reproductive disorder.pptx

Reproductive disorder

1. Chapter 12 Care of the Patient with a Reproductive Disorder Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Overview of Anatomy and Physiology Male reproductive system Testes Ductal system Epididymis Ductus deferens (vas deferens) Ejaculatory duct and urethra Accessory glands Seminal vesicles Prostate gland Cowper’s glands Urethra and penis Sperm

3. Figure 12-1 Longitudinal section of the male pelvis showing the location of the male reproductive organs. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology . [6 th ed.]. St. Louis: Mosby.)

4. Figure 12-2 Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell (ovum) surrounded by sperm at time of fertilization (right). (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology . [6 th ed.]. St. Louis: Mosby.)

5. Overview of Anatomy and Physiology Female reproductive system Ovaries Fallopian tubes Uterus Vagina External genitalia Accessory glands Skene’s glands Bartholin’s glands Perineum Mammary glands (breasts)

6. Figure 12-3 Longitudinal section of the female pelvis showing the location of the female reproductive organs. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology . [6 th ed.]. St. Louis: Mosby.)

7. Figure 12-4 Sectioned view of the uterus showing relationship to the ovaries and vagina. (From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13 th ed.]. St. Louis: Mosby.)

8. Figure 12-6 Lateral view of the breast (sagittal section). (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology . [6 th ed.]. St. Louis: Mosby.)

9. Figure 12-7 Mammalian ovary showing successive stages of ovarian (graafian) follicle and ovum development. (From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6 th ed.]. St. Louis: Mosby.)

10. Figure 12-14 A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast. (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination . [5 th ed.]. St. Louis: Mosby.)

11. Human Sexuality Sexual identity The sense of being feminine or masculine Influences on sexual health Overall wellness includes sexual health, and sexuality should be part of the health care program Illness and sexuality Illness may cause changes in a patient’s self-concept and result in an inability to function sexually

12. Laboratory and Diagnostic Examinations Diagnostic tests for the female Colposcopy; culdoscopy; laparoscopy Papanicolaou (Pap) smear Biopsies: Breast, cervical, endometrial Conization; dilation and curettage Cultures and smears Schiller’s iodine test Hysterograms Mammography; pelvic ultrasonography Tubal insufflation (Rubin’s test) Human chorionic gonadotropin; serum CA-125

13. Laboratory and Diagnostic Examinations Diagnostic tests for the male Testicular biopsy Semen analysis Prostatic smears Cystoscopy Rectal digital exam Prostate specific antigen (PSA)

14. The Reproductive Cycle Menarche The beginning of menses Follows breast development by 2 to 2½ years Average age range is between 9 and 17 years Cycle length ranges from 24 to 32 days The average flow lasts 3 to 5 days The average flow is 35 mL/cycle

15. The Reproductive Cycle Amenorrhea Etiology/pathophysiology Absent or suppressed menstrual flow Clinical manifestations/assessment No menstrual flow for at least 3 months Medical management/nursing interventions Based on underlying cause Hormone replacement may be necessary

16. Dysmenorrhea Etiology/pathophysiology Uterine pain with menstruation Clinical manifestations/assessment Breast tenderness; headache Abdominal distention; nausea and vomiting Vertigo Palpitations Excessive perspiration Colicky, cyclic pain; dull pain in the lower pelvis The Reproductive Cycle

17. The Reproductive Cycle Dysmenorrhea (continued) Medical management/nursing interventions Exercise Nutritious foods, high in fiber Heat to pelvic area Mild analgesics Prostaglandin inhibitors

18. The Reproductive Cycle Abnormal uterine bleeding Menorrhagia Excessive bleeding during the regular menstrual flow Causes: Endocrine disorders; inflammatory disturbances; uterine tumors Metrorrhagia Uterine bleeding between regular menstrual periods or after menopause May indicate cancer or benign tumors of the uterus

19. The Reproductive Cycle Premenstrual syndrome (PMS) Etiology/pathophysiology Believed to be related to the neuroendocrine events occurring within the anterior pituitary gland Clinical manifestations/assessment Irritability, lethargy, and fatigue Sleep disturbances; depression Headache; backache; breast tenderness Vertigo Abdominal distention Acne

