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reproductive final
| Question | Answer |
|---|---|
| Chapter 51: Nursing Assessment: | Reproductive System |
| STRUCTURES AND FUNCTIONS | The primary roles of male reproductive system are production and transportation of sperm, deposition of sperm in female reproductive tract, and secretion of hormones. |
| The primary male reproductive organs | are the testes. |
| The primary roles of female reproductive system | are production of ova, secretion of hormones, and protection and facilitation of the development of the fetus in a pregnant female. |
| The primary female reproductive organs | are the ovaries. |
| The hypothalamus, pituitary gland, and gonads | secrete numerous hormones that regulate the processes of ovulation, spermatogenesis, fertilization, and formation and function of secondary sex characteristics. |
| In women, follicle-stimulating hormone (FSH) production | by anterior pituitary stimulates growth and maturity of ovarian follicles. |
| Mature follicle | produces estrogen, which in turn suppresses the release of FSH. In men, FSH stimulates |
| Estrogen and progesterone are produced | by the ovaries. |
| Estrogen | is essential to development and maintenance of secondary sex characteristics, proliferative phase of menstrual cycle immediately after menstruation, and pregnancy uterine changes. |
| Progesterone | is also involved in body changes of pregnancy. |
| The major gonadal hormone of men | is testosterone, which is produced by the testes. Testosterone is responsible for development and maintenance of secondary sex characteristics and spermatogenesis. |
| Menarche | is the first episode of menstrual bleeding, indicating that a female has reached puberty.This usually occurs at 12 to 13 years of age.The length of the menstrual cycle generally ranges from 20 to 40 days. |
| The major functions of ovaries | are ovulation and secretion of hormones. These functions are accomplished during the menstrual cycle. |
| If fertilization occurs, | high levels of estrogen and progesterone continue to be secreted due to continued activity of corpus luteum from stimulation by human chorionic gonadotropin (hCG). |
| If fertilization does not take place, | menstruation occurs because of a decrease in estrogen production and progesterone. |
| Menopause | is the physiologic cessation of menses associated with declining ovarian function. It is usually considered complete after 1 year of amenorrhea. |
| The sexual response | is a complex interplay of psychologic and physiologic phenomena influenced by a number of variables, including daily stress, illness, and crisis. |
| Changes that occur during sexual excitement | are similar for men and women. |
| Sexual response | can be described in terms of the excitement, plateau, orgasmic, and resolution phases. |
| Gerontologic Considerations In women, | many changes relate to the altered estrogen production of menopause. |
| A reduction in circulating estrogen along with an increase in androgens in postmenopausal women | is associated with breast and genital atrophy, reduction in bone mass, and increased rate of atherosclerosis. |
| Changes in aging men include | an increase in prostate size, decreased testosterone level and sperm production, decreased scrotum muscle tone and size and firmness of the testicles. Erectile dysfunction and sexual dysfunction can occur as result of these changes. |
| Nurses have an important role in providing | accurate and unbiased information about sexuality and age. Nurses should emphasize normalcy of sexual activity in older adults. |
| Reproduction and sexual issues | are often considered extremely personal and private. |
| A professional demeanor | is important when taking a reproductive or sexual history. |
| The nurse needs | to be sensitive, ask gender-neutral questions, and maintain awareness of patient’s culture and beliefs. |
| It is helpful if the nurse | begins with least sensitive information (e.g., menstrual history) before asking questions about more sensitive issues such as sexual practices or sexually transmitted diseases. |
| Women should have | a complete menstrual and gynecologic history taken, including oral contraceptive use. |
| The nurse should question the patient regarding | current health status and presence of any acute or chronic health problems as problems in other body systems often relate to problems with reproductive system. |
| Physical examination: Male external genitalia: | inspection and palpation of pubis, penis, scrotum and testes, inguinal region and spermatic cord, anus and prostate. |
