Transcript Female Reproductive Disorders

Premenstrual Syndrome
(PMS)
• PMS is a group of physiological and
psychological symptoms
Causes:
• Related to release of serotonin, estrogen and
progesterone and nutritional deficiencies
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Premenstrual Syndrome
Manifestations
Headache
Breast discomfort
Peripheral edema
Abdominal bloating
Sensation of weight gain
Binge eating
Depression, Anxiety, Irritability
Premenstrual Syndrome
Treatment and Nursing Care
• Stress Reduction Techniques
• Initiation of an Exercise Program
• Diet Therapy ??
Premenstrual Syndrome
Treatment and Nursing Care
• Drug Therapy
– Selective Serotonin reuptake inhibitors
• Fluoxetine hydrochloride
• Sertraline hydrochloride
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Diuretics - Spironolactone
Prostaglandin inhibitors - Ibuprofen
Antidepressants, antianxiety – Alprasalom
Oral contraceptives
Dysmenorrhea
• Discomfort associated with menstruation
• Cause - excessive prostaglandins
• Signs and Symptoms
– Abdominal pain- colicky, radiates to lower back
and upper thighs
– Nausea, diarrhea,
– Fatigue
– Headache, light-headedness
Dysmenorrhea
• Treatment and Nursing Care
– Drug Therapy
• NSAIDS
• Oral Contraceptives
– Relaxation Techniques
– Heat Therapy
– Exercise
– Others
Abnormal Vaginal Bleeding
• Oligomenorrhea – long interval between menses
• Amenorrhea - absence of menses
• Menorrhagia – prolonged menstrual bleeding
• Metrorrhagia – irregular bleeding
– Complication is low hemoglobin
Complications of Vaginal Bleeding
• Anemia
• Assess for excessive fatigue
• Monitor vital signs
• Provide for safety with the weak patient
• Toxic Shock Syndrome (TSS)
• Assess for high fever, vomiting, diarrhea,
weakness, myalgia, and sunburn-like rash
• Patient teaching ??
Abnormal Vaginal Bleeding
• Treatment and Nursing Care
– Drug Therapy
• Oral Contraceptives
– Balloon Thermotherapy
– Myomectomy
Endometrial Ablation
• A resectoscope is a special type of telescope inserted
inside the uterus. It has a built in wire loop that uses
high-frequency electrical energy to cut or coagulate
or ablate tissue.
• The resectoscope has the advantage of being able to
remove polyps and some fibroids at the time of
ablation.
Menopause
Cessation of menses
Menopause
Perimenopause
• Irregular menses
• Vasomotor instability
• Atrophy of genitourinary
tissue
• Stress incontinence
• Breast Tenderness
• Mood changes
Menopause
• Cessation of menses
• Occasional vasomotor
symptoms
• Atrophy of genitourinary
tissue
• Stress incontinence
• Osteoporosis
• Sleep disturbances
Menopause
• Bleeding becomes irregular rt:
– follicles no longer respond to FSH
– ovarian production of estrogen and
progesterone declines
OR
• Surgically induced
Menopause
Treatment and Nursing Care
• Drug Therapy
– NO longer use Hormone Replacement Therapy –
Why?
– Antidepressants
– Selective estrogen receptor modulators
• raloxifene (Evista)
Menopause
Treatment and Nursing Care
• Non-hormonal Therapy
– Cool environment
– Loose fitting clothing
– Moisturizing soaps and lotions
– Health diet with vitamin D
– Calcium supplements; vitamin E and B6
– Exercise – weight bearing and aerobic
Review
• To prevent or decrease age-related changes
that occur after menopause in a patient who
chooses not to take HRT, the nurse teaches
the patient that the most important self-care
measure is
a. Maintain sexual activity
b. Increase intake of dairy products
c. Performing regular aerobic, weightbearing exercise
d. Taking vitamin E and B6 supplements
Infection of uterus, fallopian tubes, ovaries, and
peritoneal cavity
Pelvic Inflammatory Disease
• Cause – gonorrhea and chlamydial infections
spread up the reproductive system into the peritoneal
cavity
• Manifestation
– Abdominal pain
– Fever
– Vaginal discharge
• Diagnosis
– Vaginal culture
Pelvic Inflammatory Disease
• Complications
– Septic Shock
– Infertility
– Ectopic pregnancy
• Treatment and Nursing Care
– Drug Therapy – antibiotics
– Bedrest in Semi-fowlers position
– Force fluids
– Heat to abdomen or Sitz bath
– Patient teaching – ??
Presence of normal Endometrial Tissue outside the uterine
cavity
Endometriosis
• Clinical Manifestations
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Dysmenorrhea, pelvic pain
Dyspareunia, dysuria
Infertility
Chocolate cysts in ovaries
• Diagnosis
– Laparoscopy
Endometriosis
• Treatment and Nursing Care
– Drug Therapy
• Oral contraceptives
• Androgens
• Gonadotropin-releasing hormone agonists
– leuprolide (Lupron)
– Nafarelin (Synarel)
Endometriosis
• Treatment and Nursing Care
• Surgical Therapy
– Conservative
• Laparoscopic laser surgery / laparotomy
• Used in women who ??
– Definitive
• Hysterectomy
• Used in women who ??
As a nurse caring for a patient with
endometriosis, what would be expected
in the diagnostics?
