Session 15: Ch 16 PowerPoint Presentation

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Session 15: Ch 16 PowerPoint Presentation

  1. 1. Lecture Notes 16 Reproductive System Diseases and DisordersClassroom Activity to AccompanyDiseases of the Human BodyFifth EditionCarol D. Tamparo Marcia A. Lewis
  2. 2. Copyright © 2011 by F.A. Davis Company. All rightsreserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise— without written permission from the publisher.
  3. 3. Nobody will ever win the battleof the sexes. There’s too much fraternizing with the enemy. —Henry A. Kissinger 3
  4. 4. Infertility• Description • Failure to become pregnant after 1 year of regular unprotected intercourse, even after one or more pregnancies • Female fertility peaks at age 24 and diminishes after age 30 • Male fertility peaks at age 25 and declines after age 40 4
  5. 5. Infertility• Etiology: female • Hormonal problems • Nutritional deficiencies • Tumors • Infections • Anomalies of the reproductive system 5
  6. 6. Infertility• Etiology: male • Sperm deficiencies • Congenital abnormalities • Endocrine imbalances • Surgical intervention • Infection or chronic inflammation of the testes, epididymis, vas deferens 6
  7. 7. Infertility• Etiology: both sexes • Advancing age • Heavy alcohol use • Drug abuse • Obesity (especially in women) • Radiation exposure • Idiopathic in 10% of cases 7
  8. 8. Infertility• Signs and symptoms • Inability to conceive after 1 year of regular unprotected intercourse 8
  9. 9. Infertility• Diagnostic procedures: female • Complete gynecologic history and physical exam • Urinalysis • CBC, blood hormone levels • Endoscopy • X-rays • Ultrasound • Huhner test: cervical mucus analysis • Laparoscopy CBC = complete blood count. 9
  10. 10. Infertility• Diagnostic procedures: male • Examination of ejaculate • Complete history and physical exam • CBC, blood hormone levels • Sperm count • Urine 17-ketosteroid • Cystoscopy and catheterization of ejaculatory ducts • Vasography • Seminal vesiculography 10
  11. 11. Infertility• Treatment: female • Salpingostomy • Lysis of adhesions • Removal of ovarian abnormalities • Correction of endocrine imbalance • Correction of cervicitis • Hormone therapy • Microsurgery 11
  12. 12. Infertility• Treatment: male • Surgical correction of any abnormality • Correction of testicular hypofunction • Surgical correction of hydrocele or varicocele • Hormone therapy 12
  13. 13. Infertility• Treatment • Assisted reproductive therapy (ART) • In vitro fertilization (IVF) • Gamete fallopian transfer (GIFT) • Zygote intrafallopian transfer (ZIFT) • Tubal embryo transplant (TET) 13
  14. 14. Infertility Complementary therapy • Acupuncture, meditation, guided imagery • Yoga • Herbal therapy Client communication • Encourage weight loss • Educate about how alcohol and cigarette smoking decreases fertility 14
  15. 15. Infertility• Prognosis • 60% of couples who are treated achieve pregnancy • Some cases are untreatable• Prevention • Avoid causative factors 15
  16. 16. Sexually Transmitted Diseases 16
  17. 17. Common Signs and Symptoms ofSexually Transmitted Diseases• Dysuria, hematuria, urinary frequency, incontinence, purulent discharge, burning, itching on urination• Pelvic or genital pain• Any skin ulcerations, especially in genital areas• Fever, malaise• Dyspnea 17
  18. 18. Gonorrhea• Description • Contagious bacterial infection of epithelial surfaces of the GU tract • Most prevalent among teenagers and young adults GU = genitourinary. 18
  19. 19. Gonorrhea• Etiology • Bacteria (Neisseria gonorrhoeae) transmitted during sexual intercourse or other intimate sexual contact with infected partner • Bacteria can grow in the mouth, throat, eyes, and anus • Infected mother can infect infant during vaginal delivery 19
