Unit #4.reproductive disorder(AHN-I).pptx

Reproductive disorder

1. Adult health nursing-I Topic:- Reproductive disorder Male Female 16/02/2021 1

2. Objectives: Review the anatomy and physiology of female reproductive system Discuss the function of the supporting ligaments and pelvic floor muscles in maintaining the position of the pelvic organs Discuss the alteration in estrogen and progesterone levels as a cause of dysfunctional menstrual cycle 16/02/2021 2

3. Cont……. Discuss the causes, pathophysiology and manifestation of the following female reproductive disorder Discuss the diagnostic, medical and surgical management of the reproductive disorders Apply nursing process to provide care to clients with reproductive disorder Develop a teaching plan for a client experiencing disorders of the reproductive system 16/02/2021 3

4. Function of ligaments and pelvic floor muscles The pubocervical  ligaments  are bilateral structures, which attach the cervix to the posterior surface of the  pubic  symphysis. They  function  to  support  the uterus within the  pelvic  cavity. The uterosacral  ligaments  are also bilateral fibrous bands, which attach the cervix to the sacrum. 16/02/2021 4

5. Female reproductive organs Internal organs Vagina Uterus Fallopian tubes Cervix ovaries External organ Mons pubis Labia majora Labia minora Clitoris Hymen Bartholin's glands Fourchette Urethral opening vaginal opening 16/02/2021 5

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7. Function of pelvic floor muscles: 16/02/2021 7

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9. Structure and function of female reproductive system: Mons pubis: pear shaped and rough in appearance Labia majora: outer lip and protects internal structure Labia minora: inner lips Clitoris: most sensitive and main function is sexual pleasure. Hymen: thin membrane that rupture after intercourse. Bartholin’s glands: secrete mucous for lubrication . 16/02/2021 9

10. Fourchette: ending of labia majora. Vaginal opening : site for the ejection of penis. Urethral opening: site for the urination. Ovaries: production of egg. Fallopian tubes : a. transport ova from ovary to uterus each month. b. Fertilization of egg and sperm. Uterus: pear like structure known as womb and nourishment and house a fertilized egg until the fetus or offspring is ready to be delivered. 16/02/2021 10

11. Alternation in estrogen and progesterone level:- Progesterone  is used along with  estrogen  in women who still have their uterus. In these women,  estrogen -- if taken without  progesterone --increases a woman's risk for cancer of the endometrium (the lining of the uterus). During a woman's reproductive years, cells from the endometrium are shed during menstruation. Excess  estrogen  can increase the risk of breast cancer and reproductive cancers. While  progesterone  does have an anti-cancer effect, it also provides benefits to all cells in the body including the brain, heart, nerves, skin and bones 16/02/2021 11

12. Causes of dysfunction in menstrual cycle: Menstrual disorders can be caused by a variety of factors, including: Uterine fibroids. Hormonal imbalances. Clotting  disorders . Cancer. Sexually transmitted infections ( STIs ) Polycystic ovary syndrome ( PCOS ) - cysts on the ovaries. Genetics. 16/02/2021 12

13. Disorders : There are many disorders of female reproductive system:- Reproductive tract infections Menstrual disorders Dysfunctional utrine bleeding Menopause Endometriosis Pelvic inflammatory disease Utrine prolapse Cystocele Rectocele 16/02/2021 13

14. Conti……… 10. Fistulas 11. Infertality 12. Estopic pregnancey 13. Abortion 14. Hydatidiform mole 15. Ovarian cyst 16. Ovarian tumor and cancer 17. Utrine tumor/fibroids 18. Breast cancer 16/02/2021 14

15. Reproductive tract infection: Definition: “ Infection of the reproductive or genital tract which causes healthy life loss among sexually active women.” Causes:- Sexually transmitted diseases such as ( HIV ). Poor genital hygiene. Yeast infection. 16/02/2021 15

16. Clinical manifestation: 16/02/2021 16

17. Opening gates are blocked Consumption of Alcohol and drugs Skin piercing Blood tansfusion pathophysiology 16/02/2021 17

