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93 Cards in this Set

  • Front
  • Back
Female Reproductive System
* Normal menstruation
* Common abnormalities in female reproductive system
* Menopause
* Cervical cancer
* Breast cancer and self breast exam
* First menstrual period
* Average age of onset 12 to 13 years old
* Can range from 9-17 years old and still be within normal limits
* Often anovulatory
Menstruation (continued)
* Bleeding occurs in response to hormonal changes
* Average interval between cycles is 28 days (can range from 23-35 days)
* Average duration of flow is 2-7 days
* Average blood loss is 30-80cc
* Requires intact hypothalamus, pituitary gland, ovaries, and uterus
Menstrual Disorders
* Dysmenorrhea: painful menstruation
Can be primary or secondary
* Primary: no associated pathology, but can be associated with abnormally high levels of prostaglandins, poor hygiene, anxiety related to menstruation
* Secondary: pelvic disease present.
Common causes:
endometriosis, cervical os stenosis, fibroids, cancer
* What is the most common cause????
Other causes of amenorrhea?
chronic illness
extreme dieting
strenuous exercise
abnormally heavy menstrual flow, greater than 80cc per menses
bleeding between menstrual periods
any vaginal discharge than blood- often a symptom of vaginal or cervical infection
Defined as
abnormal growth of extra uterine endometrial cells, often in cul-de-sac of peritoneal cavity, the uterine ligaments, and the ovaries
* Cause unknown
* Occurs in 30’s & 40’s, rarely before 20
There are three theories proposed to explain the cause endometriosis
Implantation theory
Vascular, lymphatic theory
Formation theory
Implantation theory
Results from excessive endometrial production and reflux of blood and tissue through the fallopian tubes during menstrual flow
Vascular, lymphatic theory
Endometrial glands are transported through vascular & lymphatic systems to other areas
Formation theory
Endometrial tissue forms spontaneously outside the uterus
* Causes intense pain
* Can lead to infertility
* Can lead to painful intercourse
* Treatment can be medical or surgical
Medical management: mild analgesics, NSAIDS, OCs
Comfort measures: heating pads, relaxation, biofeedback
Premenstrual Syndrome
* Symptoms occur during the LUTEAL phase of menstrual cycle
* Affects women of all races, socioeconomic levels, and all educational levels
* Most common in 30-40 year olds
* Severity increases with age until menopause
* Risk factors: after pregnancy, childbirth, and tubal ligation; perimenopausal years, and during major life stresses
PMS symptoms occur during the _____
PMS most common in what age group?
PMS risk factors
after pregnancy
tubal ligation
perimenopausal years
during major life stresses
PMS emotional symptoms
easily induced crying spells
low self esteem
PMS physical symptoms
breast tenderness
fluid retention
increased appetite and food cravings
hot flashes
musculoskeletal discomfort
PMS cognitive symptoms
short term memory problems
difficulty concentrating
unclear thinking
PMS treatment - Diet & nutritional therapy
* Eat small meals throughout the day
* Limit sugar, red meat, EtOH, coffee, tea & chocolate
* Eliminating caffeine can help w/irritability
* limit sodium intake if edema is a problem
* Ca, MG, Vits A, B6, & C can be helpful
PMS treatment - Medications (most are controversial)
* mild K+ sparing diuretics
* Progesterone
* Parlodel
* OCs
* Gonadotropin-releasing hormone agonists
* Antidepressants
* Prostaglandin inhibitors (NSAIDS)
* Refers to the end of menstrual periods - the actual date cannot be determined until one year passes without menses
* FSH and LH levels increase
* Decreased estrogen levels affect the reproductive system, CV system, and bone density
* Ave age of onset 50-52
* Preceded by “perimenopause”
Average age of onset of menopause?
Effects of Menopause
* Reproductive system: uterus, cervix, ovaries, labia, and clitoris shrink in size; vaginal mucosa becomes thin and dry; pelvic floor relaxes
* Bone density decreases, leading to osteoporosis
* During perimenopausal phase: hot flashes, emotional changes, and fatigue
Cervical Cancer
* Pap smears have decreased the death rate from cervical CA, because of the ability to detect pre-malignant changes
* Risk factors: low socioeconomic status, early age of 1st intercourse or 1st pregnancy, multiple sex partners, intrauterine exposure to DES, cigarette smoking, exposure to HSV/ cytomegalovirus, and HPV
Pap smears test for?
Cervical cancer
Cervical CA Classic symptom
painless vaginal bleeding (starts as spotting between menstrual periods or after sex– as malignancy grows, the bleeding increases in frequency, duration, and amount)
Other sx of cervical cancer
* leg pain/unilateral swelling of the leg
* wt loss/pelvic pain
* dysuria/hematuria, rectal bleeding
Cervical CA - Nonsurgical
* Laser therapy
* cryosurgery
* radiation therapy
* chemotherapy
Cervical cancer - Sugical
* Conization
* hysterectomy
* pelvic exenteration
Is ovarian cancer often bilateral?
