JBorrero 10/08

Stressors of the Female and Male

Reproductive Systems

NUR240

Endometriosis

• Endometriosis is usually a benign problem of endometrial tissue implantation outside the uterine cavity.

• Manifestations include pain, dyspareunia, painful defecation, sacral backache, hypermenorrhea, and infertility.

• Erythrocyte sedimentation rate and white blood cell count rule out pelvic inflammatory disease.

• Laparoscopy is the key diagnostic procedure.

Collaborative Management

• Nonsurgical management includes hormone manipulation.

• Surgical management includes:– D&C- Dilation and curettage– Laser or balloon endometrial ablation– Hysterectomy

Uterine Prolapse

• Stages of uterine prolapse are described by the degree of descent of the uterus.

• Dyspareunia, backache, pressure in the pelvis, bowel or bladder problems

• Pessaries

• Surgery

Cystocele

• Protrusion of the bladder through the vaginal wall due to weakened pelvic structures

• Difficulty in emptying bladder, urinary frequency and urgency, urinary tract infection, stress urinary incontinence

• Kegel exercises

• Surgery

Rectocele

• Protrusion of the rectum through a weakened vaginal wall

• Constipation, hemorrhoids, fecal impaction, feelings of rectal or vaginal fullness

• High-fiber diet, stool softeners, laxatives

• Surgery

Fistulas

• Abnormal openings between two adjacent organs or structures

• Etiology

• S&S

• Nonsurgical treatment

• Surgical treatment

Bartholin Cyst

• Obstruction of the duct of the Bartholin’s gland

• Simple incision and drainage

• Marsupialization (formation of a pouch)

• Postoperative care

Uterine Tumors

Nonmalignant:

Fibroids or Leiomyomas

Malignant:

Endometrial Cancer

• Endometrial cancer is a reproductive cancer, of which adenocarcinoma is the most common type.

• The main symptom is postmenopausal bleeding.

Endometrial Cancer Dx Tests

• Diagnostic assessment includes the following tests:– CA-125 tumor marker– Chest x-ray– Barium enema– CT of the pelvis– Liver and bone scans– Functional dilation and curettage (D&C)

TX: Radiation Therapy

• External and internal

• Teletherapy

• Brachytherapy

• Intracavitary radiation

Surgical Management

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy

• Radical hysterectomy with bilateral pelvic lymph node dissection for stage II cancer

Cervical Cancer• Common reproductive cancer among

women in the U.S.• Disorder is a progression: from totally

normal cervical cells to premalignant changes in appearance of cervical cells (dysplasia), to changes in function, ultimately to transformation to cancer

• HPV- Human papillomavirus• Gardasil Vaccine- 3 doses• Carcinoma in situ• Preinvasive or invasive

Clinical Manifestations

• Client often asymptomatic• Classic symptom: painless vaginal

bleeding• Watery, blood-tinged vaginal discharge

that may become dark and foul-smelling as the disease progresses

• Leg pain• Flank pain • Unexplained weight loss, pelvic pain,

dysuria, hematuria, rectal bleeding, chest pain and cough

Diagnostic Assessment

• Pap smear

• Colposcopic examination

• Endocervical curettage

Nonsurgical Management

• Local ablation of using the loop electrosurgical excision procedure

• Laser therapy

• Cryotherapy

• Radiation therapy

• Chemotherapy

• Conization

Surgical Management

• Clinical staging performed before surgery to establish extent of the disease

• Simple hysterectomy

• Radical hysterectomy

• Pelvic exenteration

Postoperative Care

• Early stages of recovery, assess for:– Hemorrhage and shock– Pulmonary complications– Fluid and electrolyte imbalances– Renal or urinary complications– Pain

Postoperative Care

• Later stages of recovery, assess for:– Deep vein thrombosis– Pulmonary emboli– Paralytic ileus– Wound infections– Wound dehiscence– Wound evisceration– Pain

Ovarian Cancer

• Most common type—serous adenocarcinoma

• Vague abdominal discomfort, dyspepsia, indigestion, gas, and distention

• Ovarian antibody CA-125, ultrasound, intravenous pyelography, barium enema, upper gastrointestinal radiographic series to rule out tumors

Management

NONSURGICAL

• Chemotherapy with agents such as cisplatin, carboplatin, and paclitaxel

• Radiation therapy

Management

SURGICAL

• Total abdominal hysterectomy and bilateral salpingo-oophorectomy

• Staging

• Second-look procedure usually after 1 year of chemotherapy

Assessment

• Urinary pattern, frequency, nocturia, and other symptoms of bladder neck obstruction

• Lower urinary tract symptoms• Hesitancy, intermittency, reduced force

and size of urinary stream, a sensation of incomplete bladder emptying, and postvoid dribbling

• Hematuria

Laboratory Assessment

• Urinalysis

• Complete blood count

• Blood urea nitrogen and creatinine levels

• Prostate-specific antigen

• DRE

• C&S

Drug Therapy

• Finasteride ( Proscar) to shrink the prostate gland and improve urinary flow

• Terazosin hydrochloride (Hytrin)

• Doxazosin mesylate (Cardura)

• Tamsulosin hydrochloride (Flomax)

• Estrogens and androgens

Surgical Procedures

• Transurethral resection of the prostate AKA TURP

• Suprapubic prostatectomy

• Retropubic prostatectomy

• Perineal prostatectomy

Continuous Bladder IrrigationCBI

• Goal: To maintain clear urine flow• Three-way urinary catheter with a 30- to

45-mL retention balloon through the urethra into the bladder

• Traction via taping to client’s abdomen or thigh

• Uncomfortable urge to void continuously

• Antispasmodic medications

Postcatheterization Care

• Client feels burning on urination as well as some urinary frequency, dribbling, and leakage.

• Symptoms are normal and will subside.

• Monitor fluid intake.

Prostate Cancer

• Most common invasive cancer among men in the U.S.

• One of the slowest growing malignancies; metastasizes in a predictable pattern

• First symptoms related to bladder neck obstruction

• Hormonal dependent

Prostate Cancer: Dx

• Digital rectal examination

• Prostate-specific antigen (PSA)

• Biopsy necessary to confirm suspected prostatic cancer

Surgical Treatment: Radical Prostatectomy

Post op Care:• Caring for wound drains• Preventing emboli• Preventing pulmonary complications• Antibiotics• Analgesics• Laxative and stool softener• Indwelling urinary catheter• Antispasmotic

Complications

• Urinary incontinence

• Erectile dysfunction

Nonsurgical Management

• Radiation therapy

• Hormonal therapy

• Chemotherapy

• Targeted therapy

Testicular Cancer

• Although uncommon, this cancer is the most common malignancy in men 15 to 35 years of age.

• With early detection by testicular self-examination and treatment with combination chemotherapy, testicular cancer can be cured.

Diagnostics

• Alpha-fetoprotein

• Beta subunit of hCG

• Ultrasound

• Computed tomography

• Magnetic resonance imaging

• Lymphangiograms

Risk for Sexual Dysfunction

Oligospermia, azoospermia

Interventions include:– Health teaching about reproduction,

fertility, and sexuality– Sperm storage– Other reproductive options

Potential for Metastasis

• Interventions include:– Surgical management– Preoperative care– Operative procedures: radical

retroperitoneal lymph node dissection, orchiectomy

– Post op care : Pain, Immobilty, Wound/Drain Care

Nonsurgical Management

• Chemotherapy

• Radiation therapy

• Stem cell transplantation