  20. 20. Gonorrhea• Signs and symptoms • Females: may be asymptomatic or present with purulent, greenish-yellow discharge from cervix • Itching, burning pain • Males: purulent, urethral discharge; pain; urinary frequency • Newborns: gonorrheal ophthalmia neonatorum 20
  21. 21. Gonorrhea• Diagnostic procedures • Culture and sensitivity of discharge or urine• Treatment • Antibiotics; newer, potent antibiotics • Culture after 1 to 2 weeks, 6 months • Test for other STDs, also STDs = sexually transmitted diseases. 21
  22. 22. Gonorrhea Complementary therapy • Stimulate immune system by eliminating fatty foods, sugar, white flour, salt, caffeine • Vitamin, herbal supplements Client communication • Practice safer sex • Take all medications • Return for repeat cultures 22
  23. 23. Gonorrhea• Prognosis • Good with prompt treatment • PID is complication among females • Epididymitis is complication among males PID = pelvic inflammatory disease. 23
  24. 24. Gonorrhea• Prevention • Use condoms, avoid multiple partners, trace sexual partners of infected person • Instill 1% silver nitrate solution in newborn’s eyes 24
  25. 25. Genital Herpes• Description • Highly contagious viral infection of genitalia • Recurs spontaneously • Two stages • Active with skin lesions • Latent without symptoms 25
  26. 26. Genital Herpes• Etiology • HSV-1, HSV-2; latter most common genitally • Transmitted through direct contact with infected bodily secretions during sexual intimacy • Life-threatening form in infants during vaginal birth HSV = herpes simplex virus. 26
  27. 27. Genital Herpes• Signs and Symptoms • Multiple, shallow ulcerations, pustules, or erythematous vesicles on genitals, mouth, anus • Erythema • Vesicles rupture causing pain, itching 27
  28. 28. Genital Herpes• Diagnostic procedures • Physical exam shows lesions • Scrapings, biopsy • Blood test for antibodies 28
  29. 29. Genital Herpes• Treatment • Treat with valacyclovir • Topical medications for edema, pain 29
  30. 30. Genital Herpes Complementary therapy • Ice pack for erupted sores • Cold compress or baking soda to soothe • Topical cream Client communication • Take proper precautions; practice safer sex • Alleviate embarrassment 30
  31. 31. Genital Herpes• Prognosis • No cure • 80% with primary genital herpes have recurrence within 12 months • Associated with cervical cancer 31
  32. 32. Genital Herpes• Prevention • Avoid sexual intercourse and intimacy with infected persons • Use condoms • C-section if mother is infected 32
  33. 33. Genital Herpes• Herpes is characterized by multiple erythematous 1. papules 2. pustules 3. vesicles 4. macules 33
  34. 34. Genital Human Papilloma (HPV)Infection• Description • Most common STD • Forty types of HPV that can infect the genital areas • Genital warts: circumscribed, elevated skin lesions, usually seen on the external genitalia or near the anus 34
  35. 35. Genital Human Papilloma (HPV)Infection• Etiology • Spread by intimate sexual contact • Pregnant women can pass the virus to the fetus during childbirth • Has an incubation of 1 to 6 months 35
  36. 36. Genital Human Papilloma (HPV)Infection• Signs and symptoms • Most individuals are asymptomatic • Warts can be solitary in form or in clusters • In males warts at end of the penis or in perianal area • In females warts appear at vaginal entrance • High-risk HPV can cause cervical cancer 36
  37. 37. Genital Human Papilloma (HPV)Infection• Diagnostic procedures • Characteristic appearance and location • Cervical cell changes can be found during a Papanicolaou (Pap) smear 37
  38. 38. Genital Human Papilloma (HPV)Infection• Treatment • No treatment • A healthy immune system can deter HPV • Warts can be removed by carbon dioxide laser, cryosurgery, electrocautery, debridement • Cervical cancer is treatable if detected early 38
