chp 42 Nursing care of women with reproductive system disorders

benign breast disorders
-Cyclic breast discomfort (pregnancy, swelling, tenderness, hormone)

-Fibrocystic breast changes ( overesponsivness of cells, feel hard, lumpy, pain during menses cycle) (subsides w/menopause)

-Mastitis ( infection or inflammation; commonly occurs while breastfeeding, swollen, hot, red, sometimes abscess)

breast cancer
abnormal growth of breast cells

risk factors for breast cancer
-early menarche
-family hx
-late menopause
-high fat diet
-late or no pregnancies
-high alcohol intake
-no breastfeeding
-estrogen treatment

diagnosis test: breast cancer
-clinical breast exam

therapeutic interventions: breast cancer
-hormonal therapy
-biological response modifiers

different types of Mastectomy
-Simple = removing breast tissue of one or both breast
-Radical = breast tissue & underlying muscle & surrounding lymphnodes

breast surgeries
-mammoplasty ( surgical modification)
-breast reduction
-mastopexy (does not remove as much tissue, corrects sagging)
-augmentation (increase size of breast)

menstrual flow/ cycle disorder
-oligomenorrhea ( cycle more than 35 days)
-hypomenorrhea (less bleeding)
-menorrhagia (excessive blood)
-hypermenorrhea ( lasting longer than 7 days)
-polymenorrhea ( menses freq. 21 day interval)
-menometrorrhagia ( overly long & heavy, irregular bleeding)

therapeutic interventions
-D&C = dilation & curettage
-laser ablation ( targeted burning of endometrial tissue)
-hysterectomy (last resort of treatment)

-painful menstruation
-diagnostic tests:(primary) hormone levels, (secondary) laproscopy, biospy, culture
-Interventions: aspirin, NSAIDS, (secondary) D&C, correct cause

Premenstrual syndrome PMS:
-water retention
-change in affect & concentration
-stress management
-limit : alcohol, caffeine, nicotine, salt, simple sugars

endometrial tissue outside of uterus

(endometriotic cells grow in areas of sufficient blood supply, sloughing & bleeding occur in the enclosed abdominal cavity or into tissues that they invaded, which causes pain)

Signs & symptoms of Endometriosis
caused from the build up of blood
-organ damage
-scar tissue

interventions: endometriosis
-surgical intervention
-estrogen reduction (meds, oopherectomy)
-relaxation exercises
-heat to abdomen or back

happens at ages 45-55 caused from decrease hormone productivity
Perimenopause S&S:
-erratic menses
-tissue atrophy
-decreased lubrication
-hot flashes
-night sweats
-mental changes

treatment: menopause
-HRT- controversial
-dietary phytoestrogens (in foods & herbs)
-calcium / vit. D
-dress in layers (hot flashes)
-vaginal lubricant
-healthy diet

vagina & vulva disorders
*Overgrowth of organisms (normal vag. pH less than 4.2)( more acidic which protects against growth)
-bacterial vaginosis
-cytolytic vaginitis
-trichomoniasis (can be sexually transmitted)
Meds: oral, cream, suppository, douche

toxic shock syndrome TSS
Systemic infection ( strains of staphylococcus that produce an epidermal toxin) (RARE)
-highly absorbent tampons
-other packing
(affects the liver, kidney & circulatory system )

Signs & symptoms of TSS
-fever (sudden/high)
-sore throat
-redness of palms
-skin rash

TSS prevention
-change tampon q4h
-substitute pads
-wash hands
-care with barrier contraceptives
-report symptoms promptly

genital organ development disorders
-Angenesis = structure never developed
-Hypoplasia = underdeveloped
-Imperforate openings = expected opening do not exist
(genetic or environmental factors during pregnancy may cause these)

displacement disorders
stretching injury of supporting structures
-uterine position disorders (4 types)
-uterine prolapse (1,2,3 degrees)

uterine position disorders
-anteversion = uterus lies to far forward
-anteflexion = bends forward
-retroversion = lies to far back
-retroflexion = bends backward

displacement disorders: therapeutic interventions
-surgical correction
-kegal exercises

reproductive: Fertility disorders
-anatomic -ovulation
-hormonal -tubal
-genetic -uterine & other
-sexual dysfunction

reproductive life planning
-oral contraceptives & implants
-depot medications (IM shot)
-ring & patch
-barrier methods ( less effective)
-intrauterine devices (IUD)
-natural family planning

-tubal ligation ( non-surg is Essure)

pregnancy termination methods
-chemical (plan B & mifeprex)
-menstrual extraction ( during first 7 wks, removal endo.lining)
-vacuum aspiration (thru 13 wks)
-d&c (13 wks)
-dilation & evacuation (2nd trimester)
-saline or urea injection (beyond 16 weeks, injected into placenta)

women: benign growths
-fibroids/ leiomyoma (on or within urterus)
-polyps (inside uterus or on cervix; bleed)
-cysts (on ovaries)
-bartholin cyst
-dermoid cyst (rare) (also called teratoma)

Polycystic ovary syndrome (PCOS)
*endocrine imblances (cause your estrogen to go down & androgen to go up)
-menstrual disturbance
-masculinization (excess androgen)
-diabetes mellitus
-endometrial cancer

PCOS interventions
-oral hypoglycemics
-oral contraceptives
-antiandrogen agents (aldactone)
-GnRH agonists (severe cases)

malignant disorders : women
-vulvar cancer (rare)
-cervical cancer
-endometrial cancer
-ovarian cancer

Vulvar cancer
risk factors:
-persistent itching
-white or red patches
-skin ulcers
-wart -like growths

therapeutic interventions : vulvar cancer
-destruction of cancerous cells
-radical vulvrectomy
-skin grafting

Cervical cancer : risk factors
-early sexual activity
-multiple sex partners
-several pregnancies

cervical cancer: Signs & symptoms
-serosanguinous discharge
-may be asymptomatic

cervical cancer: diagnosis
-pap smear
-shiller’s test (painting cervix with iodine)

Endometrial cancer
Risk factors:
-estrogen excess
-estrogen therapy
Signs & symptoms
-abnormal bleeding

Ovarian cancer
insidious killer because cellular changes in ovaries often are asymptomatic until cancer is advanced

ovarian cancer;
risk factors:
-low fertility
-late menopause
-family hx
-high fat diet
-NONE until late
-radiation & chemo

Endoscopic surgery
-laproscopy ( most common)
-culdoscopy (access the area back of uterus; colposcopies)
-hysteroscopy ( to treat problems w/uterus)

Postoperative care: endoscopic surgery
-vitals, bleeding, temp., pain (carbon dioxide insufflation)
-Instruct to lie flat
-administer analgesics
-reinforce RN instructions

removal of uterus
-total abdominal hysterectomy (TAH)
-TAH with bilateral salpingo-oopherectomy
(removal of fallopian tubes & ovaries)

rationale for hysterectomy
-menstrual problems
-benign tumors
-cancer of the uterus

nursing diagnosis: hysterectomy
-risk for ineffective tissue perfusion ( check wound 2x day)
-risk for impaired urinary elimination (report if less than 30mL per hour)
– risk for constipation
-risk for ineffective coping

Repro: Women Benign Breast Disorders -Cyclic Breast Discomfort -Fibrocystic Breast Changes -Mastitis Repro: Women Breast Cancer Risk Factors -age -family history -high fat diet -high alcohol intake estrogen treatment -early menarche -late menopause -late or no pregnancies -no breastfeeding WE …

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Endometrial cancer refers to several types of malignancy which arise from the endometrium, or lining of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year in the U. …

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