20. The Reproductive Cycle Premenstrual syndrome (PMS) (continued) Medical management/nursing interventions Pharmacological management Analgesics; diuretics; progesterone Dietary recommendations High in complex carbohydrates Moderate in protein Low in refined sugar and sodium Limit caffeine, chocolate, and alcohol Reduce or eliminate smoking Exercise; adequate rest, sleep, and relaxation

21. The Reproductive Cycle Menopause Etiology/pathophysiology The normal decline of ovarian function resulting from the aging process May be induced by irradiation of the ovaries or surgical removal of both ovaries Not considered complete until 1 year after the last menstrual period

22. The Reproductive Cycle Menopause Clinical manifestations/assessment Decrease in frequency, amount, and duration of the normal menstrual flow Shrinkage of vulval structures; shortening of the vagina Dryness of the vaginal wall; pelvic relaxation Loss of skin turgor and elasticity Increased subcutaneous fat; decreased breast tissue; thinning of hair Osteoporosis

23. The Reproductive Cycle Menopause (continued) Medical management/nursing interventions Estrogen therapy Premarin Provera Calcium supplements

24. The Reproductive Cycle Male climacteric Etiology/pathophysiology Gradual decrease of testosterone levels and seminal fluid production; 55 to 70 years of age Clinical manifestations/assessment Decreased erections; decreased seminal fluid Enlarged prostate gland; decreased muscle tone Loss or thinning of hair Medical management/nursing interventions Emotional support; treatment for impotence

25. The Reproductive Cycle Erectile dysfunction Etiology/pathophysiology Inability of an adult man to achieve penile erection Types Functional Anatomical Atonic Medical management/nursing interventions Remove cause if possible Treat diseases Viagra Mechanical devices: penile prosthesis

26. The Reproductive Cycle Infertility Etiology/pathophysiology Inability to conceive after 1 year of sexual intercourse without birth control Medical management/nursing interventions Depends on the cause Hormone therapy Repair occlusion Intrauterine insemination In vitro fertilization

27. Infections of the Female Reproductive Tract Simple vaginitis Etiology/pathophysiology Common vaginal infection Causative organisms: E. coli ; staphylococcal; streptococcal; T. vaginalis ; C. albicans ; Gardnerella Clinical manifestations/assessment Inflammation of the vagina Yellow, white, or grayish white, curd-like discharge Pruritus and vaginal burning

28. Simple vaginitis (continued) Medical management/nursing interventions Douching Vaginal suppositories, ointments, and creams Organism-specific Sitz baths Abstain from sexual intercourse during treatment Treat partner if necessary Infections of the Female Reproductive Tract

29. Cervicitis Etiology/pathophysiology Infection of the cervix Clinical manifestations/assessment Backache Whitish exudate Menstrual irregularities Medical management/nursing interventions Vaginal suppositories, ointments, and creams; organism-specific Infections of the Female Reproductive Tract

30. Pelvic inflammatory disease (PID) Etiology/pathophysiology Any acute, subacute, recurrent, or chronic infection of the cervix, uterus, fallopian tubes, and ovaries that has extended to the connective tissues Most common causative organisms Gonorrhea; streptococcus; staphylococcus; Chlamydia ; tubercle bacilli High risk: Surgical and examination procedures; sexual intercourse (especially with multiple partners); pregnancy Infections of the Female Reproductive Tract

31. Pelvic inflammatory disease (PID) (continued) Clinical manifestations/assessment Fever and chills Severe abdominal pain Malaise Nausea and vomiting Malodorous purulent vaginal exudate Medical management/nursing interventions Antibiotics; analgesics Bed rest Infections of the Female Reproductive Tract

32. Toxic shock syndrome Etiology/pathophysiology Acute bacterial infection caused by Staphylococcus aureus Usually occurs in women who are menstruating and using tampons Infections of the Female Reproductive Tract

33. Toxic shock syndrome (continued) Clinical manifestations/assessment Usually occurs between days 2 and 4 of the menstrual period Flu-like symptoms; sore throat; headache Red macular palmar or diffuse rash Decreased urinary output; BUN elevated Pulmonary edema Medical management/nursing interventions Antibiotics; IV fluid therapy; oxygen Infections of the Female Reproductive Tract

