medical Reproductive System disorders.pptx

medical surgical

1. Reproductive System disorders Assessment of the reproductive system Pelvic Pain Characteristics: what is frequency, duration, severity, location of pain? Was the onset sudden or gradual? What aggravates and what relieves it? Associated factors: fever, nausea, vomiting, dizziness, abnormal bleeding with it? History of STDs, obstetric trauma, or abdominal surgery? Pregnancy history and history of ectopic pregnancy? 1/9/2024 Ibrahim A(BsN) 1

2. Physical Examination Physical examination for a patient with a gynecologic disorder should focus on the abdomen and genitalia. Palpate the lower abdomen for masses or tenderness. Inspect the external genitalia for lesions, discharge, or tissue bulging from the vagina. 1/9/2024 Ibrahim A(BsN) 2

3. Menstrual Conditions DYSMENORRHEA Dysmenorrhea is painful menstruation; most common of gynecologic dysfunctions. Primary Cause Increased prostaglandin production by the endometrium. Secondary cause Endometriosis, pelvic infection, congenital abnormality, uterine fibroids, ovarian cyst. 1/9/2024 Ibrahim A(BsN) 3

4. Clinical Manifestations Pain may be caused by increased uterine contractility and uterine hypoxia. Nausea, vomiting, diarrhea, headache, chills, tiredness, nervousness, and lower backache may be experienced. Diagnostic Evaluation Tests to rule out underlying lesion: Chlamydia and gonorrhea tests may show infection. Pelvic ultrasound may detect tumor, endometriosis, cysts. Pregnancy test to rule out ectopic pregnancy. 1/9/2024 Ibrahim A(BsN) 4

5. Management The following measures are for primary dysmenorrhea Treatment of secondary dysmenorrhea is aimed at underlying pathology. Local heat, to increase blood flow and decrease spasms. Exercise, to suppress prostaglandin release. Nonsteroidal anti-inflammatory agents, such as ibuprofen. Hormonal contraceptives to decrease contractility and menstrual flow. 1/9/2024 Ibrahim A(BsN) 5

6. AMENORRHEA Amenorrhea is absence of menstrual flow. Primary cause Menarche does not occur by age 16, or by age 14. Chromosomal disorders. 1/9/2024 Ibrahim A(BsN) 6

7. Secondary causes Menstruation stops for 3 cycles or 6 months in a woman in whom normal menstruation has been established. May be caused by normal pregnancy or lactation, menopause, or ovarian cysts. Inadequate nutrition with decreased body fat stores is a significant cause of amenorrhea in young women. Ovarian, adrenal, or pituitary tumor and thyroid disease (hyperthyroidism) are hormonal causes. Hormonal contraceptives, may also induce amenorrhea. It may be a result of depression, or severe psychological trauma. 1/9/2024 Ibrahim A(BsN) 7

8. Diagnostic Evaluation Pregnancy test. Hormonal levels LH and FSH to detect ovarian failure. Prolactin level (elevated) with pituitary tumor. Management Discontinue causative medications if desired. Nutritional or psychological counseling as indicated. Hormonal replacement therapy to regulate cycle. Treatment of tumor or other underlying cause. 1/9/2024 Ibrahim A(BsN) 8

9. VULVITIS Vulvitis is inflammation of the vulva. Causes Trichomonas Bacteria Fungi. 1/9/2024 Ibrahim A(BsN) 9

10. Clinical Manifestations Pruritus more acute at night. Reddened, edematous tissue, possible ulceration. Pain and burning sensation. Discharge, possibly profuse and purulent. 1/9/2024 Ibrahim A(BsN) 10

11. CANDIDA ALBICANS A fungal infection caused by Candida albicans . Predisposing factors include: Steroid therapy Obesity Antibiotic therapy Diabetes mellitus Oral contraceptives Frequent douching 1/9/2024 Ibrahim A(BsN) 11

12. Signs and symptoms Vaginal discharge is thick and irritating White or yellow patchy, cheese like particles adhere to vaginal walls. Itching is the most common complaint. May also experience burning, soreness, frequency, and dysuria. 1/9/2024 Ibrahim A(BsN) 12

13. Management Eradicate the fungus by applying antifungal vaginal cream, or vaginal suppository for 3 or 7 nights as ordered. For severe or recurrent cases use systemic antifungal. 1/9/2024 Ibrahim A(BsN) 13

14. TRICHOMONAS VAGINALIS A condition produced by a protozoan (pear-shaped and motile) that thrives in an alkaline environment. It is sexually transmitted disease. Signs and symptoms Malodorous discharge; may be frothy and yellow-green in color. May have pruritus, and spotting. May also have vulvar edema, dysuria, and hyperemia secondary to irritation of discharge. Destroy infective protozoa by taking metronidazole (orally), usually single dose of 2 Prevent re infection by treating male. Avoid alcohol during treatment. 1/9/2024 Ibrahim A(BsN) 14