Ovarian Cancer
* Leading cause of death from female reproductive malignancies
* Poor early stage detection rates= low survival rates
* Tumors grow and spread rapidly and are often bilateral
Ovarian cancer - Risk Factors
* Family history of ovarian cancer
* History of breast, bowel, or endometrial cancer
* Nulliparity
* Infertility
Ovarian cancer risk factors -
* History of dysmenorrhea or heavy bleeding
* Diets high in animal fat
* Age older than 40- peaks at age 50-55
Ovarain Cancer Assessment - Sx to look for
* abdominal pain or swelling
* dyspepsia
* indigestion
* gas
* Hx of: ovarian imbalance AEB premenstrual tension, heavy menstrual flow, or dysfunctional bleeding
The only sign of ovarian cancer may be an abdominal mass- may not be identifiable until size reaches _____ inches
Ovarian Cancer Assessment
* Pap only abnormal in 20-30%
* CA-125 may be elevated (not diagnostic- used to eval progress)
* USG and CT can be diagnostic tools
* Exploratory laparotomy used to dx and stage tumors
Ovarian cancer Treatment
* Similar to cervical cancer
* Tx depends on stage of cancer
* Chemotherapy
* Radiation
* Surgery
Breast Cancer
* Early detection is paramount to successful treatment
* If cancer is localized without metastasis, clinical cure rate 75-90%
* When axillary lymph nodes are involved, 5year survival rate 40-50% & 10year rate only 25%
* 2nd leading cause of cancer deaths in women
* Leading cause of cancer deaths in women 35-54 yrs of age
Breast cancer types
* Multiple pathologic types
* Most common: infiltrating ductal carcinoma
* Noninvasive
* invasive
Early detection methods - breast cancer
* Self breast exam needs to be done monthly in women over 20
* Mammography- begin age 40, then annually
* Yearly clinical breast exam- assess for symmetry and size, contour, skin changes (color, texture, venous patterns), nipple changes, and lesions; also assess axillary lymph nodes
Breast Cancer Assessment
* Note location of mass (in clock face method), shape, size, consistency, and fixation to surrounding tissues
* Skin changes: peau d’ orange (dimpling or orange peel appearance), increased vascularity, nipple retraction or ulceration
* Psychosocial: fear of cancer; threats to body image, sexuality, intimate relationships, and survival; and decisional conflict about treatment
Breast Cancer Risk Factors
* Female
* Hx of previous breast cancer
* Age > 40
* Early menarche, late menopause or both
* Nulliparity or 1st child after 30
* Family hx
* Diet
* Alcohol
* Obesity
* Ionizing radiation
* Benign breast disease
* OCs
* Exogenous hormones
Breast cancer in men
* 1% of all cases occur in men
* Ave age of onset 60 yrs
* Common sx
- Hard
- nonpainful mass
- nipple discharge
- retraction
- erosion
- ulceration
Breast Cancer Surgical
1. Lumpectomy: local excision and resection
2. Partial mastectomy: removal of portion of breast that contains the tumor
3. Modified radical mastectomy: entire affected breast is removed (pectoral muscles and nerves left intact)
Breast CA – Nursing Dx
* Anxiety
* Anticipatory grieving
* Acute pain
* Disturbed sleep pattern
* Disturbed body image
* Sexual dysfunction
Male Reproductive Disorders
* Benign Prostatic Hypertrophy
* Prostate Cancer
* Erectile Dysfunction
* Testicular Cancer
Benign Prostatic Hypertrophy
* Saw Palmetto
* Occurs in almost all men with aging
* Prostate tissue begins to have abnormal increase in number of cells which leads to enlargement of the gland
* Leads to narrowing of prostatic urethral channel
* Cause is unknown
BPH symptoms
* Urinary frequency
* Nocturia
* Urinary hesitancy
* Hematuria
* Diminished force of urinary stream
* Post-void dribbling
* Bladder distention
* Possible renal insufficiency (edema, pallor, pruritis)
* Uniform, elastic, nontender palpable prostate
BPH Assessment
* Clinical manifestations
* Distended bladder
* Digital rectal exam
BPH Laboratory assessment
* CBC (infection or anemia)
* BUN & serum creatinine (eval renal function)
* Prostate specific antigen (PSA) to rule out malignancy
* Flowmetry- evaluates flow rate and residual urine
What is an important disticntion betwenn BPH and Proatate Cancer when assesseing?