  39. 39. Genital Human Papilloma (HPV)Infection Complementary therapy • Ointment of vitamin A and herbs may be applied topically – wash hands after application Client communication • Recommend the use of condoms • Encourage annual Pap smears • Limit number of sexual partners 39
  40. 40. Genital Human Papilloma (HPV)Infection• Prognosis • Low-risk HPV responds well to treatment • Prognosis is variable for high-risk HPV or cervical cancer• Prevention • HPV vaccine • Annual Pap test 40
  41. 41. Trichomoniasis• Description • Protozoal infection of the vagina, urethra, or prostate • Common STD — 7.4 million new cases each year 41
  42. 42. Chlamydial Infections• Description • Highly prevalent • One of the most potentially damaging STDs in the United States• Etiology • Chlamydia trachomatis through vaginal, oral, or anal sexual contact with infected person • Neonate exposed during delivery may develop conjunctivitis 42
  43. 43. Chlamydial Infections• Signs and symptoms • Silent STD; asymptomatic; transmission occurs unknowingly • Burning, itching in genitalia • Mucopurulent vaginal discharge • Discharge from penis • Burning on urination • Swollen scrotum 43
  44. 44. Chlamydial Infections• Diagnostic procedures • Cytologic, serologic studies of bodily fluids• Treatment • Antibiotics for both partners 44
  45. 45. Chlamydial Infections Complementary therapy • Diet that eliminates sugar and includes probiotics • Multivitamins Client communication • Refrain from sexual activity until treatment is completed • Take all medications 45
  46. 46. Chlamydial Infections• Prognosis • Good with early treatment • If untreated, such complications as PID, infertility in females; epididymitis in males; sterility in both• Prevention • Use condoms • Contact tracing of intimate partners 46
  47. 47. Reproductive SystemDiseases & Disorders in Males 47
  48. 48. Common Signs and Symptoms ofReproductive System Diseases andDisorders in Males• Urinary complaints • Frequency, urgency, incontinence, dysuria, nocturia • Pain in any reproductive organ or unusual discharge • Swelling or enlargement of any reproductive organs • Any sexual disorder or concern 48
  49. 49. Benign Prostatic Hyperplasia• Description • An enlarged prostate caused by growth • Cells multiply and squeeze the urethra • Cells grow into urethra and bladder outlet • Common over age 50 • Significant if obstructs urinary outflow• Etiology • Due to metabolic, hormonal changes associated with aging 49
  50. 50. Benign Prostatic Hyperplasia• Signs and symptoms • Difficulty initiating urination or completely emptying bladder • Nocturia, urinary frequency • Dribbling, weak stream • Incontinence 50
  51. 51. Benign Prostatic Hyperplasia• Diagnostic procedures • Symptoms • Digital rectal exam • Blood test for PSA and PAP • Completion of AUA Prostate Symptom Index • Uroflowmetry PSA = prostate-specific antigen; PAP = prostatic acid phosphatase; AUA = American Urological Association. 51
  52. 52. Benign Prostatic Hyperplasia• Treatment • “Watchful waiting” • Alpha blocker medications • Thermotherapy: microwave or radio frequency • Transurethral prostate resection (TURP) 52
  53. 53. Benign Prostatic Hyperplasia Complementary therapy • Avoid caffeine, tobacco, red pepper • Herbal remedy from saw palmetto products • Add soy and tomatoes to diet Client communication • Regular prostate exams • Discuss sexuality, impotence concerns 53
  54. 54. Benign Prostatic Hyperplasia• Prognosis • Good with proper intervention; 80% to 90% surgical success rate • Complications include cystitis, dilation of ureters, hydronephrosis• Prevention • None • Regular prostate exams 54
  55. 55. Prostatitis• Description • Inflammation of the prostate gland • May be acute or chronic • Most common in males over age 50 • Routes of infection through urethra or blood 55
  56. 56. Epididymitis• Description • Inflammation due to infection • Typically unilateral • Most common infection of male reproductive system • Typically affects those ages 19 to 35 56
