chapter053
TRANSCRIPT
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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Chapter 53: Caring for Clients with Disorders of the Female Reproductive
System
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Premenstrual Syndrome (PMS)Premenstrual Syndrome (PMS)
• Occurs 7 to 10 days before menstruation
• Unknown cause, possible hormonal connection; Physical and emotional symptoms
• Signs and symptoms: Weight gain; Headache; Pain; Irritability; Personality changes; Anxiety
• Menstrual diary aid in diagnosis
• Treatment: Depends on symptom severity; Healthful lifestyle changes; Hormonal therapy
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QuestionQuestion
Is the following statement true or false?
The cause of PMS is hormones.
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AnswerAnswer
False.
The cause of PMS is unknown. Proposals suggest a connection with excess estrogen, deficient progesterone (or both), glandular dysregulation, or effects of reproductive hormones on brain chemicals.
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DysmenorrheaDysmenorrhea• Painful menstruation; Idiopathic; Primary,
secondary
• Symptoms: Low abdominal pain; Cramping
• Treatment: Non-narcotic analgesics; Heat
Figure 53-2
Knee–chest
position
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Various Menstrual DisordersVarious Menstrual Disorders• Amenorrhea: Absence of Menstrual Flow
• Oligomenorrhea: Infrequent Menses
– Causes: Endocrine imbalances; Stress; Poor nutrition
– Associated conditions: Polycystic ovarian syndrome; Premature ovarian failure
• Menorrhagia: Menstruation longer than 7 days
– Causes: Endocrine, coagulation disorders
– Medical, surgical management: NSAIDs; Hormones; Endometrial ablation; Uterine balloon therapy; Photodynamic therapy
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Uterine Balloon TherapyUterine Balloon Therapy
Left: Insertion of the catheter
Right: Infusion and heating of fluid within the balloon
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QuestionQuestion
Is the following statement true or false?
Menorrhagia is a disorder where menstruation lasts longer than 7 days.
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AnswerAnswer
True.
Menorrhagia is a disorder where menstruation lasts longer than 7 days, which can be caused by endocrine disorders, coagulation disorders, or can be a symptom of a more serious condition.
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MetrorrhagiaMetrorrhagia• Unexpected, Irregular Bleeding
– Intermenstrual or postcoital bleeding
– Causes
• Pituitary or ovarian stimulation
• Uterine malignancies and cervical irritation
• Breakthrough bleeding with HRT
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MenopauseMenopause• Cessation of Menstrual Cycle: Physiologic,
surgical menopause
– Climacteric and postmenopausal period
• Pathophysiology and Etiology: Diminishing ovarian function; Reduction in hormones; Hypothalamic-pituitary stimulation
• Signs and Symptoms: Menstrual irregularities; Vasomotor disturbances
• Medical Management: HRT; Antidepressants; Biphosphonates; Symptomatic relief
• Nursing Management
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VaginitisVaginitis• Vaginal Inflammation
– Pathophysiology and Etiology: Chemical or mechanical irritants; Pathogenic microorganisms; Predisposing factors
• Assessment Findings: Symptoms: Abnormal vaginal discharge, itching, burning, and redness
• Medical Management: Anti-infective agents; Treatment of sexual partner; Symptomatic relief measures
• Nursing Management
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CervicitisCervicitis• Inflammation of the Cervix
• Pathophysiology and Etiology: Trauma of gynecologic procedures; Chronic cervicitis may lead to infertility
• Assessment Findings: History of spotting, unusual bleeding; Dyspareunia; Unhealthy vaginal discharge
• Medical Management: Antibiotics; Douching; Electrocautery; Conization
• Nursing Management
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Pelvic Inflammatory DiseasePelvic Inflammatory Disease• Infection of pelvic organs except uterus
• Pathophysiology and Etiology: Microorganisms entering through cervix
• Assessment Findings: Malodorous vaginal discharge; Severe abdominal, pelvic pain; Fever; Menorrhagia; Dysmenorrhea
• Medical Management: Hospitalization; Rest; Symptomatic relief measures; Emergency surgery for pelvic abscess
• Nursing Management
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Toxic Shock SyndromeToxic Shock Syndrome
• Septic Shock; Life-threatening systemic reaction
• Pathophysiology and Etiology: Virulent bacteria production with no immunological defense
– Superabsorbent tampons; Internal contraceptives
• Signs and Symptoms: Sudden onset of high fever, chills, myalgia, N/V, diarrhea, hypotension, disorientation, headache
• Medical Management: IV fluid administration; IV ATB therapy; Adrenergics
• Nursing Management
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EndometriosisEndometriosis
• Pathophysiology and Etiology: Not clearly understood
– Ectopic tissue responds to hormones
– Result in adhesions, sterility
• Assessment Findings: Severe dysmenorrhea; Copious menstrual bleeding; Chocolate cyst formation
• Medical, Surgical Management: Natural or surgical menopause; Cyst removal
• Nursing Management
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• Unnatural Opening Between Structures
– Different types
• Pathophysiology and Etiology: CA; Surgical injury; Radiation therapy; Congenital anomaly; Ulcerative colitis
• Assessment Findings: Leakage of urine or stool through vagina
• Medical, Surgical Management: Surgery; Symptomatic relief measures
• Nursing Management
Vaginal FistulasVaginal Fistulas
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Pelvic Organ ProlapsePelvic Organ Prolapse• Cystocele; Rectocele
• Pathophysiology and Etiology: Weakness in muscles, fascia; Urinary, bowel alterations; Irritation of protruding cervix
• Signs and Symptoms: Stress incontinence (cystocele); Cystitis; Constipation (rectocele); “Something is dropping out” (uterovaginal prolapse)
• Medical, Surgical Management: Pessary; Kegel exercises; Transvaginal repairs
• Nursing Management
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QuestionQuestionIs the following statement true or false?