18. Diagnostic management : Physical examination by sign and symptoms. Remove IUCD (intra uterine contraceptive device). Broad spectrum Antibiotics. Medical management: Chemotherapy Radio therapy Combined therapy surgical treatment: Laser therapy Laparotomy 16/02/2021 18

19. Menopause : Definition :- The time of life when a woman's ovaries stop producing hormones and menstrual periods stop. Natural  menopause  usually occurs around age 50 . Causes :- change in the balance of the sex hormones. estrogen no longer release an egg each month. Produce less estrogen and progesterone 16/02/2021 19

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21. , clinical manifestation:- Diagnostic management: Physical examination by sign and symptoms. Women under 40 years menopause is suspected. Medical management: Estrogen therapy. Vaginal lubricant such as to prevent from vaginal dryness . 16/02/2021 21

22. Mentural disorders: Definition:- “ Menstrual disorders   are a disruptive physical and/or emotional symptoms just before and during  menstruation ” Some women get through their monthly  periods  easily with few or no concerns. Causes: Hormonal imbalance. Sexually transmitted disease(STD). Genetics. Cancer. Clotting disorder. 16/02/2021 22

23. pathophysiology Prostaglandins Cramps Elevated uterine pressure Ischemia (lack of oxygen) pain 16/02/2021 23

24. Clinical manifestation: Abnormal menstrual bleeding. Pain or cramping. Depression. Headaches. Diagnostic management: Hormones supplement. Anti depressant. Diatery modification. Medical management: Antibiotics Non steroid anti inflammatory agent. 16/02/2021 24

25. Dysfunctional uterine bleeding Definition: Dysfunctional is a condition that cause vaginal bleeding to occur outside of the regular menstrual cycle. causes: Medication Obesity excessive exercise or weight loss stress or illness 16/02/2021 25

26. pathophysiology: Prolonged unopposed estrogen Proliferative endometrium Complexed hyperplasia Complexed hyperplasia with atypia Adenocarcinoma 16/02/2021 26

27. Clinical manifestation: 16/02/2021 27

28. Diagnostic management: Pregnancy test. Platelet count. Laparoscopy. CBC test. Medical management: Possible transfusion. Progesterone therapy. Hormonal contraceptive. Androgen therapy. 16/02/2021 28

29. Endometriosis: Definition : Endometriosis  is a disease in which the endometrium (the tissue that lines the inside of the uterus or womb) is present outside of the uterus.  Causes: Genetic factors Immune system problems Hormones Surgery 16/02/2021 29

30. Clinical manifestation : Painful periods. Pain during or around ovulation. Pain during or after sex. Heavy bleeding or irregular bleeding. Pain with bowel movements or urination. Pain in the pelvic area, lower back, or legs. Nausea. Diagnostic management: Laparoscopy. CT scan. 16/02/2021 30

31. Medical management: Hormonal contraceptives. Gonadotropin. NSAIDS drugs, such as Ibuprofen. Surgical management: Laparoscopy Laparotomy Hysterectomy 16/02/2021 31

32. Pelvic inflammatory disease: Definition:- “ Pelvic inflammatory disease   is an infection of a woman's reproductive organs”  It is a complication often caused by some STDs , like chlamydia. Causes:- Infection of reproductive organ Bacterial vaginosis Sexually transmitted disease 16/02/2021 32

33. pathophysiology: 16/02/2021 33

34. Clinical Manifestation: Pain in your lower abdomen; Fever ; Bleeding between periods. Burning sensation when urinate. Diagnostic management: There are no test that can accurately diagnose(PID). Medical management: A ntibiotic therapy Laparoscopy Laparotomy 16/02/2021 34

35. Uterine prolapse: Definition: - “ Uterine prolapse   occurs when pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the  uterus .” Causes:- Weakened and damage muscle During pregnancy Obesity Severe coughing. 16/02/2021 35