  57. 57. Epididymitis• Etiology • Result of prostatitis, UTI, TB, STDs • Chlamydia trachomatis, Neisseria gonorrhoeae most common agents TB = tuberculosis. 57
  58. 58. Epididymitis• Signs and symptoms • Epididymis becomes enlarged, hard, tender, painful • Scrotal, groin tenderness • Fever, malaise • “Waddle” walk• Diagnostic procedures • UA with culture and sensitivity • Ultrasound 58
  59. 59. Epididymitis• Treatment • Antibiotics • Antimicrobial therapy • If STD is cause, treat partner(s) 59
  60. 60. Epididymitis Complementary therapy • Scrotal support, analgesic • Scrotal elevation, cool compress to reduce swelling, pain Client communication • Take all medication, analgesics 60
  61. 61. Epididymitis• Prognosis • Responds well to therapy • Epididymis may be scarred • Sterility is threat; orchitis is a complication • Mumps vaccine for young males to prevent orchitis 61
  62. 62. Epididymitis• Prevention • Early treatment of UTIs • Use condoms 62
  63. 63. Epididymitis• Untreated epididymitis can lead to 1. incontinence 2. sterility 3. testicular cancer 4. BPH 63
  64. 64. Prostatic Cancer• Description • Generally classified as adenocarcinoma • Third leading cause of cancer deaths in males • Tends to metastasize • Rare before age 50 64
  65. 65. Prostatic Cancer• Etiology • Family or race predisposition • Exposure to environmental elements • Coexisting STDs • Endogenous hormonal influence • Eating fat-containing animal products 65
  66. 66. Prostatic Cancer• Signs and symptoms • Asymptomatic or symptoms of urinary obstruction • Dysuria, difficulty voiding • Urinary frequency, urinary retention • Hematuria, bone pain • Weight loss 66
  67. 67. Prostatic Cancer• Diagnostic procedures • Digital rectal exam • Biopsy • CT scan or ultrasonography • PSA blood test • AMACR genetic marker AMACR = alpha-methylacyl-CoA racemase. 67
  68. 68. Prostatic Cancer• Treatment • Depends on tumor stage/grade • Surgical removal • Hormonal therapy, radiation, chemotherapy • “Watchful waiting” for some older clients 68
  69. 69. Prostatic Cancer Complementary therapy • Genistein appears to inhibit growth of prostatic cancer • Cryoablation Client communication • Explain procedures, any possibility of impotence, potential for cure 69
  70. 70. Prostatic Cancer• Prognosis • The earlier detected, the better the prognosis• Prevention • None 70
  71. 71. Testicular Cancer• Description • Malignant neoplasm of the testis • Affects men under age 40 • Cryptorchidism may be predisposing factor • Cure rate of nearly 90% if caught early 71
  72. 72. Reproductive SystemDiseases & Disorders in Females 72
  73. 73. Common Signs and Symptoms ofReproductive System Diseases andDisorders in Females• Pre-, postmenstrual complaints (amenorrhea, dysmenorrhea, oligomenorrhea, metrorrhagia; skin changes; psychological reactions to hormonal changes)• Lower abdominal or pelvic pain• Any abnormal vaginal discharge or itching 73
  74. 74. Common Signs and Symptoms ofReproductive System Diseases andDisorders in Females• Fever• Dyspareunia or any sexual dysfunction• Breast changes (unusual swelling, lumpiness, mass formation, pain, nipple abnormalities)• Bloating or fullness 74
  75. 75. Premenstrual Syndrome• Description • Distinct cluster of physical, psychological symptoms; regularly recur 3 to 14 days before menses; relieved by onset • 30% to 40% experience mild to severe PMS • More frequent in 30s and 40s PMS = premenstrual syndrome. 75
  76. 76. Premenstrual Syndrome• Etiology • Multifactorial • Water retention, estrogen-progesterone imbalance • Psychological factors, dietary deficiencies • Endorphin level changes 76
  77. 77. Premenstrual Syndrome• Signs and symptoms • Irritability, anxiety, depression • Sleeplessness, fatigue • Food cravings, headaches • Abdominal bloating • Heart palpitations • Swollen, tender breasts 77