BPH = uniform, elastic, nontender palpaplbe prostate

Prostate cancer = hard, irregular prostate
BPH Interventions Pharmacologic
1. finasteride (Proscar) shrinks prostate gland and improves urine flow by decreasing the level of dihydrotestosterone (DHT), which is responsible for prostate growth
2. alpha-adrenergic agonists (Cardura & Flomax) cause constriction of prostate gland, which reduces urethral pressure, improves urine flow, and decreases residual mass
BPH Interventions Nonsurgical
* measures that minimize obstructive symptoms, by causing a release of prostatic fluid (prostatic massage, frequent sexual intercourse, and masturbation)
* Avoid large amounts of fluid in a short time
* Avoid alcohol, caffeine, and diuretics
* Void as soon as urge is felt
***Prevent overdistention of bladder, which leads to loss of tone
***Avoid meds that cause urinary retention: anticholinergics, antihistamines, and decongestants
BPH Operative interventions
* Most common is transurethral resection of the prostate (TURP) to relieve obstruction caused by hypertrophy- only removes part of the enlarged prostate
* Prostatectomy
- Suprapubic
- Transvesical
- Retropubic
- Perineal
Prostate Cancer
* Most common cancer among American men; second leading cause of cancer deaths in this population
* Screening is done with digital rectal exam (DRE) and PSA--annually after age 50
* If at risk (prostate CA in 1st degree relative or African American), need screening earlier
* DRE yields hard, irregular prostate
Prostate Cancer
* One of the slowest growing malignancies & metastasizes in a fairly predictable manner
* Most commonly metastasizes to the prostatic & perivesicular lymph nodes, pelvic lymph nodes, bone marrow, & bones of the pelvis, sacrum, & lumbar spine
* Involvement of visceral organs occurs later in progression of disease, usu spreads to the lungs, liver, adrenals, & kidneys
Prostate Cancer Grading of the tumor is done with
Gleason grading system
____ pain is associated with prostete cancer...
Prostate Cancer risk
* Advancing age
* Incidence increases 75% in men > 65 yo
* Heavy metal exposure
* Hx of vasectomy or STD
* Uncertain link between BPH & prostate cancer
* Screening
- Most effective procedures are DRE & PSA
Prostate Cancer - DRE
* a hard, irregular mass is felt & presumed to be malignant
* Immunogenic glycoprotein secreted by the prostate
* Normal level is 4ng/mL
* Levels can be increased by prostate CA, BPH, prostatic infarction, and prostatitis
* PSA needs to be done in combination with DRE (25% of men with prostate CA have normal PSA)
* Normal PSA level is slightly higher in older adults & in African-American
Other Prostate screening
* Transrectal USG
* If malignancy suspected, need biopsy
* After dx made, need CT & MRI of pelvis & abdomen to assess nodes
* Bone scan can determine metastasis
* Most pts with prostate CA have elevated serum acid phosphatase; and elevated serum alkaline phosphatase if mets to bone
Prostate Cancer Interventions
* Management includes surgery, radiation therapy, & drug therapy
* Surgery is the standard treatment
* Surgical approaches similar to BPH
* Advanced cases require pelvic lymphadenectomy
* Radical Prostatectomy
* Cryosurgical ablation
* Newer, less invasive procedure
* Chemotherapy
* Radiation
* Hormonal therapies
Radical Prostatectomy
* removal of prostate gland, prostatic capsule, the cuff at the bladder neck, seminal vesicles, and regional lymph nodes
* Patient is sterile, but ability to have erection and orgasm shouldn’t be permanently impaired
* May have erectile dysfunction if damage is done to pudendal nerve during surgery
* Urinary incontinence possible complication- need to learn perineal strengthening exercises after surgery and removal of foley
Cryosurgical ablation
* Newer, less invasive procedure
- A transrectal US probe is placed to determine the size of the prostate & the number of cryoprobes to be placed around the prostate gland
- Liquid nitrogen freezes the gland & the dead cells are absorbed by the body
* Advantages
- Minimal blood loss
- Minimal postoperative pain
- Dec risk of incontinence after surgery
– A shorter hospital stay
– Procedure can be repeated as needed
Prostate Cancer Nonsurgical
* Chemotherapy
* Radiation
* Hormonal therapies- can be accomplished by bilateral testicle removal, administering estrogens, gonadotropin-releasing hormone agonist, or Depo-Provera
* Estrogens, & GnRH agonists, & Depo inhibit the release of LH from the pituitary
Erectile Dysfunction
* Inability to maintain an erection for sexual intercourse
* Can be organic or functional
Organic ED
* Gradual deterioration of function- first diminishing firmness, then decrease in frequency of erections
* Multiple causes: inflammation of prostate, urethra, or seminal vesicles; prostate surgeries; pelvic fx; HTN; neurologic disorders; DM; thyroid dysfunction; priapism; smoking; ETOH; certain medications; poor overall health
Functional ED
* Psychologic cause
* Have normal nocturnal and morning erections
* Usually precipitated by stress
* Medical, social, sexual history are needed
* Complete PE, lab tests
* Need to determine if ED is organic or functional in nature
* If ED is functional the pt is referred to a certified sexual therapist
men taking _____ cannot take Viagra because of vasodilatation effects
Testicular Cancer
* Most common malignancy in men ages 15-35; peak incidence between 18-40 yo
* Risk is increased in men with undescended testes; having a brother or close male relative with testicular CA; hx of testicular trauma or infection
* Occurs more often in caucasians, rarely African-Americans
* Testicular CA rarely bilateral- if it is, usually metastatic
* Early detection aided by self exam
Is testicular cancer usually bilateral?