| Physical examination: Female: | begins with inspection and palpation of breasts and then proceeds to abdomen and external genitalia including mons pubis, labia majora, labia minora, perineum, and anal region. Pelvic and bimanual examinations are considered advanced skills. |
| Serum hormone test, hCG, | is used to identify pregnancy. |
| Prolactin assay | is used for patient with amenorrhea. |
| Serum progesterone and estradiol | can also help in ovarian function assessment, particularly for amenorrhea. |
| Hormonal blood studies | are essential for a fertility workup. |
| Chapter 52: Nursing Management: | Breast Disorders |
| Screening guidelines for early detection of breast cancer | are yearly mammograms starting at age 40, and clinical breast examinations every 3 years for women between ages 20 and 30 and every year for women beginning at age 40. |
| Women should report any breast changes | promptly to their health care provider. |
| Breast self-examination | is an option for women. |
| Women at increased breast cancer risk | (family history,genetic tendency,past breast cancer)should talk with their health care provider about benefits and limitations of starting mammography screening earlier, having additional tests (breast ultrasound), or having more frequent examinations. |
| Mammography | is used to visualize internal structures of the breast using x-rays. This procedure can detect tumors and cysts not felt by palpation. |
| Ultrasound | is another procedure used to differentiate a benign tumor from a malignant tumor. It is useful for women with fibrocystic changes whose breasts are very dense. |
| Definitive diagnosis of breast cancer | is made by histologic examination of biopsied tissue. Biopsy techniques include fine-needle aspiration (FNA) biopsy, stereotactic or handheld core biopsy, and open surgical biopsy. |
| Mastalgia (breast pain): | is the most common breast-related benign complaint in women.It is described as diffuse breast tenderness or heaviness. |
| Mastalgia (breast pain): | may last 2 to 3 days or most of month.Symptoms often decrease with menopause. |
| Mastalgia (breast pain): | Some relief may occur with caffeine and dietary fat reduction; hormonal therapy, taking vitamins, and gamma-linolenic acid (evening primrose oil); and wearing of support bra. |
| Mastitis | is a breast inflammatory condition that occurs most frequently in lactating women. |
| Lactational mastitis | manifests as a localized area that is erythematous, painful, and tender to palpation. |
| Mastitis | Fever is usually present. Infection develops when organisms, usually staphylococci, gain access to breast through cracked nipple.In its early stages, mastitis can be cured with antibiotics. |
| Fibrocystic changes | is a common benign condition characterized by changes in breast tissue including development of excess fibrous tissue, hyperplasia of epithelial lining of mammary ducts, proliferation of mammary ducts, and cyst formation. |
| Fibrocystic changes in breast: | These changes produce pain by nerve irritation from edema in connective tissue and by fibrosis from nerve pinching. |
| Fibrocystic changes in breast: | Types of treatment that might help fibrocystic breast disease include use of good support bra,dietary therapy(low-salt diet,restriction of methylxanthines |
| Fibroadenoma | is a common cause of benign breast lumps in young women. A possible cause may be increased estrogen sensitivity in localized area of breast. Treatment includes surgical excision or cryoablation. |
| Gynecomastia | is a transient, noninflammatory enlargement of one or both breasts and is the most common benign breast problem in men. |
| Breast cancer | is the most common malignancy in American women except for skin cancer. |
| Although the etiology of breast cancer | not completely understood,# of factors are thought to relate to breast CA including a family history,environmental factors, genetics,early menarche,late menopause,age 60+. However, most women who develop breast cancer have no identifiable risk factors. |
| Noninvasive breast cancers | include ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). |
| ductal carcinoma in situ DCIS | tends to be unilateral and most likely would progress to invasive breast cancer if left untreated. |
| lobular carcinoma in situ (LCIS) | is a risk factor for developing breast cancer, but it is not known to be a premalignant lesion. No treatment is necessary for LCIS. Tamoxifen may be given as a chemoprevention. |
| Paget’s disease | is a rare breast malignancy characterized by a persistent lesion of the nipple and areola with or without a palpable mass.Treatment is a simple or modified radical mastectomy. |
| Inflammatory breast cancer | is the most malignant form of all breast cancers. |