  78. 78. Premenstrual Syndrome• Diagnostic procedures • Depends on timing of symptoms • Keep journal for 3 months to document • Blood levels of estrogen, progesterone • History and physical examination 78
  79. 79. Premenstrual Syndrome• Treatment • Multivitamin with high folic acid, calcium, and vitamin D • Reduce salt intake 2 weeks prior to menses • Diuretics, analgesics • Avoid coffee, nicotine, alcohol, simple sugars • Proper diet, exercise, rest 79
  80. 80. Premenstrual Syndrome Complementary therapy • Daily exercise • Relaxation programs • Vitamin B6, vitamin E, calcium, magnesium, zinc • Acupuncture Client communication • Encourage support from family, friends 80
  81. 81. Premenstrual Syndrome• Prognosis • Variable • Chronic condition ceases at menopause• Prevention • None 81
  82. 82. Dysmenorrhea• Description • Pain associated with menstruation • Primary: not associated with identifiable pelvic disorder • Secondary: there is underlying pelvic pathology or disease • More common in women with early onset of menses 82
  83. 83. Ovarian Cysts and Tumors• Description • Cysts derived from ovarian follicles that do not open to release ovum • Occur from puberty to menopause • True ovarian neoplasms may be benign (teratomas), ovarian, or polycystic • PCOS is a complex endocrine disorder in females in reproductive years PCOS = polycystic ovarian syndrome. 83
  84. 84. Ovarian Cysts and Tumors• Etiology • Unknown • Genetics, especially in PCOS • Defects in ovary • Hypothalamus–pituitary dysfunction • Irregular menstrual cycles 84
  85. 85. Ovarian Cysts and Tumors• Signs and symptoms • Asymptomatic with small cysts • Large cysts produce pelvic pain, lower-back pain • Dyspareunia • Spasmodic abdominal pain • Fever and vomiting 85
  86. 86. Ovarian Cysts and Tumors• Diagnostic procedures • Ultrasonography • CT scan • Blood tests for hormone levels 86
  87. 87. Ovarian Cysts and Tumors• Treatment • Cyst may disappear spontaneously • Drug-induced ovulation therapy • Surgical resection • Oral contraceptives to regulate periods, encourage ovulation 87
  88. 88. Ovarian Cysts and Tumors• Ovarian cysts derive from the 1. fimbriae 2. epithelium 3. endometrium 4. follicles 88
  89. 89. Ovarian Cysts and Tumors Complementary therapy • Exercise, weight control • Vegetarian diet with organic foods • Avoid fried foods, coffee, tobacco, alcohol, sugar Client communication • Educate about disease process • Offer support if infertility results 89
  90. 90. Ovarian Cysts and Tumors• Prognosis • Varies • Resultant infertility • Chronic nonovulation predisposes to endometrial cancer, CV disease • Hyperinsulinemia• Prevention • None CV = cardiovascular. 90
  91. 91. Endometriosis• Description • Growth of endometrial tissue in areas outside the endometrium • Responds to hormonal signals but no tissue sloughing • May lead to scarring of ectopic site 91
  92. 92. Endometriosis• Etiology • Unknown, perhaps familial • Endometrial tissue gets into blood or lymph • Dioxin exposure 92
  93. 93. Endometriosis• Signs and symptoms • Dysmenorrhea, profuse menses • Pain in lower back, vagina • Pain at ectopic site during menses • Dyspareunia • Dysuria 93
  94. 94. Endometriosis• Diagnostic procedures • History and physical examination • Laparoscopy • Palpation • Staged from 1 (superficial to minor lesions) to 4 (deep involvement, dense adhesions) 94
  95. 95. Endometriosis• Treatment • Depends on symptoms, desire to have child, stage of disease • Hormone therapy; pain medications • Surgery 95
  96. 96. Endometriosis Complementary therapy • Increase essential fatty acids • Reduce intake of meat, eggs, dairy products Client communication • Client support 96
  97. 97. Endometriosis• Prognosis • Varies with location of ectopic site, severity of symptoms • Infertility• Prevention • None 97
  98. 98. Pelvic Inflammatory Disease• Description • Acute or subacute infection of the uterus, fallopian tubes, or ovaries • May be recurrent or chronic 98