rarely, if it is usually metastatic
Testicular Cancer Assessment
* Testes, lymph nodes, and abdomen are thoroughly examined
* Palpate for lumps or swelling
* Psychosocial assessment is done to determine pts feelings about disease/outcomes
Testicular cancer Diagnostic Assessment
* Primary tumor markers are alpha-fetoprotein and hCG
* Also used to evaluate responses to therapy
* Continued elevated levels after orchiectomy is evidence of metastatic disease
* Reappearance of elevated levels shows recurrence
* Benign testicular tumors NEVER cause an increase in these markers
Primary tumor markers of testicular cancer are
* alpha-fetoprotein
* hCG
Diagnostic Assessment Testicular Cancer
After dx a pt should have:
– CT scan of the abdomen & chest
– CXR & bones scans if metastasis is suspected
* A cystic mass that forms around the testis
* Disorder in the lymphatic draining of the scrotum
* No treatment is needed unless swelling becomes severe
* Treatment
– Aspiration or removal
* Sperm-containing cystic mass that develops on the epididymis by the tesicle
* No treatment needed if remains small & assymptomatic
* Can be removed if becomes uncomfortable
* Cluster of dilated veins posterior to and above the testis
* Dx by palpation, the scrotum feels ‘wormlike’
* Most unilateral & on L side of scrotum
* Not treatment necessary unless painful and then they are surgically removed
* May cause infertility
Scrotal trauma
* Rare because of mobility of the scrotum
* Torsion
- Twisting of the spermatic cord
- Occurs most often during puberty
- Occurs after strenuous exercise, trauma, or spontaneously
- A medical emergency – cuts off blood supply and can cause irreparable testicular damage
Scrotal trauma - Torsion
- Pt c/o pain (sudden onset,extreme), n/v, erythema, & edema
- Surgery straightens and fixates the affected testicle and fixates the other testicle as well
- If necrotic the testicle is removed
- Keep ice on scrotum for 72 hrs, elevate
- Avoid heavy lifting for 4-6 wks
- No strenuous activity for 1 mo
- Wear scrotal support for at least 3 wks
* Undescended testis
* Mainly a pediatric problem
* 3% full-term & 20% pre-term
* 80% descend spontaneously in 1st year
* In an adult the testicle can be surgically placed into the scrotum (ochidopexy)
Cancer of the penis
* Rare, < 1% of all malignancies in men
* Presents as a painless, wart-like growth or ulcer on the glans under the forskin
* May appear as a reddened lesion w/plaque
* If lesion only involves skin it will be removed
* If not curable w/excision or radiation a penectomy will be done
* Circumcision as an infant almost eliminates the risk of penile cancer
* Infection of the epididymis
* May result from infection of the prostate
* Can be associated w/long-term use of indwelling foley catheter, prostatic surgery, or cystoscopic exam
* < 35 yo the major cause is chlamydia
* c/o pain along the inguinal canal & along the vas deferens, followed by pain & swelling of the scrotum & groin
* If untreated can progress to point where testicles need to be removed
* Pt should remain in bed w/scrotum elevated on a towel
* May be given antibiotics until inflammation is gone
* Cold compresses, sitz baths will help w/comfort
* Avoid lifting, straining, or sexual activity until infection is under control
* Testicular tumor should be r/o
* If chronic the epididymis can be removed from the testicle
* Acute testicular inflammation
* Can result from infection or trauma
* Can be unilateral or bilateral
* c/o scrotal pain & edema, n/v, & pain that radiates to the inguinal canal
* Tx similar to epididymitis
- Bedrest w/scrotal elevation
- Application of ice
- Pain meds, antibiotics
Bacterial Vaginoses
pH >4.5
Thin, white discharge
Fishy odor
c/o discharge, bad smells, itchy
pH >4.5
yellow-green forthy discharge
may have fishy odor
c/o frothy discharge, bad odor, itchy
pH < 4.5
white cottage cheese-like discarhge
no odr
c/o dischrging discharging, itchy, burning