The document discusses the nursing role in women's health, which includes health promotion, illness prevention, counseling, and encouraging healthy behaviors and lifestyle choices. It covers assessing the female reproductive system, common procedures like Pap smears and breast exams, and managing various reproductive health issues like menstruation, menopause, infertility, and contraception. The nursing responsibilities are to educate, support, and counsel patients in a non-judgmental manner while respecting cultural and personal factors.

1. Reproductive Health
Ch 46, 47

2. Nursing Role in Women’s
Health
• Health promotion
• Illness prevention
• Provide support & counseling
• Encourage women in their health goals and
behaviors
– personal hygiene, detecting & preventing diseases
(STDs), diet & exercises, sexuality issues-
menopause, contraception, preconception,
pre-/postnatal care, stress management & well-
being, healthy lifestyles, & avoiding risky behaviors

3. Nursing Role in Women’s Health
• Nurses need to model that lifestyle for
patients
• Recommend & promote regular
examinations
• Non-judgmental, understanding &
sensitive
• Screen for/and recognize s/sx. abuse
• Recognize cultural differences & beliefs
• Respect sexual orientation

4. External genitals of the female

5. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
oviduct
ovary
uterus
urinary bladder
pubic symphysis
urethra
vagina
anus
rectum
cervix
oviduct
fimbriae ovary uterus
vagina
Female Reproductive System

6. Function of Female Reproductive System
• Ovulation – ova begins to mature & enlarge
until discharged
– Migrates toward & enters oviduct where
possible fertilization may take place
• Mentrual Cycle – involves production of
estrogen & progesterone
• Menopausal period – end of woman’s
reproductive capacity.
• Early menopause – surgical removal of
ovaries, chemotherapy, radiations, unknown
etiology

7. Assessment
• Health Hx. – past illnesses, STDs,
treatments, hx sexual/physical abuse,
• Sexual Hx. – PE findings, lab results
• Female genital mutilation –
– Cutting, partial/total removal of external
genitalia
– Cultural passage to womanhood: Africa,
Middle East. Crime in the U.S.
– Type I, II, III, IV p 1620

8. Assessment
• Domestic violence
– Physical: for child, elderly; men & women
– Emotional degradation, coercive control,
threats, intimidation.
– Sexual assaults
• The need to maintain control of a partner
is rooted in sex role inequality.
• Sensitive care is required if a woman
states that she is being hurt.
• Report & provide safety for pt. (p.1621)

9. Physical Assessment
• Periodic examination/ pelvic & breast
• Routine cancer screening
• Positioning: supine lithotomy, upright
lithotomy vs. Sims position (left side)
• Proper equipment
• Inspection : lesions of the labia
majora/minora (venereal warts,
melanoma lesions) trauma to the
vaginal wall, cystocele, rectocele,
presence of a hymen

10. Assessment
• Women with disabilities experience
increase risk for abuse
–Inquire about barriers to health care
–Any healthcare limitations
–Cognitive or developmental changes
affecting understanding
• Gerontology considerations
–Facing health disparities or end-of-life
issues

11. Physical Assessment
Speculum Examination:
• Cervix – 2-3 cm, smooth vs. laceration
• Malignant changes
• cysts, polyps
• Discoloration
• Cauliflower-like growth (cancer)
• Vaginal discharge

12. Inspection
of the
Cervix

13. Diagnostic Testing
• PAP Smear – cytology for detecting cervical
cancer
– Atypical cells: Human papillomavirus (HPV)
• Colposocpy – visual examination with a
portable microscope
• Cervical biopsy – analysis of cervical tissue
• Cryotherapy/laser therapy – freezing cervical
tissue with nitrous oxide
• Cone Bx Loop Electrosurgical Excision
Procedure (LEEP) – surgical procedure using
laser beam

14. Diagnostic Testing
• Endometrial Aspiration Bx. – allows for
detection of cellular changes in the
endometrium
• Dilation & Curettage (D&C) – surgery;
dilation if cervical canal and scraping of
endometrial/endocervical tissue for
cytology
• Endoscopic laparoscopy – visualization of
the pelvic structures

15. Diagnostic Testing
• Hysteroscopy – visualization of all the
parts of the uterine cavity
• Hysterosalpingography or
Uterotubography – x-ray of uterus &
fallopian tubes.
• Computed Tomography (CT) –
transverse radiographic images
• Ultrasonography – ultra sound images.
• Magnetic Resonance Images (MRI) –
definitive images using magnetic waves

16. Management of Physiologic
Processes
• Menstruation – 28-day cycle during
reproductive years
– Understand cutural beliefs, customs &
values, psycological consideration, NSAID
• Perimenopause – 1st
sign of menopause:
hot flashes, vaginal dryness, irregular
menses.
– Consider issues in sexuality, fertility,
STD,oral contraceptives, breast cancer,

17. Management of Physiologic
Processes
• Menopause – permanent physiologic cessation
of menses
• Associated with decrease ovarian function,
some breast & genital organ atrophy
• Irregular menses, breast tenderness, mood
changes, hot/warm flashes, noc sweats, sleep
disturbances, gradual thinning of pubic hair,
shrinkage, fatigue, forgetfulness
• Be sensitive to all possible side effects
• Tx – hormone therapy