  99. 99. Pelvic Inflammatory Disease• Etiology • Infections from Neisseria gonorrhoeae or Chlamydia trachomatis • Infections following parturition • Iatrogenic 99
  100. 100. Pelvic Inflammatory Disease• Signs and symptoms • Often asymptomatic, but damage occurs • Symptoms include • Sudden pelvic pain • Purulent, foul-smelling discharge • Fever • Sexual dysfunction • Metrorrhea • Rebound pain 100
  101. 101. Pelvic Inflammatory Disease• Diagnostic procedures • Difficult to diagnose • Smear of uterine secretions for culture • ESR, WBC • C-reactive protein (CRP) in the blood • Ultrasonography ESR = erythrocyte sedimentation rate; WBC = white blood cell. 101
  102. 102. Pelvic Inflammatory Disease• Treatment • Antibiotics • Analgesics • Bed rest • Surgery 102
  103. 103. Pelvic Inflammatory Disease Complementary Therapy • Abstinence during the infectious stage • Acupuncture for pain • Multivitamins and vitamin C • Castor oil packs warmed and placed on the lower abdomen Client Communication • Remind client of the importance of taking all medication • Educate about possible complications 103
  104. 104. Pelvic Inflammatory Disease• Prognosis • Good with early treatment • Delayed treatment may result in formation of scar tissue and adhesions• Prevention • Prompt treatment of an STD 104
  105. 105. Menopause• Description • Not a disease • Cessation of menses, ovarian function due to decrease in estrogen levels 105
  106. 106. Menopause I used to have Saturday nightfever; now I have Saturday night hot flashes. —Maxine 106
  107. 107. Menopause• Etiology • Occurs between ages 45 and 55 • Surgically induced by oophorectomy • Also induced by malnutrition, severe stress, or disease with hormonal imbalance 107
  108. 108. Menopause• Signs and symptoms • Menstrual irregularities; flow decreases, then ceases • Occurs over months or years • Night sweats, hot flashes • Syncope • Tachycardia • Loss of skin elasticity • Transient psychological symptoms 108
  109. 109. Menopause• Diagnostic procedures • History and physical examination • Screening of blood serum levels of estradiol, FSH, LH FSH = follicle-stimulating hormone; LH = luteinizing hormone. 109
  110. 110. Menopause• Treatment • No treatment or some require HRT • Antidepressants may lessen symptoms HRT = hormone replacement therapy. 110
  111. 111. Menopause Complementary therapy • Avoid spicy food, caffeine, alcohol • Increase calcium intake • Moderate exercise • Acupuncture, yoga, meditation Client communication • Teach symptoms and treatment options 111
  112. 112. Menopause• Prognosis • Good; recognize mood swings • Postmenopausal women may suffer bone loss and cholesterol changes• Prevention • None 112
  113. 113. Menopause• Menopause can be surgically induced by 1. oophorectomy 2. oophorotomy 3. salpingectomy 4. hysterectomy 113
  114. 114. Ovarian Cancer• Description • Sixth most common cancer among females • Risk decreases by 60% for women who take oral contraceptives for longer than 5 years • “Silent killer” 114
  115. 115. Ovarian Cancer• Etiology • Exact cause is unknown • Contributing factors • Familial tendency • HRT with only estrogen • Obesity • Use of androgens to treat endometriosis • Increased risk for women who carry BRCA1, BRCA2, BNC2, or HNPCC genes HNPCC = hereditary nonpolyposis colorectal cancer. 115
  116. 116. Ovarian Cancer• Signs and symptoms • Urinary urgency • Pelvic pain • Abdominal pressure • Fullness and bloating • Persistent indigestion or nausea • Change in bowel habits 116
  117. 117. Ovarian Cancer• Signs and symptoms (cont.) • Loss of appetite • Increased abdominal girth • Dyspareunia • Lack of energy • Low back pain • Changes in menstruation 117
  118. 118. Ovarian Cancer• Diagnostic procedures • Clinical evaluation • Complete history and physical • Transvaginal sonography • Abdominal ultrasound • CT scan • Test for HE4 biomarker • Test for protein CA125 118