36. Pathophysiology: Clinical manifestation: Backache. Abdominal pain Bloody discharge Pressure and heaviness in vagina region. 16/02/2021 36

37. Diagnostic management: P elvic E xamination Medical management: Hysterectomy Vaginal pessary(plastic device inserted into vagina). Estrogen cream(to decreases genital atrophy). 16/02/2021 37

38. Cystocele: Definition:- “ cystocele is a downward displacement of bladder into vagina” Causes:- Muscle straining during child birth Straining from heavy lifting. Straining during bowel movement. Menopause. 16/02/2021 38

39. Other Causes: 16/02/2021 39

40. Clinical manifestation: A feeling of fullness in Pelvis region. Pressure in pelvis vagina. A bulge of tissue. Continuous urge to urination . Diagnostic management: By sign and symptoms. Pelvic examination. Urinalysis and culture. Surgical management : Pelvic strengthening exercise Estrogen therapy 16/02/2021 40

41. Rectocele: Definition:- A posterior vaginal prolapse, also known as a  rectocele , occurs when the wall of fibrous tissue that separates the rectum from the vagina weakens. Causes:- Pregnancy and child birth. Chronic cough or bronchitis. Chronic constipation. Over weight or obese. Repeated heavy lifting. 16/02/2021 41

42. Pathophysiology: 16/02/2021 42

43. Clinical manifestation:- Constipation. Straining with bowel movement. Stool getting stuck in the bluge of the rectum. Diagnostic management:- Diagnosis after examine the vagina and rectum. Determine the size of the rectocele. 16/02/2021 43

44. Surgical and medical Management Mild cases can often be improved with pelvic floor exercises and bowel training . Estrogen to prevent or treat prolapse NSAIDS Antibiotics Moderate to severe cases are often  treated  with : vaginal pessary (a support device inserted into the vagina)   R ectocele  repair (a minimally invasive surgical procedure). 16/02/2021 44

45. Lifestyle and home remedies Perform Kegel  exercises  to strengthen and support the weakened pelvic Muscles. Avoid  constipation  by eating high- fiber  foods and drinking plenty of fluids. Avoid bearing down to move your bowels. Avoid heavy lifting. Control  coughing . Lose weight if you're overweight or obese. 16/02/2021 45

46. Fistulas: Definition:- “ A fistula is an abnormal connection between two body parts, such as organs or blood vessels another structure.” Fistulas are usually the result of an injury or surgery. Causes:- Crohn’s disease. Radiation (treatment for cancer). 16/02/2021 46

47. Clinical manifestation: Racing heart rate. Extreme abdominal pain. Nausea and vomiting. Constipation. Diagnostic management: Blue dye test. CT scan. Surgical Management :- Fistulotomy (the lying open technique). Seton techniques. 16/02/2021 47

48. Conti… Medical management : injecting a glue into the  fistula  while you're under a general anesthetic. The glue helps seal the  fistula  and encourages it to heal . Antibiotics NSAIDS Nursing management: skin protection containment of effluent odor control patient comfort quantification of output volume patient mobility ease of care 16/02/2021 48

49. Infertality:- Definition:- “ Not being able to get pregnant (conceive) after one year (or longer) of unprotected sex.” Causes:- Polycystic ovary syndrome( PCOS ). Hypothalamic dysfunction. Premature ovarian failure. To much prolactin/ hyperprolectinemia 16/02/2021 49

50. Causes conti … 16/02/2021 50

51. Clinical manifestation:- Irregular menstrual cycle of women. Hormonal imbalance. Low folical count. Diagnostic management:- May have blood test. Determine the level of testosterone and male hormones. Some genetic test done. M anagement :- Fertility drugs. IUI (intra utrine insemination). 16/02/2021 51

52. Ectopic pregnancy:- Definition:- “ Ectopic pregnancy occur when a fertilize egg implants and grows outside the main cavity of the uterus.” This type of pregnancy is called tubal pregnancy. Causes:- Damage fallopian tube Stress Abnormal health Infections Abnormal development of the fertilized egg 16/02/2021 52