34. Disorders of the Female Reproductive System Endometriosis Etiology/pathophysiology Endometrial tissue appears outside the uterus The tissue responds to the normal stimulation of the ovaries; bleeds each month Clinical manifestations/assessment Lower abdominal and pelvic pain May radiate to lower back, legs, and groin Medical management/nursing interventions Antiovulatory medications; pregnancy Laparoscopy; total hysterectomy

35. Figure 12-9 Common sites of endometriosis.

36. Vaginal fistula Etiology/pathophysiology Abnormal opening between the vagina and another organ Clinical manifestations/assessment Urine and/or feces being expelled from vagina Medical management/nursing interventions Oral or parenteral antibiotics Diet: high protein; increase vitamin C Surgery: Repair fistula; urinary or fecal diversion Disorders of the Female Reproductive System

37. Figure 12-10 Types of fistulas that may develop in the vagina and uterus. (From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3 rd ed.]. St. Louis: Mosby.)

38. Displaced uterus Etiology/pathophysiology Congenital Childbirth Backward displacement Retroversion Retroflexion Disorders of the Female Reproductive System

39. Displaced uterus (continued) Clinical manifestations/assessment Backache Muscle strain Leukorrheal discharge Heaviness in the pelvic area Medical management/nursing interventions Pessary Uterine suspension Disorders of the Female Reproductive System

40. Uterine prolapse Etiology/pathophysiology Prolapse of the uterus through the pelvic floor and vaginal opening Clinical manifestations/assessment Fullness in vaginal area Backache Bowel or bladder problems Protrusion of cervix and vaginal walls in perineal area Disorders of the Female Reproductive System

41. Figure 12-11 Uterine prolapse. (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical examination . [5 th ed.]. St. Louis: Mosby.)

42. Uterine prolapse (continued) Medical management/nursing interventions Pessary Surgery Vaginal hysterectomy Anteroposterior colporrhaphy Disorders of the Female Reproductive System

43. Cystocele and rectocele Etiology/pathophysiology Cystocele Displacement of the bladder into the vagina Rectocele Rectum moves toward posterior vaginal wall Disorders of the Female Reproductive System

44. Figure 12-12 A, Cystocele. B, Rectocele. (From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7 th ed.]. St. Louis: Mosby.)

45. Cystocele and rectocele (continued) Clinical manifestations/assessment Cystocele Urinary urgency, frequency, and incontinence; pelvic pressure Rectocele Constipation; rectal pressure; hemorrhoids Medical management/nursing interventions Surgical repair Anteroposterior colporrhaphy; bladder suspension Disorders of the Female Reproductive System

46. Leiomyomas of the uterus (fibroids, myomas) Etiology/pathophysiology Arise from the muscle tissue of the uterus Stimulated by ovarian hormones Clinical manifestations/assessment Pelvic pressure; pain; backache Dysmenorrhea; menorrhagia Constipation; urinary symptoms Medical management/nursing interventions Surgery: Myomectomy; hysterectomy Disorders of the Female Reproductive System

47. Figure 12-13 Leiomyomas. (Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak’s gynecologic and obstetric pathology. [6 th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the biologic basis for disease in adults and childre n. [4 th ed.]. St. Louis: Mosby.)

48. Ovarian cysts Etiology/pathophysiology Benign tumors that arise from dermoid cells of the ovary Clinical manifestations/assessment May be no symptoms Palpable on examination Disturbance of menstruation Pelvic heaviness; pain Medical management/nursing interventions Ovarian cystectomy Disorders of the Female Reproductive System

49. Cancer of the Female Reproductive Tract Cancer of the cervix Etiology/pathophysiology Squamous cell carcinoma Carcinoma in situ If untreated, invades the vagina, pelvic wall, bladder, rectum, and regional lymph nodes High risk Sexually active during teens Multiple sexual partners Multiple births Chronic cervical infections

50. Cancer of the cervix (continued) Clinical manifestations/assessment Few symptoms in early stages Leukorrhea Irregular vaginal bleeding; spotting Advanced Pain in the back, upper thighs, and legs Cancer of the Female Reproductive Tract

