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Chapter 46
Assessment and Management of
Female Physiologic Processes
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Women’s Health
• Evolving area of health care
• Role of the nurse
• Emphasis on health promotion
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Review of Anatomy and Function
• Function of the female reproductive system
• Ovulation and the menstrual cycle
• Significant hormones and hormonal changes
– Estrogens
– Progesterone
– Androgens
– Follicle-stimulating hormone (FSH) and luteinizing
hormone (LH)
• Perimenopause and menopause
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External Female Genitalia
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Internal Female Reproductive Structures
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Menstrual Cycle
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Health History and Sexual Assessment
• Menstrual history and history of pregnancies
• History of exposure to medications
• Pain with menses or intercourse
• Vaginal discharge, odor, or itching
• Urinary and bowel function
• Sexual history, including sexual or physical abuse
• History of STDs, surgeries, or procedures
• Chronic illness or disabilities that affect health/self-care
• Family and genetic history
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Sexual Assessment
• Include subjective and objective data.
• Purpose is to obtain information to picture a woman’s
sexuality and sexual practices to promote sexual health.
• May move from less sensitive areas of general health
history/assessment to more sensitive areas
• Ask for permission to discuss these issues.
• Do not assume sexual preferences.
• Asking the patient to label herself as married, single, etc.
may be interpreted as inappropriate; asking about
current meaningful relationships may be less offensive.
• PLISST model
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Domestic Violence
• A broad term that includes child abuse, elder abuse, and the
abuse of women and men
• Abuse can be:
– Emotional
– Physical
– Sexual
– Economic
• Asking about abuse is part of a comprehensive assessment.
See Chart 46-3
• Reporting abuse and guidelines
See Chart 46-2
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Diagnostic Examinations and Tests
• Pelvic examination
• Pap smear
• Colposcopy and cervical biopsy
• Cryotherapy and laser therapy
• Cone biopsy and loop electrosurgical excision (LEEP)
• Endometrial biopsy
• Dilation and curettage
• Laparoscopy (pelvic peritoneoscopy) and hysteroscopy
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Speculum Examination of the Vagina and
Cervix
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Bimanual Examination of the Pelvis
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Use of Ayre Spatula to Obtain Cervical
Secretions for Cytology
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Laparoscopy
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Menstrual Disorders
• Premenstrual syndrome
• Dysmenorrhea
• Amenorrhea
• Abnormal uterine bleeding
– Menorrhagia
– Metrorrhagia
– Postmenopausal bleeding
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Nursing Care of the Patient with
Premenopausal Syndrome (PMS)
• Assessment: health history, nutritional history, recording
of symptoms
• Assess for potential for violence, suicide or uncontrollable
behavior, and refer appropriately.
• Identification of patient goals: improved coping,
reduction of anxiety, improved relationships
• Interventions and patient teaching
– Social support, counseling, and stress reduction
– Diet and exercise
– Medications
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Menopause
• Permanent physiologic cessation of menses associated
with declining ovarian function
• Changes in menstruation
• Clinical manifestations
• Psychological considerations
• Medical management: HRT; risks and benefits
• Alternative therapy for hot flashes
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Nursing Teaching for the Patient
Approaching Menopause
• View as natural life change, a new phase with potential
for growth and new activities.
• Promote general good health, including diet and exercise.
• Note that fatigue and stress may worsen hot flashes.
• Nutrition: decrease fat and calories and increase
calcium, whole grains, fiber, fruit, and vegetables.
Calcium and vitamin D supplementation may be helpful.
• Address sexual activity and prevention or management of
common problems.
• See Chart 46-8
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Contraception
• Each year more than half of all pregnancies are
unintended.
• Nurses can assist by providing women with information
and support women in making contraceptive choices.
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Methods of Contraception
• Abstinence and natural methods
• Sterilization
• Tubal ligation
• Vasectomy
• Intrauterine device (IUD)
• Hormonal contraception
• Mechanical barriers
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Hormonal Contraception
• Benefits and risks
• Adverse reactions
• Contraindications
• Hormone types
– Estrogen and progestin
– Progestin only
• Patient education related to hormonal contraceptives
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Combination
Progestin Only
• Oral pills
• Oral pills or mini-pills
• Vaginal ring
• “Plan B”
• Transdermal patch
• Injection
• Levonorgestrelreleasing intrauterine
system
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Barrier Methods
• Diaphragm
• Cervical cap
• Contraceptive sponge
• Female and male condoms
• Note: assess for latex allergy!
Spermicides: nonoxynol-9 and octoxynol
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Female Condom
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Emergency Contraception
• Hormonal methods
– Plan B: progestin
– Dose of oral contraceptive (i.e., levonorgestrel and
ethinyl estradiol) given and repeated in 12 hours
• Postcoital IUD insertion
• Timing of emergency contraception
• Nursing support, teaching, and counseling
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Abortion
• Spontaneous abortion
• Habitual abortion
• Medical management
• Nursing support of the patient
• Grief process and dysfunctional grief
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Elective Abortion
• Pre-abortion counseling
• Pelvic examination and laboratory tests
• Use of RhoGAM for Rh-negative patient
• Types of elective abortions
• Patient teaching, including instructions for follow-up care
and information on contraception
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Infertility
• A couple’s inability to achieve a pregnancy after 1 year of
unprotected intercourse
• Primary infertility refers to a couple who have never had
a child.
• Secondary infertility means at least one conception has
occurred but the couple cannot achieve a pregnancy.
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Pathophysiology of Infertility
• Ovarian and ovulation factors
• Tubal factors
• Uterine factors
• Semen factors
• Other male factors
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Management of Infertility
• Pharmacologic therapy
See Chart 46-16
– Potential for multiple pregnancies
– Ovarian hyperstimulation syndrome (OHSS)
• Artificial insemination
• In vitro fertilization
• Other technologies
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Ectopic Pregnancy
• A leading cause of pregnancy-related death in the first
trimester
• Causes include salpingitis, peritubal adhesions, structural
abnormalities of the fallopian tube, previous ectopic
pregnancy, previous tubal surgery, tumors, IUD,
progestin-only contraception, and pelvic inflammatory
disease (PID)
• Clinical manifestations
– Delay in menses, slight bleeding, vague soreness or
sharp colicky pain, GI symptoms, dizziness,
lightheadedness
– With tube rupture: agonizing pain, dizziness,
faintness, N/V, progression to shock
– Later: generalized abdominal pain that radiates to
shoulder
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Sites of Ectopic Pregnancy
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Note:
• All women need to be educated about early treatment
and seek care if a period does not seem normal or if they
have pain or pain and a suspected pregnancy.
• Fatal hemorrhage may occur with ruptured ectopic
pregnancy if treatment is delayed.
• Women who have had an ectopic pregnancy are at
increased risk for recurrent ectopic pregnancy and
require teaching regarding early signs and symptoms.
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Nursing Process: The Care of the Patient
with Ectopic Pregnancies- Diagnoses
• Acute pain
• Anticipatory grieving
• Deficient knowledge
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Collaborative Problems/Potential
Complications
• Hemorrhage
• Hemorrhagic shock
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Nursing Process: Care of the Patient with
Ectopic Pregnancy: Planning
• Major goals include relief of pain, acceptance and
resolution of grief and pregnancy loss, increased
knowledge about ectopic pregnancy and its treatment
and outcome, and absence of complications.
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Interventions
• Supporting the grief process
– Listen and provide support.
– If appropriate, the partner should participate in the
process.
– Referral for counseling as needed
• Management of complications
– Continuous/frequent monitoring of VS, LOC, amount
of bleeding, I&O, laboratory values
– Bed rest
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