15. CANCER OF THE CERVIX Cancer of the cervix is a common gynecologic malignancy. Most common between ages 35 and 55. Cause: Unknown Predisposing factor Early sexual activity, multiple sexual partners, and history of STDs, especially HPV, are major risk factors 1/9/2024 Ibrahim A(BsN) 15

16. Clinical Manifestations Early disease is usually asymptomatic. Initial symptoms include postcoital bleeding, irregular vaginal bleeding or spotting between periods or after menopause, and malodorous discharge. As disease progresses, bleeding becomes more constant and is accompanied by pain that radiates to buttocks and legs. Weight loss, anemia, and fever signal advanced disease. 1/9/2024 Ibrahim A(BsN) 16

17. Diagnostic Evaluation Pap smear-routine screening measure. Management Hysterectomy Radiotherapy(for localized early stage) Chemotherapy, used for advanced disease; or for metastatic disease. Complications Spread to bladder and rectum; metastasis to lungs, bones, and liver. 1/9/2024 Ibrahim A(BsN) 17

18. Nursing Assessment Obtain history of Pap tests, sexual activity, past STDs. Obtain history of symptoms. Assess understanding of disease and responses, such as guilt, fear, denial, anxiety. Nursing Diagnoses Anxiety related to cancer and treatment Disturbed Body Image related to surgical treatment Goal Relieving Anxiety 1/9/2024 Ibrahim A(BsN) 18

19. Nursing Intervention Assist patient to seek information on stage of cancer, treatment options. Goal Enhancing Body Image Nursing Intervention Provide emotional support during treatment. Encourage patient to take pride in appearance by dressing, putting on makeup as able. Encourage activity and socialization when patient able. 1/9/2024 Ibrahim A(BsN) 19

20. Explain the importance of lifelong follow-up, regardless of treatments, to determine the response to treatment and detect spread of cancer. Expected Outcomes Reports decreased anxiety, increased decision-making ability Reports continued interest in appearance 1/9/2024 Ibrahim A(BsN) 20

21. MYOMAS OF THE UTERUS Myomas (fibroids) are benign tumors of the uterine myometrium (smooth muscle). Develop in women ages 25 to 50. Cause : unknown. 1/9/2024 Ibrahim A(BsN) 21

22. Clinical Manifestations Small myomas do not cause symptoms. First indication may be palpable mass. Irregular bleeding usually menorrhagia. Pain comes from pressure on adjacent organs possible heavy feeling in pelvis. Secondary symptoms include fatigue because of anemia, urinary disturbances, and constipation Diagnostic Evaluation Ultrasound to identify size and location of myomas. 1/9/2024 Ibrahim A(BsN) 22

23. Management Myomectomy may be done for small tumor. Hysterectomy for large or numerous tumors. Gonadotropin-releasing hormone antagonist (Lupron) therapy to create hypoestrogenic environment and to try to shrink tumors. Complications Infertility Habitual abortion 1/9/2024 Ibrahim A(BsN) 23

24. PELVIC INFLAMMATORY DISEASE (PID) PID is an infection that may involve the fallopian tubes, ovaries, uterus, or peritoneum. Cause Causative agents include N. gonorrhoeae, anaerobes, gram-negative bacteria, and streptococci. Cervical infection ascends through the endometrium, into the fallopian tubes, and possibly into the peritoneal cavity. 1/9/2024 Ibrahim A(BsN) 24

25. Predisposing factors: Multiple sexual partners Use of IUCDs Criminal abortion Clinical Manifestations Pelvic pain most common presenting symptoms. Fever Cervical discharge mucopurulent. Cervical motion tenderness. Irregular bleeding. GI symptoms nausea, vomiting, acute abdomen. 1/9/2024 Ibrahim A(BsN) 25

26. Diagnostic Evaluation Culture to identify organisms. Laparoscopy provides direct visualization of the fallopian tubes. 1/9/2024 Ibrahim A(BsN) 26

27. Management Antibiotics combinations of tetracyclines, penicillins , and cephalosporins, orally or parenterally depending on the patient's condition. Clindamycin 900 mg I.V. every 8 hours plus gentamicin 2 mg/kg of body weight I.V. or I.M. as loading dose. followed by 1.5 mg/kg every 8 hours as maintenance dosage. Ceftriaxone 250 mg I.M. once per day plus doxycycline 100 mg orally twice per day for 14 days. 1/9/2024 Ibrahim A(BsN) 27