51. Cancer of the cervix (continued) Medical management/nursing interventions Carcinoma in situ Removal of the affected area Early carcinoma Hysterectomy Intracavitary radiation Advanced carcinoma Radical hysterectomy with pelvic lymph node dissection Cancer of the Female Reproductive Tract

52. Cancer of the endometrium Etiology/pathophysiology Adenocarcinoma of the uterus Clinical manifestations/assessment Postmenopausal bleeding (50% will have cancer) Abdominal pressure; pelvic fullness Medical management/nursing interventions Surgery: total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) Radiation; chemotherapy Cancer of the Female Reproductive Tract

53. Cancer of the ovary Etiology/pathophysiology Fourth most common cause of cancer death in women High risk: infertile; anovulatory; nulliparous; habitual aborters; high-fat diet; exposure to industrial chemicals Cancer of the Female Reproductive Tract

54. Cancer of the ovary (continued) Clinical manifestations/assessment Early Vague abdominal discomfort Flatulence; mild gastric disturbance Advanced Enlarged abdominal girth Flatulence; constipation Urinary frequency Nausea and vomiting Weight loss Cancer of the Female Reproductive Tract

55. Cancer of the ovary (continued) Medical management/nursing interventions Surgery TAH-BSO and omentectomy Radiation and/or chemotherapy Cancer of the Female Reproductive Tract

56. Hysterectomy Total hysterectomy Removal of the uterus including the cervix TAH-BSO Removal of the uterus, fallopian tubes, and ovaries Radical hysterectomy TAH-BSO with removal of the pelvic lymph nodes Vaginal hysterectomy The uterus is removed through the vagina Abdominal hysterectomy Abdominal incision is made to perform procedure

57. Disorders of the Female Breast Fibrocystic breast condition Etiology/pathophysiology Hyperplasia and cystic formation in mammary ducts Clinical manifestations/assessment Cysts are soft, well-differentiated, tender, and freely moveable; often bilateral and multiple Medical management/nursing interventions Eliminate methylxanthines Danazol (danocrine); vitamin E

58. Disorders of the Female Breast Acute mastitis Etiology/pathophysiology Acute bacterial infection of the breast Clinical manifestations/assessment Breasts are tender, inflamed, and engorged Medical management/nursing interventions Keep breasts clean Application of warm packs Support: Well-fitting bra Systemic antibiotics

59. Disorders of the Female Breast Chronic mastitis Etiology/pathophysiology Fibrosis and cysts in the breast Clinical manifestations/assessment Tender, painful, and palpable cysts Usually unilateral Medical management/nursing interventions Same as for acute mastitis

60. Disorders of the Female Breast Breast cancer Etiology/pathophysiology Unknown cause; usually adenocarcinoma Clinical manifestations/assessment Small, solitary, irregular-shaped, firm, non-tender, and non-mobile tumor Change in skin color Puckering or dimpling of tissue Nipple discharge; retraction of nipple Axillary tenderness

61. Disorders of the Female Breast Breast cancer (continued) Medical management/nursing interventions Depends on the stage Radiation Chemotherapy Surgery Lumpectomy Mastectomy—simple, radical

62. Inflammatory Disorders of the Male Reproductive System Prostatitis Etiology/pathophysiology Acute or chronic infection of the prostate gland Clinical manifestations/assessment Chills and fever Dysuria; urgency and frequency of urination Cloudy urine Perineal fullness; lower back pain Arthralgia; myalgia Tenderness, edema, and firmness of the prostate

63. Prostatitis (continued) Medical management/nursing interventions Antibiotics Digital massage of the prostate Sitz baths Monitor I&O Inflammatory Disorders of the Male Reproductive System

64. Epididymitis Etiology/pathophysiology Infection of the epididymis Clinical manifestations/assessment Scrotal pain and edema Pyuria; chills and fever Medical management/nursing interventions Bed rest Elevate scrotum; cold compresses Antibiotics Inflammatory Disorders of the Male Reproductive System

