing • No sexual contact while lesions are present • Encourage use of condoms
74.
Slide 74Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Syphilis Etiology/pathophysiology • Treponema pallidum organism • Transmission occurs primarily with sexual contact Clinical manifestations/assessment • Incubation period No symptoms • Primary stage Chancre; headaches; enlarged lymph nodes
75.
Slide 75Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Syphilis (continued) Clinical manifestations/assessment • Secondary stage Rash on palms of hands and soles of feet Generalized enlargement of lymph nodes • Latent stage No symptoms • Tertiary or late stage Lesions may affect many different systems; may be fatal
76.
Slide 76Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Syphilis (continued) Medical management/nursing interventions • Pharmacological management Penicillin Tetracycline or erythromycin, if allergic to penicillin • May be treated in any stage; damage from previous stages will not be reversed • Treat all sexual contacts
77.
Slide 77Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Gonorrhea Etiology/pathophysiology • N. gonorrhoeae • Transmitted by sexual contact Clinical manifestations/assessment • Vaginal (female) Urinary frequency and pain Yellowish discharge Nausea and vomiting
78.
Slide 78Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Gonorrhea (continued) Clinical manifestations/assessment (continued) • Urethra (male) Urethral discomfort; dysuria Yellowish discharge containing pus Red and swollen meatus • Rectal (male and female) Perineal discomfort; purulent rectal discharge • Pharyngitis (male and female) Sore throat and swallowing discomfort Edema of the throat
79.
Slide 79Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Gonorrhea (continued) Medical management/nursing interventions • Pharmacological management Penicillin Rocephin Doxycycline or tetracycline • Patient education • TREAT ALL SEXUAL CONTACTS
80.
Slide 80Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Trichomoniasis Etiology/pathophysiology • T. vaginalis protozoan • Usually sexually transmitted Clinical manifestations/assessment • Most are asymptomatic • Male: Urethritis, dysuria, urinary frequency, pruritus, and purulent exudate
81.
Slide 81Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Trichomoniasis (continued) Clinical manifestations/assessment (continued) • Female Frothy, gray, green, or yellow malodorous discharge Pruritus Edema Tenderness of vagina Dysuria and urinary frequency Spotting; menorrhagia; dysmenorrhea
82.
Slide 82Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Trichomoniasis (continued) Medical management/nursing interventions • Pharmacological management Metronidazole (Flagyl) • Patient education • TREAT ALL SEXUAL CONTACTS
83.
Slide 83Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Candidiasis Etiology/pathophysiology • C. albicans and C. tropicalis Clinical manifestations/assessment • Mouth: Edema; white patches • Nails: Edematous, darkened, erythematous nail base; purulent exudate • Vaginal: Cheesy, tenacious white discharge; pruritus; inflammation of the vagina • Penis: Purulent exudate • Systemic: Chills; fever; general malaise
84.
Slide 84Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Candidiasis (continued) Medical management/nursing interventions • Pharmacological management Nystatin (Mycostatin) Topical amphotericin B • Treat underlying condition
85.
Slide 85Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Chlamydia Etiology/pathophysiology • Chlamydia trachomatis Clinical manifestations/assessment • Usually asymptomatic • Male Scanty white or clear exudate Burning or pruritus Urinary frequency; mild dysuria
86.
Slide 86Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Sexually Transmitted Diseases • Chlamydia (continued) Clinical manifestations/assessment • Female Vaginal pruritus or burning Dull pelvic pain Low-grade fever Vaginal discharge; irregular bleeding Medical management/nursing interventions • Pharmacological management Tetracycline; doxycycline; Zithromax • TREAT ALL SEXUAL CONTACTS
87.
Slide 87Mosby items
and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process • Nursing diagnoses Anxiety Body image, disturbed Coping, ineffective Fear Fluid volume, deficient Health maintenance, ineffective Infection, risk for Knowledge, deficient Pain, acute and chronic Self-esteem, situational low Sexual dysfunction Skin integrity, impaired Tissue perfusion, ineffective Urinary elimination, impaired
88.
Sex Hormones Production
influenced by the anterior pituitary Male: testosterone; androgens Female: estrogen; progesterone 88Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
89.
Androgens Actions Development of
secondary sex characteristics; tissue building Uses Hypogonadism, hypopituitarism, dwarfism, eunuchism, cryptorchidism, oligospermia, and male androgen deficiency Adverse Reactions Edema due to sodium retention, acne, hirsutism, male pattern baldness, cholestatic hepatitis with jaundice, buccal irritation, nausea and vomiting, diarrhea 89Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
90.
Androgens (cont.) Drug Interactions
Increased effects – anticoagulants, antidiabetic agents, and other drugs Decreased effects – barbiturates Concurrent use with corticosteroids increase edema Nursing Implications Assessment, diagnosis, planning, implementation, and evaluation Drug Table 21-9 90Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
91.
Androgens (cont.) Patient and
Family Teaching Administration Response time Diet Symptoms to report Administration considerations 91Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
92.
Female Sex Hormones
Estrogens Progestins Table 21-10 92Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
93.
Estrogens Action and Uses
Used for hormone replacement therapy in menopause and other conditions (ovarian failure); infertility work- ups; palliative breast cancer treatment Adverse Reactions Drug Interactions 93Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
94.
Progestins Action Uses Contraception, control
excessive uterine bleeding, treatment of secondary amenorrhea, dysmenorrhea, premenstrual tension, and control of pain in endometriosis Drug Interactions Nursing Implications and Patient Teaching 94Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
95.
Oral Contraceptives Combination Drugs:
Estrogen and Progestin Table 21-11 Action Prevent ovulation Use Contraception Adverse Reactions Estrogen excess, progestin excess, androgen excess, estrogen deficiency, progestin deficiency Contraindications for Oral Contraceptives 95Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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