chapter053

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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


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


QuestionQuestion

Is the following statement true or false?

The cause of PMS is hormones.


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.


DysmenorrheaDysmenorrhea• Painful menstruation; Idiopathic; Primary,

secondary

• Symptoms: Low abdominal pain; Cramping

• Treatment: Non-narcotic analgesics; Heat

Figure 53-2

Knee–chest

position


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


Uterine Balloon TherapyUterine Balloon Therapy

Left: Insertion of the catheter

Right: Infusion and heating of fluid within the balloon


QuestionQuestion

Is the following statement true or false?

Menorrhagia is a disorder where menstruation lasts longer than 7 days.


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.


MetrorrhagiaMetrorrhagia• Unexpected, Irregular Bleeding

– Intermenstrual or postcoital bleeding

– Causes

• Pituitary or ovarian stimulation

• Uterine malignancies and cervical irritation

• Breakthrough bleeding with HRT


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


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



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



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



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



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



• 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


Vaginal FistulasVaginal Fistulas


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



QuestionQuestionIs the following statement true or false?

Is it common to use a pessary as treatment for a rectocele.


AnswerAnswerFalse.

Is it common to use a pessary as treatment for a cystocele. Cleaning the pessary biweekly is important to avoid serious complications.


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



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



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



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



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.



• 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


Vaginal CancerVaginal Cancer


• 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


Vulvular CancerVulvular Cancer


End of Presentation

chapter053

Documents

surgical management

balloon copyright

headache medical management

redness medical management

coagulation disorders

cervix pathophysiology

endocrine disorders

secondary symptoms