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A. CBC with differential
C. Pelvic ultrasound
D. Exploratory laproscopy
E. Biopsy
F. Ablation
Tutorial on endometriosis
• Go to the following website for a tutorial on
endometriosis:
• http://www.nlm.nih.gov/medlineplus/tutorials
/endometriosis/htm/index.htm
Leiomyomas
Polycystic ovary
Uterine Fibroids (Leiomyomas)
• Benign smooth muscle tumors in uterus
diagnosed with Hysteroscopy
• Signs and Symptoms
– Most do NOT have symptoms
– Abnormal uterine bleeding
– Pain, pelvic pressure
Uterine Fibroids (Leiomyomas)
• Diagnosis
– Enlarged uterus distorted with nodular masses
• Treatment and Nursing Care
– Myeomectomy, hysterectomy
– Cryosurgery
– ExAblate 2000 system
Chronic endocrine disorder
resulting in:
Insulin resistance
Hyperandrogenism
Altered gonadotropin functioning
Polycystic ovaries
LH, FSH
No egg
released
from ovary
Diagnosed – Pelvic Ultrasound
Small cysts
develop in
ovaries rt
failure to
release egg
Polycystic Ovaries
Polycystic ovaries
• Treatment and Nursing Care
– Drug therapy
• Oral contraceptives
• GnRH agonist
• Metformin (Glucophage)
– Surgery
• Oophorectomy
Diagnostic Testing
Pelvic Examination
• What are the duties of the
nurse in assisting with a
pelvic exam?
Pap Test
Colposcopy
LUMA Cervical Imaging System
Conization
Loop Electrosurgery Excision Procedure
Endometrial Biopsy
Cervical Cancer
Cervical cancer
• Risk factors
– In situ 25-40 years old
– Invasive 40-60 years old
– Dysplasia
– DES exposure
– Lifestyle
– STD exposure
• HPV, HSV II
Staging and Treatment
Endometrial Cancer
Endometrial Cancer
• Major Risk factor
– Prolonged exposure to Estrogen
• Other Risk factors
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Age - >60
Infertility
Diabetes
Family hx, other cancers
Lifestyle – obesity, smoking
• Clinical Manifestations
– Abnormal vaginal bleeding
Endometrial Cancer
Treatment and Nursing Care
• Diagnosed
– Endometrial biopsy
Treatment:
• Surgical Therapy
– Hysterectomy – first choice of treatment
• Chemotherapy
• Radiation - brachytherapy
Postop interventions for
PanHysterectomy
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Analgesia
Ambulation
I&O
Passage of flatus
Heat to abdomen
Psychological support
Teaching for home care
Ovarian Cancer
Ovarian Cancer
• Greatest risk factor is ??
• Other risk factors include
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Age
High-fat diet
Greater number of ovulatory cycles
Hormone replacement therapy
Use of infertility drugs
• 90% of ovarian cancers are epithelial carcinomas
from malignant transformation of surface epithelial
cells
Ovarian Cancer
Manifestations
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General abdominal discomfort
Sense of pelvic heaviness
Loss of appetite
Feeling of fullness
Change in bowel habits
Abnormal vaginal bleeding
Clinical Manifestations
• As malignancy grows, there can be an
– Increase in abdominal girth
– Bowel and bladder dysfunctions
– Persistent pelvic or abdominal pain
– Menstrual irregularities
– Ascites
Ovarian Cancer
Diagnosis
• Exploratory laparotomy to diagnose and stage
disease
• Screening for high risk women should include
CA-125, ultrasound, and yearly pelvic
examination
• CA-125 is positive in 80% of women with
ovarian cancer
Tutorial on ovarian cancer
• http://www.nlm.nih.gov/medlineplus/tutorials/o
variancancer/htm/index.htm
• Treatment of Ovarian Cancer
– Surgery – most common
– Chemotherapy
Vaginal Cancer
• Risk Factors
– Elderly
– Cancer of the cervix or endometrium
– Young women - DES exposure
• Manifestations
– Bleeding not related to menses
– Dyspareunia, Dysuria
– Vaginal discharge
– Teachings
Vulvar Cancer
• Risk Factors
– 50 plus
– Chronic irritation
– History of HPV or Herpes 2
• Manifestations
– Pruritis
– Burning
– Enlarged inguinal lymph nodes
– Asymmetry
– Lesions or mass
– Change in color
Treatment options for all Cancers
• Surgery
– Oophorectomy, Panhysterectomy
– Pelvic Exenteration
• Chemotherapy
• Radiation
– External
– Brachytherapy
Problems with Pelvic
Support
Uterine Prolapse
• Downward displacement of uterus into vagina
Second degree
First degree
Third Degree
Uterine Prolapse
• Signs and symptoms
– Stress incontinence
– Dyspareunia
– Heavy feeling in pelvis
• Treatment and Nursing Care
– Pessary
– Hysterectomy with A&P repair
Cystocele and Rectocele
• Cystocele – support is
lost and bladder
protrudes into the
vagina
• Rectocele – support is
lost and rectum
protrudes into the
vagina
Treatment and Nursing Care
• Patient teaching – Kegels exercises
• Surgery
– Anterior or Posterior colporrhaphy
– Post-op nursing care
• Patient teaching ??
Lunch Time!