Reproductive years assessment and health promotion
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Transcript Reproductive years assessment and health promotion
Assessment of the
Female Reproductive
System
Female Reproductive System
External genitalia: vulva, labia majora,
labia minora, clitoris, vestibule,
perineum
Internal genitalia: vagina, uterus,
corpus, cervix, fallopian tubes, ovaries
Breasts
Menstruation and menopause
Assessment Techniques:
Female
History: pain, bleeding, discharge,
masses
Physical assessment
Breast examination
Abdominal examination
Examination of the external genitalia
Pelvic examination
Bimanual examination
Rectovaginal examination
Papanicolaou Test
Client preparation for pap test
Procedure
Follow-up care
Blood Studies
Pituitary gonadotropin
Steroid hormones
Serologic tests
Syphilis detection
Prostate-specific antigen
Other Studies
Urinalysis for steroid hormones
Wet preparation (smears)
Cultures
General x-rays
CT scans for reproductive system
disorders
(Continued)
Other Studies (Continued)
Hysterosalpingography: an x-ray of the
cervix, uterus, and fallopian tubes
Mammography
Ultrasonography
Magnetic resonance imaging to scan
for pelvic tumors
Colposcopy
Laparoscopy
Hysteroscopy
Cervical biopsy
Other Diagnostic Tests
Needle biopsy of the prostate
Semen analysis
Interventions for Clients
with Gynecologic
Problems
Primary Dysmenorrhea
One of the most common gynecologic
problems, occurring most often in
women in their teens and early 20s.
Treatment
Postaglandin synthetase inhibitors, oral
contraceptives
Complementary and alternative therapy
Premenstrual Syndrome
A collection of symptoms that are
cyclic in nature
Diet therapy
Drug therapy: mild potassium-sparing
diuretics, progesterone, bromocriptine
mesylate, Sarafem
Amenorrhea
Absence of menstrual periods
Primary amenorrhea
Secondary amenorrhea
Treatment: hormone replacement,
ovulation stimulation, periodic
progesterone withdrawal
Postmenopausal Bleeding
Manifestation (not disease)—vaginal
bleeding that occurs after a 12-month
cessation of menses after the onset of
menopause
Atrophic vaginitis
Endometrial hyperplasia
Treatment: endometrial biopsy,
hysterectomy, hormonal replacement
therapy, vaginal lubricants
Endometriosis
Endometriosis is usually a
benign problem of
endometrial tissue
implantation outside the
uterine cavity.
Manifestations include pain,
dyspareunia, painful
defecation, sacral backache,
hypermenorrhea, and
infertility.
Erythrocyte sedimentation
rate and white blood cell
Endometriosis:
Interventions
Drug therapy
Mild analgesics, nonsteroidal antiinflammatory drugs, hormonal
therapies, pseudopregnancy,
pseudomenopause, or medical
oophorectomy
Complementary and alternative therapy
Surgical management
Dysfunctional Uterine Bleeding
Nonspecific term to describe bleeding that is excessive or abnormal in
amount or frequency without predisposing anatomic or systemic
conditions
Associated with:
Endocrine disturbances
Polycystic ovary disease
Stress
Extreme weight changes
Long-term drug use
Anatomic abnormalities
Management
Nonsurgical management includes hormone manipulation.
Surgical management includes:
Dilation and curettage procedure
Laser or balloon endometrial ablation
Hysterectomy
Menopause
Normal biologic event marked for most
women by the end of menstrual periods
(6 to 12 months of amenorrhea)
Role of hormone replacement therapy
in the management of symptoms
Perimenopause indicated by changes
in ovarian function
Interventions, including hormone
replacement therapy
Simple Vaginitis
Inflammation of the lower genital tract
Result of one or more of the following:
Menopause
Trichomonas vaginalis
Candida albicans
Changes in normal flora
Alkaline pH
Foreign bodies
Chemical irritants
Diabetes
Management of Vaginitis
Perineal cleaning after urination or
defecation
Wearing cotton underwear
Avoiding strong douches and feminine
hygiene sprays
Avoiding tight-fitting pants
Using estrogen creams
Eating yogurt with antibiotics
Vulvitis
Inflammatory condition of the vulva
(itching) associated with symptoms of
pruritus and a burning sensation
Other causes include the following:
Atrophic vaginitis
Vulvar kraurosis
Vulvar leukoplakia
Cancer
Urinary incontinence
Management of Vulvitis
Measures to relieve itching, including
sitz baths
Prescribed antibiotics
Treatment of pediculosis and scabies, if
needed
Laser therapy
Toxic Shock Syndrome (TSS)
First recognized in 1980 when it was
found to be related to menstruation and
tampon use
Staphylococcus aureus
Abrupt onset of high temperature,
headache, sore throat, vomiting,
diarrhea, generalized rash, hypotension
Penicillin or vancomycin
Follicular Cysts
Cyst—usually small and may be
asymptomatic unless it ruptures
Rupture of a follicular cyst or torsion—
may cause acute, severe pelvic pain
Medical management
Surgical management includes:
Cystectomy
Oophorectomy
Corpus Luteum Cyst
Occurs after ovulation and often with
increased secretion of progesterone;
usually small, purplish red
May cause unilateral low abdominal or
pelvic pain that is dull or aching
Intraperitoneal hemorrhage possible if
cyst ruptures
Theca-Luatein Cysts
These cysts are uncommon, often
associated with hydatidiform molar
pregnancy.
Cysts develop as a result of prolonged
stimulation of the ovaries by excessive
amounts of hCG.
Cysts regress spontaneously within 3
months with the removal of the molar
pregnancy.
Polycystic Ovary
High levels of luteinizing hormone
overstimulate the ovaries, producing
multiple cysts on one or both ovaries.
Endometrial hyperplasia or even
carcinoma may result.
Typical client is obese, hirsute, has
irregular menses, and may be infertile.
Treatment is with oral contraceptives,
surgery, or clomiphene.
Other Benign
Ovarian Cysts and Tumors
Dermoid cysts
Ovarian fibromas
Epithelial ovarian tumors
Uterine leiomyomas