53. Pathophysiology: 16/02/2021 53

54. Clinical manifestation: Tummy pain low down on one side. Vaginal bleeding. Pain in the tip of the shoulders. Discomfort when peeing/ Urinate Diagnostic management: Pelvic examine HCG(human chorionic gonadotrophin) which produce progesterone in pregnancy An ultrasound Medical management: Tubal ectopic pregnancy detected early can be treated successfully. Required surgical interventions. 16/02/2021 54

55. Abortion 3/18/2021 55 T he deliberate termination of a human pregnancy, most often performed during the first 28 weeks of pregnancy. " An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or fetus and placenta from the uterus"

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57. Causes 3/18/2021 57 Ovo fetal factors Chromosomal abnormalities Congenital malformation 2. Maternal factors Trauma Toxins Viral infection 3 . Cervico uterine factors Cervical incompetence Sperm defects Psychological defects

58. 3/18/2021 58 Retroverted uterus Immunological defect Drug abuse Blood incompatibility Signs and Symptoms Bleeding from vagina Backache Brownish vaginal discharge Pyrexia Uterine cramps Low abdominal pain Colicky pain

59. Diagnostic Evaluation 3/18/2021 59 USG Culture test X-ray Blood test (Hb, ABO grouping) Cervical swab culture Immunological test Management Bed rest Avoid straining at stool Antibiotics therapy Healthy diet Fluid replacement and blood transfusion

60. 3/18/2021 60 Hydatidiform mole A hydatidiform mole is growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta .  Women appear to be pregnant, but the uterus enlarges much more rapidly than in a normal pregnancy. Causes The cause of hydatidiform mole is unclear. Some expert believed it is caused by problems with the chromosomes.

61. 3/18/2021 61 Risk Factors: Placental abnormality Lower malignancy potential

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63. 3/18/2021 63 Manifestation Vaginal bleeding Enlarged uterus Pelvic pain Pelvic infection Severe nausea Vomiting Diagnostic Management Ultrasound Blood test

64. 3/18/2021 64 M anagement dilatation of cervix and evacuation of the uterus Hysterectomy

65. Nursing Management: Remember to assess the BP, check if the patient is bleeding occur and make sure to notify the doctor immediately. Teach deep breathing techniques to alleviate the pain. Use diversional activities if possible. Check for abdominal pain and relief from it. If nausea and vomiting are present, make sure the patient would not aspirate it. After D&C patient is at risk for infection. Make sure the patient has good perineal hygiene. Administer all medications as ordered.  P rovide emotional  support. M onitoring the hCG level and follow-ups. 16/02/2021 65

66. 3/18/2021 66 Ovarian Cyst An ovarian cyst is a fluid-filled sac within the ovary.

67. 3/18/2021 67 Causes Hormonal problems Endometriosis Severe pelvic infections Pregnancy Pathophysiology increase luteinizing hormone Hormonal imbalance Follicles fail to ovulate Cyst grow in size upto 15cm

68. 3/18/2021 68 Manifestation Pelvic pain Pain during sex A frequent need to urinate Heavy periods, irregular periods or lighter periods than normal Bloating Diagnostic Evaluation X-ray MRI Ultrasound

69. 3/18/2021 69 Medical management I buprofen N aproxen A cetaminophen Surgical management Cystectomy Oophorectomy

70. 3/18/2021 70 Ovarian tumor and cancer “ Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. If left untreated, the tumor can spread to other parts of the body.” Causes Family history Use of certain fertility of drugs Gene mutation Endometriosis

71. 3/18/2021 71 Manifestation Abdominal bloating or swelling Quickly feeling full when eating Weight loss Discomfort in the pelvis area Changes in bowel habits, such as constipation A frequent need to urinate Back pain

72. 3/18/2021 72 Diagnostic Evaluation T ransvaginal U ltrasound (TVUS) CA-125 blood test Medical treatment Chemotherapy (Platinum , taxane ) Surgical treatment Hysterectomy Oophorectomy

