Reproductive disorder

1. Chapter 12
Care of the Patient with a
Reproductive Disorder
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2. Slide 2
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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 3
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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 4
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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 5
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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 6
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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 7
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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 8
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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 9
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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 10
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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 11
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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 12
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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 13
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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 14
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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 15
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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 16
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• 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 17
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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 18
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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 19
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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 20
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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 21
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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 22
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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 23
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The Reproductive Cycle
• Menopause (continued)
 Medical management/nursing interventions
• Estrogen therapy
 Premarin
 Provera
• Calcium supplements

24. Slide 24
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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 25
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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 26
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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 27
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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 28
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• 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 29
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• 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 30
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• 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 31
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• 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 32
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• 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 33
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• 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 34
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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 35
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Figure 12-9
Common sites of endometriosis.

36. Slide 36
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• 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 37
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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 38
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• Displaced uterus
 Etiology/pathophysiology
• Congenital
• Childbirth
• Backward displacement
 Retroversion
 Retroflexion
Disorders of the Female
Reproductive System

39. Slide 39
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• 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 40
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• 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 41
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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 42
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• Uterine prolapse (continued)
 Medical management/nursing interventions
• Pessary
• Surgery
 Vaginal hysterectomy
 Anteroposterior colporrhaphy
Disorders of the Female
Reproductive System

43. Slide 43
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• 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 44
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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 45
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• 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 46
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• 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 47
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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 48
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• 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 49
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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 50
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• 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 51
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• 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 52
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• 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 53
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• 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 54
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• 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 55
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• 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 56
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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 57
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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 58
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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 59
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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 60
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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 61
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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 62
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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 63
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• 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 64
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• 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 65
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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 66
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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 67
Mosby 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 68
Mosby 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 69
Mosby 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 70
Mosby 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 71
Mosby 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 72
Mosby 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 73
Mosby 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 74
Mosby 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 75
Mosby 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 76
Mosby 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 77
Mosby 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 78
Mosby 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 79
Mosby 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 80
Mosby 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 81
Mosby 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 82
Mosby 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 83
Mosby 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 84
Mosby 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 85
Mosby 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 86
Mosby 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 87
Mosby 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
88
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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
89
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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
90
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91. Androgens (cont.)
Patient and Family Teaching
 Administration
 Response time
 Diet
 Symptoms to report
 Administration considerations
91
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92. Female Sex Hormones
 Estrogens
 Progestins
 Table 21-10
92
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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
93
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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
94
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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
95
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