18. Management of Menstrual Disorders
• PMS - prementstrual syndrome:
• Irritability, fatigue, bloating, edema, HA,
depression, low back pain, painful breast, mood
swings
• Tx symptoms, promote exercise, avoid caffeine
& high-fat diets
• Vit. B, E, magnesium, oil of primrose are used
but show no evidence of effectiveness
• Selective serotonin reuptake inhibitors (Prozac,
Sarafem, Fluoxetime, Ibuprofen, Naproxenk
Anaprox, diuretics, antianxiety, calcium
supplements

19. Management of Menstrual Disorders
Nursing management:
• Establish nurse/pt rapport, for good
health history
• Nutrition history
• Minimize side effects, stress-coping
strategies
• Pt educ: avoid caffeine, alcohol, eating
diet low in essential nutrients. Teach how
to record timing & intensity of symptoms

20. Menstrual Disorders
Dysmenorrhea: painful menstruation,
severe crampings
• Tx: relieve discomfort, A.S.A. NSAIDs,
low level local heat
– Contraindicated with peptic ulcers
Amenorrhea – absence of menstrual cycle
• Allow pt to express concerns, PE,
medical hx., stress level, pregnancy,
eating disorders, anorexia & bulimia

21. Menstrual Disorders
• Menorrhagie – excessive menstruation;
profuse, prolong flow during regular
periods
• Related to endocrine distrubances,
inflammatory disturbances, uterine tumors
• Can result in anemia; need to see MD
– Count # pads, & saturation (absorbency)

22. Menstrual Disorders
• Metrorrhagie – heavy uterine bleeding between
periods; irregular
– May signal cancer, benign tumors of the
uterus
– Health hx., taking oral contraceptives or HR?
• Hypomenorrhea – scanty flow
• Oligomenrrhea – reduced frequency of periods

23. Contraception
• Abstinenece – practice celibacy; only
effective method
• Sterilization
–Bilateral tubal ligation: laparoscopy
procedure
• Fellopian tubes are coagulated,
sutured, or ligated with bands/clips.
• Transcervical tubal occlusion
– Vasectomy – excision of the vas
deferens

24. Contraception
• More than half of pregnancies in the U.S.
are unintended
• Nurses can assist in providing information
and support
• Family planning resources
• Listen, educate and take time to answer
questions
• Be unbiased and nonjudgmental
• Understand the risks & benefits

25. Contraception
• Hormonal – use of estrogens & progestins by
women.
• Block ovarian stimulation, prevent release of
FSH from the anterior pituitary gland.
• Benefits: reduce incidence of benign breast
disease, uterine & ovarian cancers, anemia,
pelvic infections; Improves acne.
• Risks: DVT, breast soreness, HA, nausea, leg
cramps
** Inform pts that hormonal contraception protects
against pregnancy but not from STD of HIV

26. Contraception
• Intrauterine device (IUD) – a plastic, t-shaped
device inserted into the uterine cavity to prevent
pregnancy.
• Causes local inflammation, which is toxic to
sperm & blastocysts; therefore prevents
fertilization
• May cause excessive bleeding, cramps,
backaches, slight risk of tubal pregnancy,
perforation of cervix and uterus is rare

27. Contraception
• Mechanical barriers – diaphragm
• Cervical cap
• Contraceptive spong
• Female condom (p1645)
• Male condom
• Spermicides
• Coitus interruptus (withdrawal)
• Rhythm & natural method – “safe period”
• Emergency contraception – morning after pill

28. Contraception
• Abortion –
• Spontaneous abortion
• Habitual (recurrent) abortion
– After 2 consecutive abortion, pt is referred
to genetic counseling and testing
• Elective abortion – voluntary
– Pt education & counseling on choices
– Explore pts fears, feelings and options
– Review use of birth controls methods

29. Nursing management
• For spontaneous abortion - provide bed
rest, sexual abstinence, no straining on
defecation
• Allow expression of feelings: listen
• Pt education: available forms of
contraception, community resources
• Counseling
• Pelvic exam, lab studies, RhoGAM,
STD screening

30. Infertility
• The couple’s inability to achieve
pregnancy after 1 yr. of unprotected
intercourse.
• Ovarian/ovulation factors
• Tubal factors
• Uterine factors
• Semen & other male factors

31. Artificial Insemination
• Deposit of semen into the female genital tract
by artificial means
– Sperm cannot penetrate the cervical canal
– Donor or partner/husband semen is frozen
– Written consent
– Safeguards set in place for legal, ethical, emotional &
religious issues
• Must meet certain condition: the women should
have no genital abnormalities, require patent
fallopian tubes, available ovum.
• Viable sperm: normal shape, amount, motility
and endurance

32. Ectopic Pregnancy
• Decreasing in rate, but remains the
leading cause of pregnancy related
dealth in 1st
trimester
• Acute condition – require surgery
• Relieve acute pain
• Monitor potential complications–
prevent hemorrhage, shock.
• Provide emotional support