Transcript Chapter 78
Stressors of the Female and Male Reproductive Systems NUR240 JBorrero 10/08 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 count rule out pelvic inflammatory disease. • Laparoscopy is the key diagnostic procedure. Collaborative Management • Nonsurgical management includes hormone manipulation. • Surgical management includes: – D&C- Dilation and curettage – Laser or balloon endometrial ablation – Hysterectomy Uterine Prolapse • Stages of uterine prolapse are described by the degree of descent of the uterus. • Dyspareunia, backache, pressure in the pelvis, bowel or bladder problems • Pessaries • Surgery Cystocele • Protrusion of the bladder through the vaginal wall due to weakened pelvic structures • Difficulty in emptying bladder, urinary frequency and urgency, urinary tract infection, stress urinary incontinence • Kegel exercises • Surgery Rectocele • Protrusion of the rectum through a weakened vaginal wall • Constipation, hemorrhoids, fecal impaction, feelings of rectal or vaginal fullness • High-fiber diet, stool softeners, laxatives • Surgery Fistulas • Abnormal openings between two adjacent organs or structures • Etiology • S&S • Nonsurgical treatment • Surgical treatment Bartholin Cyst • Obstruction of the duct of the Bartholin’s gland • Simple incision and drainage • Marsupialization (formation of a pouch) • Postoperative care Uterine Tumors Nonmalignant: Fibroids or Leiomyomas Malignant: Endometrial Cancer • Endometrial cancer is a reproductive cancer, of which adenocarcinoma is the most common type. • The main symptom is postmenopausal bleeding. Endometrial Cancer Dx Tests • Diagnostic assessment includes the following tests: – CA-125 tumor marker – Chest x-ray – Barium enema – CT of the pelvis – Liver and bone scans – Functional dilation and curettage (D&C) TX: Radiation Therapy • • • • External and internal Teletherapy Brachytherapy Intracavitary radiation Surgical Management • Total abdominal hysterectomy and bilateral salpingo-oophorectomy • Radical hysterectomy with bilateral pelvic lymph node dissection for stage II cancer Cervical Cancer • Common reproductive cancer among women in the U.S. • Disorder is a progression: from totally normal cervical cells to premalignant changes in appearance of cervical cells (dysplasia), to changes in function, ultimately to transformation to cancer • HPV- Human papillomavirus • Gardasil Vaccine- 3 doses • Carcinoma in situ • Preinvasive or invasive Clinical Manifestations • Client often asymptomatic • Classic symptom: painless vaginal bleeding • Watery, blood-tinged vaginal discharge that may become dark and foul-smelling as the disease progresses • Leg pain • Flank pain • Unexplained weight loss, pelvic pain, dysuria, hematuria, rectal bleeding, chest pain and cough Diagnostic Assessment • Pap smear • Colposcopic examination • Endocervical curettage Nonsurgical Management • Local ablation of using the loop electrosurgical excision procedure • Laser therapy • Cryotherapy • Radiation therapy • Chemotherapy • Conization Surgical Management • Clinical staging performed before surgery to establish extent of the disease • Simple hysterectomy • Radical hysterectomy • Pelvic exenteration Postoperative Care • Early stages of recovery, assess for: – Hemorrhage and shock – Pulmonary complications – Fluid and electrolyte imbalances – Renal or urinary complications – Pain Postoperative Care • Later stages of recovery, assess for: – Deep vein thrombosis – Pulmonary emboli – Paralytic ileus – Wound infections – Wound dehiscence – Wound evisceration – Pain Ovarian Cancer • Most common type—serous adenocarcinoma • Vague abdominal discomfort, dyspepsia, indigestion, gas, and distention • Ovarian antibody CA-125, ultrasound, intravenous pyelography, barium enema, upper gastrointestinal radiographic series to rule out tumors Management NONSURGICAL • Chemotherapy with agents such as cisplatin, carboplatin, and paclitaxel • Radiation therapy Management SURGICAL • Total abdominal hysterectomy and bilateral salpingo-oophorectomy • Staging • Second-look procedure usually after 1 year of chemotherapy Assessment • Urinary pattern, frequency, nocturia, and other symptoms of bladder neck obstruction • Lower urinary tract symptoms • Hesitancy, intermittency, reduced force and size of urinary stream, a sensation of incomplete bladder emptying, and postvoid dribbling • Hematuria Laboratory Assessment • Urinalysis • Complete blood count • Blood urea nitrogen and creatinine levels • Prostate-specific antigen • DRE • C&S Drug Therapy • Finasteride ( Proscar) to shrink the prostate gland and improve urinary flow • Terazosin hydrochloride (Hytrin) • Doxazosin mesylate (Cardura) • Tamsulosin hydrochloride (Flomax) • Estrogens and androgens Surgical Procedures • Transurethral resection of the prostate AKA TURP • Suprapubic prostatectomy • Retropubic prostatectomy • Perineal prostatectomy Continuous Bladder Irrigation CBI • Goal: To maintain clear urine flow • Three-way urinary catheter with a 30- to 45-mL retention balloon through the urethra into the bladder • Traction via taping to client’s abdomen or thigh • Uncomfortable urge to void continuously • Antispasmodic medications Postcatheterization Care • Client feels burning on urination as well as some urinary frequency, dribbling, and leakage. • Symptoms are normal and will subside. • Monitor fluid intake. Prostate Cancer • Most common invasive cancer among men in the U.S. • One of the slowest growing malignancies; metastasizes in a predictable pattern • First symptoms related to bladder neck obstruction • Hormonal dependent Prostate Cancer: Dx • Digital rectal examination • Prostate-specific antigen (PSA) • Biopsy necessary to confirm suspected prostatic cancer Surgical Treatment: Radical Prostatectomy Post op Care: • Caring for wound drains • Preventing emboli • Preventing pulmonary complications • Antibiotics • Analgesics • Laxative and stool softener • Indwelling urinary catheter • Antispasmotic Complications • Urinary incontinence • Erectile dysfunction Nonsurgical Management • • • • Radiation therapy Hormonal therapy Chemotherapy Targeted therapy Testicular Cancer • Although uncommon, this cancer is the most common malignancy in men 15 to 35 years of age. • With early detection by testicular selfexamination and treatment with combination chemotherapy, testicular cancer can be cured. Diagnostics • • • • • • Alpha-fetoprotein Beta subunit of hCG Ultrasound Computed tomography Magnetic resonance imaging Lymphangiograms Risk for Sexual Dysfunction Oligospermia, azoospermia Interventions include: – Health teaching about reproduction, fertility, and sexuality – Sperm storage – Other reproductive options Potential for Metastasis • Interventions include: – Surgical management – Preoperative care – Operative procedures: radical retroperitoneal lymph node dissection, orchiectomy – Post op care : Pain, Immobilty, Wound/Drain Care Nonsurgical Management • Chemotherapy • Radiation therapy • Stem cell transplantation