| Inflammatory breast cancer | The skin of the breast looks red, feels warm, with a thickened appearance described as resembling an orange peel (peau d’orange). |
| Inflammatory breast cancer | Metastases occur early and widely. Radiation, chemotherapy, and hormone therapy are more likely to be used for treatment than surgery. |
| Breast cancer | is detected as a lump or mammographic abnormality in the breast. It occurs most often in upper, outer quadrant of breast. |
| If palpable, breast cancer | is usually hard, and may be irregularly shaped, poorly delineated, nonmobile, and nontender. Nipple discharge may also be present. |
| In addition to earlier listed tests, other tests useful in predicting risk of recurrence or metastatic breast disease | include axillary lymph node status, tumor size, estrogen and progesterone receptor status, and cell proliferative indices. |
| Patients with breast cancer | should discuss all treatment options with their health care provider, including local excision, mastectomy with breast reconstruction, breast-conserving treatment (lumpectomy), radiation therapy, and/or tamoxifen. |
| Common options for resectable breast cancer | include breast conservation surgery with radiation therapy and modified radical mastectomy with or without reconstruction. |
| Breast conservation surgery (lumpectomy) | involves removal of entire tumor along with a margin of normal tissue. Modified radical mastectomy includes removal of breast and axillary lymph nodes, but it preserves pectoralis major muscle. |
| Lymphedema | can occur due to surgical excision or radiation of lymph nodes. Symptoms are heaviness, pain, impaired motor function in the arm, and numbness and paresthesia of the fingers as a result of lymphedema. |
| Following surgery, radiation therapy | is delivered to the entire breast, ending with a boost to the tumor bed. If there is evidence of systemic disease, then chemotherapy may be given before radiation therapy. |
| Radiation therapy may be used for breast cancer | as a primary treatment to prevent local breast recurrences after breast conservation surgery, adjuvant treatment following mastectomy to prevent local and nodal recurrences, and palliative treatment for pain caused by local recurrence and metastases. |
| Breast cancer | is one of the solid tumors most responsive to chemotherapy with the use of combinations of drugs, which is clearly superior to use of single drug therapy. |
| Hormonal therapy removes or blocks the source of estrogen, | thus promoting tumor regression. |
| Nursing interventions at time of breast cancer diagnosis | include exploring woman’s usual decision-making patterns, helping the woman accurately evaluate advantages and disadvantages of options, and providing information and support relevant to treatment decisions. |
| The woman with breast conservation surgery | usually has an uneventful postoperative course with only a moderate amount of pain. If an axillary lymph node dissection or mastectomy is done, drains are often left in place. |
| Postoperative discomfort | is minimized by administering analgesics 30 minutes before initiating exercises. With showering, the flow of warm water over the involved shoulder often has a soothing effect and reduces joint stiffness. |
| Mammoplasty | is a surgical change in size or shape of the breast.It may be done electively for cosmetic purposes to either augment or reduce the size of breasts or to reconstruct the breast after mastectomy. |
| Mammoplasty | In augmentation, an implant is placed in a surgically created pocket between the capsule of the breast and the pectoral fascia. |
| Reduction mammoplasty | is performed by resecting wedges of tissue from upper and lower quadrants of breast. |
| Breast reconstructive surgery | may be done simultaneously with mastectomy or some time afterward to achieve symmetry and to restore or preserve body image. |
| methylxanthines | coffee & chocolate), vitamin E therapy, analgesics, danazol, diuretics, hormone therapy, antiestrogen therapy. |
| Chapter 54: Nursing Management: | Female Reproductive Problems |
| Infertility | is the inability to achieve a pregnancy after at least 1 year of regular intercourse without contraception. |
| Infertility | Diagnostic studies include ovulatory studies, tubal patency studies, and postcoital studies. |
| Infertility | Management depends on the cause and can include supplemental hormone therapy and antibiotic therapy. |
| Abortion | is the loss or termination of a pregnancy before the fetus has developed to a state of viability. |
| Abortions are classified as | spontaneous (those occurring naturally) or induced (those occurring as a result of mechanical or medical intervention). |