  119. 119. Ovarian Cancer• Treatment • Dependent on grading and staging • Surgery to remove tumor • Chemotherapy • Immunotherapy • Drug Avastin 119
  120. 120. Ovarian Cancer Complementary therapy • Controlled amino acid therapy • Green tea and ginger capsules for nausea • Acupuncture, meditation, and aroma therapy Client communication • Educate clients about staging, typing of cancer, and subsequent treatment plans • Encourage reporting of treatment side effects 120
  121. 121. Ovarian Cancer• Prognosis • Dependent upon type and stage of cancer when diagnosed • Early detection has a 95% 5-year survival rate • If progressed, survival rate is less than 35%• Prevention • Yearly pelvic exam • Genetic testing • Factors that reduce risk are oral contraceptives, breast feeding after pregnancy, tubal ligation or hysterectomy 121
  122. 122. Fibrocystic Breasts• Description • Palpable lumps, cysts that fluctuate in size with menses • Fluid-filled round or oval cysts, fibrosis, and hyperplasia of the cells lining the milk ducts • Ages 30 to 55 122
  123. 123. Fibrocystic Breasts• Etiology • Linked to hormonal changes associated with ovarian activity • Familial 123
  124. 124. Fibrocystic Breasts• Signs and symptoms • Most frequent in upper, outer quadrant of breast • Widespread lumpiness or localized mass • Pain, tenderness, feeling of fullness before menses • Fluctuating size • Nonbloody nipple discharge (rare) 124
  125. 125. Fibrocystic Breasts• Diagnostic procedures • Monthly breast self-exam • Mammogram • Ultrasound • Biopsy for suspicious area 125
  126. 126. Fibrocystic Breasts• Treatment • Severe pain or large cysts may require • Needle aspiration • Analgesics • Supportive bra to alleviate pain • Restricting caffeine and salt 126
  127. 127. Fibrocystic Breasts Complementary therapy • Evening primrose oil, 1 capsule 3 times a day • Removal of caffeine Client communication • Teach breast self-exam to determine “normal” from “abnormal” lumps 127
  128. 128. Fibrocystic Breasts• Prognosis • Good • Exacerbations may continue until menopause• Prevention • Monthly breast self-exams • Regular mammography • Reduce caffeine in diet 128
  129. 129. Carcinoma of the Breast• Description • Variety of malignant neoplasms of the breast • Usually begins in milk-producing glands • Most common site of cancer in females 129
  130. 130. Carcinoma of the Breast• Etiology • Unknown • Hereditary • Higher in women with biopsy-confirmed atypical hyperplasia, a long menstrual history, obesity after menopause, smoking • High-fat diet; little or no exercise 130
  131. 131. Carcinoma of the Breast• Signs and symptoms • Abnormality on mammogram • Breast changes such as lump, thickening, dimpling, swelling, skin irritation, distortion • Nipple discharge • Pain, tenderness 131
  132. 132. Carcinoma of the Breast• Diagnostic procedures • Monthly breast self-exam • Mammogram • Ultrasound, CT, and MRI • Biopsy • Staging, typing MRI = magnetic resonance imaging. 132
  133. 133. Carcinoma of the Breast• Treatment • Depends on stage, type • Surgery: lumpectomy or mastectomy • Radiation, chemotherapy • Hormone therapy 133
  134. 134. Carcinoma of the Breast Complementary therapy • Enhance immune system • Acupuncture, massage, Reiki, tai chi, yoga Client communication • Educate about all types of treatment • Refer to support system 134
  135. 135. Carcinoma of the Breast• Prognosis • In early stages, prognosis is good, especially without metastasis• Prevention • Breast self-exam, regular mammography 135
  136. 136. Common Symptoms of Diseasesand Disorders of Pregnancy andDelivery• Abdominal pain, tenderness, cramping• Unusual discharge, pink or brown in color, or clotted• Hypertension, rapid weight gain, edema• Malaise 136