65. Disorders of Male Genital Organs Phimosis Etiology/pathophysiology Prepuce is too small to allow retraction of the foreskin over the glans Usually congenital; may be due to inflammation or disease Clinical manifestations/assessment Infection of foreskin and glans penis Occasionally causes obstruction of urine flow Medical management/nursing interventions Circumcision

66. Disorders of the Male Genital Organs Paraphimosis Etiology and pathophysiology An edematous condition of the retracted uncircumcised foreskin preventing a normal return over the glans Medical management/nursing interventions Warm compresses Circumcision

67. Disorders of Male Genital Organs Hydrocele Etiology/pathophysiology Accumulation of fluid between the membranes of the testes Clinical manifestations/assessment Enlargement of the scrotum; pain Medical management/nursing interventions Aspiration of fluid Surgical removal of testicular sac Bed rest; elevate scrotum; cold compresses

68. Disorders of Male Genital Organs Varicocele Etiology/pathophysiology Dilation of scrotal veins causing obstruction and malfunction of circulation Clinical manifestations/assessment Engorgement and elongation of the scrotum Pulling sensation in scrotum; dull, aching pain Medical management/nursing interventions Surgery: Removal of obstruction Bed rest Elevate scrotum; cold compresses

69. Cancer of the Male Reproductive Tract Cancer of the testis Etiology/pathophysiology Cause unknown Clinical manifestations/assessment Enlarged scrotum; feeling of heaviness Firm, painless, smooth mass Medical management/nursing interventions Radical inguinal orchiectomy Radiation and/or chemotherapy Teach testicular self-examination

70. Cancer of the Male Reproductive Tract Cancer of the penis Etiology/pathophysiology Very rare Clinical manifestations/assessment Painless, wart-like growth or ulceration, usually on the glans penis Medical management/nursing interventions Surgery Removal of tissue Partial or total amputation of the penis Metastasis: Radical surgical procedures

71. Sexually Transmitted Diseases Genital herpes (HSV) Etiology/pathophysiology Infectious viral disease; usually acquired sexually Clinical manifestations/assessment Fluid-filled vesicles Eventually rupture and develop shallow, painful ulcers Fever; malaise Dysuria Leukorrhea (female)

72. Figure 12-19 Herpes simplex virus type II in a male and female patient. (From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3 rd ed.]. St. Louis: Mosby.)

73. Sexually Transmitted Diseases Genital herpes (HSV) (continued) Medical management/nursing interventions No cure; treat symptoms Acyclovir (Zovirax) Sitz baths Local anesthetic; analgesics Keep lesions clean and dry GOOD handwashing No sexual contact while lesions are present Encourage use of condoms

74. Sexually Transmitted Diseases Syphilis Etiology/pathophysiology Treponema pallidum organism Transmission occurs primarily with sexual contact Clinical manifestations/assessment Incubation period No symptoms Primary stage Chancre; headaches; enlarged lymph nodes

75. Sexually Transmitted Diseases Syphilis (continued) Clinical manifestations/assessment Secondary stage Rash on palms of hands and soles of feet Generalized enlargement of lymph nodes Latent stage No symptoms Tertiary or late stage Lesions may affect many different systems; may be fatal

76. Sexually Transmitted Diseases Syphilis (continued) Medical management/nursing interventions Pharmacological management Penicillin Tetracycline or erythromycin, if allergic to penicillin May be treated in any stage; damage from previous stages will not be reversed Treat all sexual contacts

77. Sexually Transmitted Diseases Gonorrhea Etiology/pathophysiology N. gonorrhoeae Transmitted by sexual contact Clinical manifestations/assessment Vaginal (female) Urinary frequency and pain Yellowish discharge Nausea and vomiting

78. Sexually Transmitted Diseases Gonorrhea (continued) Clinical manifestations/assessment (continued) Urethra (male) Urethral discomfort; dysuria Yellowish discharge containing pus Red and swollen meatus Rectal (male and female) Perineal discomfort; purulent rectal discharge Pharyngitis (male and female) Sore throat and swallowing discomfort Edema of the throat

79. Sexually Transmitted Diseases Gonorrhea (continued) Medical management/nursing interventions Pharmacological management Penicillin Rocephin Doxycycline or tetracycline Patient education TREAT ALL SEXUAL CONTACTS