| Abortion Nursing management | includes the use of comfort measures to provide needed physical and mental rest. The support of the patient and her family is essential. |
| Premenstrual syndrome (PMS) | is a common disorder of physical and psychologic symptoms during the last few days of the menstrual cycle and before onset of menstruation. |
| PMS | is thought to have a biologic trigger with compounding psychosocial factors. |
| Premenstrual syndrome (PMS) Physical symptoms | include breast discomfort, abdominal bloating, sensation of weight gain, episodes of binge eating, and headache. Anxiety, depression, irritability, and mood swings are some of the emotional symptoms. |
| Premenstrual syndrome (PMS) | No single treatment is available to relieve symptoms. The goal is to reduce symptom severity. |
| Dysmenorrhea | is abdominal cramping pain or discomfort associated with menstrual flow. |
| Primary dysmenorrheal | is caused by an excess of prostaglandin F2α (PGF2α) and/or an increased sensitivity to it. |
| Secondary dysmenorrheal | is acquired after adolescence; pelvic causes include endometriosis, chronic pelvic inflammatory disease, and uterine fibroids. |
| Treatment for primary dysmenorrhea | includes heat, exercise, and drug therapy. For secondary dysmenorrhea, it depends on the cause. |
| Abnormal vaginal or uterine bleeding | is a common gynecologic concern and is caused by dysfunction of hypothalamic-pituitary-ovarian axis, infection, and stressful changes in lifestyle. Treatment varies depending on the cause but can include drug therapy and surgery. |
| An ectopic pregnancy | is the implantation of the fertilized ovum anywhere outside the uterine cavity.Any blockage of the tube or reduction of tubal peristalsis that impedes or delays the zygote passing to the uterine cavity can result in tubal implantation. |
| ectopic pregnancy | Risk factors include a history of pelvic inflammatory disease, prior ectopic pregnancy, current progestin-releasing intrauterine device (IUD), progestin-only birth control failure, and prior pelvic or tubal surgery. |
| ectopic pregnancy | Eventually the tube ruptures with acute peritoneal symptoms of abdominal/ pelvic pain, missed menses, and irregular vaginal bleeding. Less acute symptoms begin 6 to 8 weeks after last normal menstrual period. |
| ectopic pregnancy | Surgery is usually the treatment. |
| Menopause | is the physiologic cessation of menses associated with declining ovarian function. It is usually considered complete after 1 year of amenorrhea.Ovarian changes start the cascade of events that result in menopause. |
| Premenopausal symptoms | include hot flashes, irregular vaginal bleeding, fat redistribution, and a tendency to gain weight. |
| Menopause Treatment | might include hormone replacement, drug therapy, and alternative therapies. |
| Infection and inflammation of vagina, cervix, and vulva | commonly occur when natural defenses of the acid vaginal secretions (maintained by sufficient estrogen levels) and presence of Lactobacillus are disrupted. |
| Abnormal vaginal discharge and reddened vulvar lesions | are often noted with itching and dysuria. |
| Infection and inflammation of vagina, cervix, and vulva | Treatment includes antibiotics and antifungal preparations. |
| Pelvic inflammatory disease (PID) | is an infectious condition of pelvic cavity that may involve infection of fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic peritoneum (peritonitis). |
| PID | is often the result of untreated cervicitis. |
| Pelvic inflammatory disease (PID) | The main symptom is constant lower abdominal pain. |
| Pelvic inflammatory disease (PID) Long-term complications | include ectopic pregnancy, infertility, and chronic pelvic pain. |
| PID | is usually treated with antibiotics. |
| Endometriosis | is the presence of normal endometrial tissue in sites outside endometrial cavity. |
| Endometriosis | One cause is retrograde menstrual flow through the fallopian tubes carrying viable endometrial tissues into the pelvis. |
| Endometriosis Symptoms | are secondary dysmenorrhea, infertility, pelvic pain, dyspareunia, and irregular bleeding. |
| Endometriosis Drug therapy | reduces symptoms with surgery for a potential cure. |
| Leiomyomas (uterine fibroids) | are benign smooth-muscle tumors that occur within the uterus. |
| Leiomyomas (uterine fibroids) Symptoms | may include abnormal uterine bleeding, and pain. |
| Leiomyomas (uterine fibroids) Treatment | depends on size of tumor and may include surgery. |
| CERVICAL CANCER | There is a strong relationship between sexual exposure of papillomavirus (HPV) and dysplasia. |
| CERVICAL CANCER | Later signs are leukorrhea, intermenstrual bleeding, and pain. |
| CERVICAL CANCER | The finding of an abnormal Pap test indicates need for follow-up. |