Is it common to use a pessary as treatment for a rectocele.
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AnswerAnswerFalse.
Is it common to use a pessary as treatment for a cystocele. Cleaning the pessary biweekly is important to avoid serious complications.
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Uterine DisplacementUterine Displacement• Retroversion, Retroflection
– May cause infertility
• Anteversion, Anteflexion
• Pathophysiology and Etiology: Positional displacement ; Congenital, PID, Endometriosis
• Assessment Findings: Backache; Dyspareunia; Dysmenorrhea;
• Medical, Surgical Management: Pessary; Knee-chest position
• Nursing Management
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Uterine LeiomyomaUterine Leiomyoma• Benign growth of smooth muscle, fibrous
connective tissue; Most common in pelvis; AKA fibroid tumors
• Pathophysiology and Etiology: Growth stimulated by estrogen; Slow growth; Various sites
• Assessment Findings: Menorrhagia; Anemia; Dysmenorrhea
• Medical, Surgical Management: D & C; Myomectomy; Hysterectomy
• Nursing Management
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Cervical, Endometrial CancerCervical, Endometrial Cancer
• Cervical CA: 2nd most common female reproductive CA
• Pathophysiology and Etiology: Age (>50 y.o.); DES exposure; High-risk sexual activity; HPV; Smoking; Pelvic radiation
• Signs and Symptoms: Bleeding; Pain; Pressure on bladder
• Medical, Surgical Management: Depends on tumor staging; Hysterectomy; Chemotherapy
• Nursing Management
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Ovarian Cysts, Benign Ovarian TumorsOvarian Cysts, Benign Ovarian Tumors
• Pathophysiology and Etiology: Unknown; Endocrine dysfunction implicated
• Different Types
– Affect menstruation, fertility
• Assessment Findings: Menstrual irregularities, pain; Lower abdomen discomfort; Backache
• Medical, Surgical Management: Range from no treatment to BCPs to surgery
• Nursing Management
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Ovarian CancerOvarian Cancer• Leading cause of death from gynecologic
malignancies
• Pathophysiology and Etiology: Hereditary; Nulliparous women; Other types of female reproductive CAs
• Signs and Symptoms: Vague abdominal discomfort; Urinary frequency
– Later: Ascites; Weight loss; Severe pain
• Medical, Surgical Management: Various surgeries, including oophorectomy, etc.
• Nursing Management
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• Pathophysiology and Etiology: HPV infection; Nonhygienic pessary use; DES exposure
• Signs and Symptoms: Abnormal vaginal bleeding; Dyspareunia
• Medical, Surgical Management: Based upon tumor extent; Laser photovaporization treatments; Total vaginectomy; Radiotherapy
– Complications
• Nursing Management
Vaginal CancerVaginal Cancer
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• Pathophysiology and Etiology: Relatively rare; Usually in women > 60 y.o.; Increasing in HPV, herpes
– Highly curable
• Signs and Symptoms: Pruritus, genital burning; White, raised labial patches; Bloody discharge; Enlarged lymph nodes; Vulvular ulceration; Mass development
• Medical, Surgical Management: Vulvectomy; Laser photovaporization
• Nursing Management
Vulvular CancerVulvular Cancer
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End of Presentation