  137. 137. Spontaneous Abortion• Description • Also called miscarriage • Expulsion of the fetus before the 20th week of pregnancy • Incidence is higher in first pregnancy • Risk higher in women over age 35 137
  138. 138. Ectopic Pregnancy• Description • Fertilized ovum implants, grows somewhere other than uterine cavity • Usually within one fallopian tube 138
  139. 139. Ectopic Pregnancy• Etiology • Scarring, inflammation of fallopian tubes as result of infection • Congenital tube malformation • Endometriosis, PID, tumors 139
  140. 140. Ectopic Pregnancy• Signs and symptoms • Signs of early pregnancy • Abdominal pain, tenderness • Slight vaginal bleeding • If tube ruptures, severe abdominal pain, intra-abdominal bleeding 140
  141. 141. Ectopic Pregnancy• Diagnostic procedures • Pelvic exam • History and physical examination • Serum pregnancy test • Ultrasound • Laparoscopy, exploratory laparotomy 141
  142. 142. Ectopic Pregnancy• Treatment • Laparotomy with saving ovary if possible • Blood transfusions 142
  143. 143. Ectopic Pregnancy Complementary therapy • None Client communication • Support during diagnosis, treatment phases 143
  144. 144. Ectopic Pregnancy• Prognosis • With rupture, complications can be life- threatening: hemorrhage, shock, peritonitis• Prevention • Prompt treatment of any GU infection 144
  145. 145. Pregnancy-Induced Hypertension• Description • PIH disorder develops during third trimester • Occurs more frequently in primigravidae, ages 12 to 18 or older than age 35 with multiple births • Preeclampsia is the nonconvulsive form • Eclampsia is the convulsive form with coma 145
  146. 146. Pregnancy-InducedHypertension• Etiology • Unknown • Related to malnutrition, especially lack of protein • Preexisting vascular, renal disease 146
  147. 147. Pregnancy-Induced Hypertension• Signs and symptoms • Preeclampsia • Eclampsia • Hypertension • Tonic-clonic convulsions • Generalized edema • Coma • Proteinuria • Rales, rhonchi • Sudden weight gain • Nystagmus • Oliguria, anuria 147
  148. 148. Pregnancy-InducedHypertension• Diagnostic procedures • Elevated, steadily rising blood pressure • UA for low levels of placental growth factor • Clinical picture 148
  149. 149. Pregnancy-InducedHypertension• Treatment • Preeclampsia: prevent eclampsia, deliver normal baby, rest, antihypertensives • Eclampsia: hospitalized with intensive care • Goal is to manage delivery until 32 to 34 weeks into pregnancy; then cesarean delivery 149
  150. 150. Pregnancy-InducedHypertension Complementary therapy • None Client communication • Stress importance of rest during preeclampsia • Support during labor, delivery 150
  151. 151. Pregnancy-InducedHypertension• Prognosis • Good with preeclampsia • In eclampsia, maternal mortality rate is 15%• Prevention • Adequate nutrition • Good prenatal care • Control of blood pressure during pregnancy 151
  152. 152. Pregnancy-InducedHypertension• Eclampsia is the _____ form of PIH. 1. benign 2. convulsive 3. malignant 4. nonconvulsive 152
  153. 153. Placenta Previa• Description • Placenta is implanted abnormally low in the uterus so that it covers all or part of the cervical os • Placenta may prematurely separate from the uterus causing maternal hemorrhage and interrupting oxygen flow to the fetus 153
  154. 154. CreditsPublisher: Margaret BiblisAcquisitions Editor: Andy McPheeDevelopmental Editor: Yvonne Gillam, Julie MundenBackgrounds: Joseph John Clark, Jr.Production Manager: Sam RondinelliManager of Electronic Product Development: Kirk PedrickElectronic Publishing: Frank MusickThe publisher is not responsible for errors of omission or for consequences from application of information in this presentation,and makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should beapplied by the reader in accordance with professional standards of care used with regard to the unique circumstances that mayapply in each situation. 154

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