| CERVICAL CANCER Invasive disease | is treated with surgery, radiation, and chemotherapy. |
| CERVICAL CANCER | A new vaccine can protect against most types of cervical cancer. |
| The major risk factor of endometrial cancer | is unopposed estrogen. |
| endometrial cancer | It has low mortality rate, as most cases are diagnosed early. |
| The first sign of endometrial cancer | is abnormal uterine bleeding. |
| endometrial cancer Treatment | is total hysterectomy and bilateral salpingo-oophorectomy with lymph node biopsies. Radiation and chemotherapy may also be given. |
| The etiology of ovarian cancer | is generally not known. |
| ovarian cancer | Most women with ovarian cancer have advanced disease at diagnosis. |
| ovarian cancer | The greatest risk factor is family history. |
| ovarian cancer | In the early stages, manifestations are vague and may consist of abdominal discomfort (gas, indigestion, pressure, bloating, cramps) and change in bowel habits. |
| ovarian cancer | Yearly bimanual pelvic examinations should be performed to identify an ovarian mass. |
| ovarian cancer | Treatment includes surgery, chemotherapy, and radiation. |
| ovarian cancer | Nurses can teach women importance of routine screening for cancers of the reproductive system. |
| Uterine prolapsed | is the downward displacement of uterus into the vaginal canal. |
| Uterine prolapsed Symptoms | are dyspareunia, dragging or heavy pelvic feeling, backache, and bowel or bladder problems if cystocele or rectocele is also present. |
| Uterine prolapsed Therapy | depends on degree of prolapse and can include strengthening exercises, and a pessary. |
| Sexual assault | is the forcible perpetration of a sexual act on a person without his or her consent. It can include sodomy, forced vaginal or anal intercourse, oral copulation, and assault with a foreign object. |
| Sexual assault | Physical injuries may include bruising and lacerations to perineum, hymen, vulva, vagina, cervix, and anus. |
| Sexual assault | Feelings of humiliation, degradation, embarrassment, anger, self-blame, and fear of another assault are commonly expressed. |
| Sexual assault | Ensuring the woman’s emotional and physical safety is the highest priority. Follow-up physical and psychologic care is essential. |
| Chapter 55: Nursing Management: | Male Reproductive Problems |
| Benign prostatic hyperplasia (BPH) | is prostate gland enlargement due to increased epithelial cells and stromal tissue. |
| Benign prostatic hyperplasia (BPH) | results from endocrine changes associated with the aging process. |
| Benign prostatic hyperplasia (BPH) | The compression of the urethra leads to clinical symptoms including decrease in caliber and force of the urinary stream, difficulty in initiating voiding, intermittency and dribbling. |
| Benign prostatic hyperplasia (BPH) | Conservative and initial treatment is “watchful waiting” when there are no symptoms or only mild ones. Drug therapy may also be used. |
| Invasive treatment of symptomatic BPH | involves prostate resection or ablation. |
| Prostate cancer | is the most common cancer among men, excluding skin cancer. |
| Prostate cancer | Risk factors include family history, age, and ethnicity. |
| Symptoms of prostate cancer | are similar to those for BPH, including dysuria, hesitancy, dribbling, frequency, and urgency. |
| Elevated levels of prostate-specific antigen (PSA) | indicate prostatic pathology, although not necessarily prostate cancer. |
| Prostate cancer | The conservative approach to management is “watchful waiting.” |
| Prostate cancer Invasive therapies | include radical prostatectomy and cryosurgery. Treatment may also include drugs, hormones, chemotherapy, and radiation. |
| Prostate cancerThe nursing role | is to encourage patients, in consultation with health care providers, to have annual prostate screening (PSA and digital rectal examination) starting at age 50 or younger if risk factors present. |
| The term prostatitis | describes a group of inflammatory and noninflammatory conditions affecting the prostate gland. |
| prostatitis | It includes acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis. |
| Antibiotics are used for | acute and chronic bacterial prostatitis. |
| Epididymitis | is an acute, painful inflammatory process of the epididymis secondary to an infectious process, trauma, or urinary reflux down the vas deferens. |
| Epididymitis | Antibiotic use is important for both partners if transmission was through sexual contact. |
| Epididymitis | Conservative treatment consists of bed rest with elevation of scrotum, use of ice packs, and analgesics. |
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