28. Complications Sepsis. Infertility because of adhesions to fallopian tubes and ovaries. Ectopic pregnancy caused by inability of fertilized egg to pass stricture. 1/9/2024 Ibrahim A(BsN) 28

29. MALE REPRODUCTIVE DISORDER PROSTATITIS Prostatitis is an inflammation of the prostate gland Cause Bacteria, fungi, mycoplasma Microorganisms are usually carried to the prostate from the urethra. 1/9/2024 Ibrahim A(BsN) 29

30. Clinical Manifestations Perineal discomfort Burning urgency Frequency, and pain with or after ejaculation. Acute bacterial prostatitis may produce sudden fever and chills and perineal, rectal, or low back pain. Urinary symptoms, such as dysuria, frequency, urgency, and nocturia ( urination during the night), may occur. 1/9/2024 Ibrahim A(BsN) 30

31. Complications: swelling of the prostate gland Urinary retention. Epididymitis Bacteremia Pyelonephritis. 1/9/2024 Ibrahim A(BsN) 31

32. Diagnostic Findings Urinalysis after prostate examination commonly reveals many white blood cells. Medical Management The goal of therapy for acute bacterial prostatitis is to avoid the complications of abscess formation and septicemia. A broad spectrum antibiotic agent is administered for 10 to 14 days. 1/9/2024 Ibrahim A(BsN) 32

33. Nursing Management Nursing management includes: Administration of prescribed antibiotics and prescribed analgesic agents. Sitz baths (to relieve pain and spasm) 1/9/2024 Ibrahim A(BsN) 33

34. Benign prostatic hyperplasia In many patients older than 50 years, the prostate gland enlarges Extending upward into the bladder and obstructing the outflow of urine. This condition is known as benign prostatic hyperplasia (BPH). Cause Evidence suggests that hormones initiate hyperplasia 1/9/2024 Ibrahim A(BsN) 34

35. Clinical Manifestations Examination reveals a prostate gland that is large, and nontender. The hypertrophied lobes may obstruct the vesical neck or prostatic urethra, causing incomplete emptying of the bladder and urinary retention. Generalized symptoms may also be noted, including fatigue, anorexia, nausea, vomiting, and epigastric discomfort.. 1/9/2024 Ibrahim A(BsN) 35

36. The obstructive and irritative symptoms includes: increased frequency of urination, nocturia, urgency, hesitancy in starting urination, A decrease in the volume and force of the urinary stream, interruption of the urinary stream, dribbling (urine dribbles out after urination) A sensation that the bladder has not been completely emptied, acute urinary retention , and recurrent urinary tract infections 1/9/2024 Ibrahim A(BsN) 36

37. Medical Management If the patient is admitted on an emergency basis because he cannot void, he is immediately catheterized. Prostatectomy to remove the hyperplastic prostatic tissue is frequently performed. Rest elevation of the scrotum Ice packs to reduce scrotal edema Antibiotics, analgesic agents, and anti-inflammatory medications are recommended. 1/9/2024 Ibrahim A(BsN) 37

38. EPIDIDYMITIS Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract. It may also develop as a complication of gonorrhea. Cause Chlamydia trachomatis. The infection passes upward through the urethra and the ejaculatory duct and then along the vas deferens to the epididymis. 1/9/2024 Ibrahim A(BsN) 38

39. Signs and symptoms The patient complains of unilateral pain and soreness in the inguinal canal along the course of the vas deferens and then develops pain and swelling in the scrotum and the groin. The epididymis becomes swollen and extremely painful; the patient’s temperature is elevated. The urine may contain pus (pyuria) and bacteria (bacteriuria), and the patient may experience chills and fever. 1/9/2024 Ibrahim A(BsN) 39

40. Medical Management If the patient is seen within the first 24 hours after onset of pain, the spermatic cord may be infiltrated with a local anesthetic agent to relieve pain. If the epididymitis is from a chlamydial infection, the patient and his sexual partner must be treated with antibiotics. The patient is observed for abscess formation as well. If no An epididymectomy (excision of the epididymis from the testis) may be performed for patients with recurrent, epididymitis or for those with chronic, painful conditions. 1/9/2024 Ibrahim A(BsN) 40

41. Complication infertility REDUCING ANXIETY Nursing Intervention When appropriate, the patient is encouraged to discuss anxieties and fear associated with the diagnosis, therapy, or prognosis. By individualizing teaching efforts, factual information applied to specific needs may offer reassurance. 1/9/2024 Ibrahim A( BsN ) 41

42. END THANKS FOR YOUR ATTENTION 1/9/2024 Ibrahim A(BsN) 42