80. Sexually Transmitted Diseases Trichomoniasis Etiology/pathophysiology T. vaginalis protozoan Usually sexually transmitted Clinical manifestations/assessment Most are asymptomatic Male: Urethritis, dysuria, urinary frequency, pruritus, and purulent exudate

81. Sexually Transmitted Diseases Trichomoniasis (continued) Clinical manifestations/assessment (continued) Female Frothy, gray, green, or yellow malodorous discharge Pruritus Edema Tenderness of vagina Dysuria and urinary frequency Spotting; menorrhagia; dysmenorrhea

82. Sexually Transmitted Diseases Trichomoniasis (continued) Medical management/nursing interventions Pharmacological management Metronidazole (Flagyl) Patient education TREAT ALL SEXUAL CONTACTS

83. Sexually Transmitted Diseases Candidiasis Etiology/pathophysiology C. albicans and C. tropicalis Clinical manifestations/assessment Mouth: Edema; white patches Nails: Edematous, darkened, erythematous nail base; purulent exudate Vaginal: Cheesy, tenacious white discharge; pruritus; inflammation of the vagina Penis: Purulent exudate Systemic: Chills; fever; general malaise

84. Sexually Transmitted Diseases Candidiasis (continued) Medical management/nursing interventions Pharmacological management Nystatin (Mycostatin) Topical amphotericin B Treat underlying condition

85. Sexually Transmitted Diseases Chlamydia Etiology/pathophysiology Chlamydia trachomatis Clinical manifestations/assessment Usually asymptomatic Male Scanty white or clear exudate Burning or pruritus Urinary frequency; mild dysuria

86. Sexually Transmitted Diseases Chlamydia (continued) Clinical manifestations/assessment Female Vaginal pruritus or burning Dull pelvic pain Low-grade fever Vaginal discharge; irregular bleeding Medical management/nursing interventions Pharmacological management Tetracycline; doxycycline; Zithromax TREAT ALL SEXUAL CONTACTS

87. Nursing Process Nursing diagnoses Anxiety Body image, disturbed Coping, ineffective Fear Fluid volume, deficient Health maintenance, ineffective Infection, risk for Knowledge, deficient Pain, acute and chronic Self-esteem, situational low Sexual dysfunction Skin integrity, impaired Tissue perfusion, ineffective Urinary elimination, impaired

88. Sex Hormones Production influenced by the anterior pituitary Male: testosterone; androgens Female: estrogen; progesterone 88 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

89. Androgens Actions Development of secondary sex characteristics; tissue building Uses Hypogonadism, hypopituitarism, dwarfism, eunuchism, cryptorchidism, oligospermia, and male androgen deficiency Adverse Reactions Edema due to sodium retention, acne, hirsutism, male pattern baldness, cholestatic hepatitis with jaundice, buccal irritation, nausea and vomiting, diarrhea 89 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

90. Androgens (cont.) Drug Interactions Increased effects – anticoagulants, antidiabetic agents, and other drugs Decreased effects – barbiturates Concurrent use with corticosteroids increase edema Nursing Implications Assessment, diagnosis, planning, implementation, and evaluation Drug Table 21-9 90 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

91. Androgens (cont.) Patient and Family Teaching Administration Response time Diet Symptoms to report Administration considerations 91 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

92. Female Sex Hormones Estrogens Progestins Table 21-10 92 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

93. Estrogens Action and Uses Used for hormone replacement therapy in menopause and other conditions (ovarian failure); infertility work-ups; palliative breast cancer treatment Adverse Reactions Drug Interactions 93 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

94. Progestins Action Uses Contraception, control excessive uterine bleeding, treatment of secondary amenorrhea, dysmenorrhea, premenstrual tension, and control of pain in endometriosis Drug Interactions Nursing Implications and Patient Teaching 94 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

95. Oral Contraceptives Combination Drugs: Estrogen and Progestin Table 21-11 Action Prevent ovulation Use Contraception Adverse Reactions Estrogen excess, progestin excess, androgen excess, estrogen deficiency, progestin deficiency Contraindications for Oral Contraceptives 95 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.