73. 3/18/2021 73 Uterine Tumor or Fibroid Uterine cancer  occurs when  cancer  cells form in the muscles  of the uterus  or tissues that support the  uterus . Fibroids are non-cancerous growths that develop in or around the womb (uterus). Causes Genetic change Hormones Extracellular matrix Obesity Drinking alcohol

74. 3/18/2021 74 Manifestation Heavy vaginal bleeding Prolonged or painful periods Pain in the lower abdomen or back Frequent urination Chronic pelvic pain Risk Factors: Inappropriate growth of uterine smooth muscle tissues Depend on estrogen and progestron

75. 3/18/2021 75 Diagnostic Evaluation Ultrasound Medical management Gonadotropin-releasing hormone (GnRH) Surgical Management Hysterectomy Myomectomy

76. 3/18/2021 76 Breast Cancer “Breast cancer is a disease in which cells in the breast grow out of control.” There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.

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78. 3/18/2021 78 Causes No actual causes but some are : Heredity Chemical Obesity Hormonal Radiation Age

79. 3/18/2021 79 Risk Factors: Manifestation Lump in the breast Swelling of part of the breast Nipple retraction Dumpling of skin Nipple discharge Pain in the nipple area Predisposing factors Precipitating factors

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81. Breast Self Examination : 16/02/2021 81

82. 3/18/2021 82 Diagnostic evaluation Physical examination Mammography Chest X-ray Axillary node sampling Breast self examination Medical management Chemotherapy Cyclophosphamide Bleomycin Methotrexate

83. 3/18/2021 83 Surgical management Lumpectomy Partial Mastectomy Total Mastectomy Radical Mastectomy Mammoplasty

84. Nursing Interventions: Breast cancer affects several quality of life domains – psychological ,social and spiritual. Health functioning, socioeconomic, psychological/spiritual and family domains should be considered when caring for breast cancer patients. According to National Cancer Institute, symptom management is defined as care given to improve the quality of life of patients who have a serious or life threatening disease. 16/02/2021 84

85. Conti… The goal of symptom management is to prevent or treat as early as possible the symptoms of the cancer and the side effects caused by treatment . Nursing interventions promotes efficient, patient centered care highlighting the need for the patients to receive the treatment that they need in a timely and efficient manner 16/02/2021 85

86. 3/18/2021 86 Discuss the diagnostic , medical and surgical management of the below mentioned disorders Apply nursing process including assessment , planning, implementation and evaluation of care provided to the clients with male reproductive disorders Develop a teaching plan for client experiencing disorders of the reproductive system Benign prostrate hypertrophy Erectile dysfunction Prostrate and testicular cancer Infertility Objectives:

87. 3/18/2021 87 Scrotum: S ac like structure that enclosed testes Penis: Rod like structure and helps in the transmission of sperms into vagina. Testes : O val shaped and responsible for spermatogenesis Vas deferens: Muscular tube and transport mature sperms to urethra. Seminal vesicle: helps in semen secretion, sperm motility, stability of sperm chromatin Structure and function of male reproductive organs

88. 3/18/2021 88 Prostate glands : Pre ss forcefully semen towards urethra Ejaculatory ducts: Adding secretions and additives from the prostate necessary for the sperm function and delivers to urethra. Cowper's glands): Duri ng sexual arousal produces secretions containing glycoproteins that provides lubricating medium for the urethra and at tip of penis .

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90. Functions of male reproductive system 3/18/2021 90 Spermatogenesis(formation of sperms) Performance of male sexual act Regulation of male reproductive system by various hormones

91. Male Reproductive Disorders 3/18/2021 91 1.Benign prostrate hypertrophy 2.Erectile dysfunction 3.Prostate and Testicular cancer 4.Infertility

92. 3/18/2021 92 Benign prostate hypertrophy(BPH) C ondition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia . Causes The actual cause of prostate enlargement is unknown Old age above 50 years

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94. Pathophysiology 3/18/2021 94 Hyperactivity of testosterone Hyperplasia of prostrate tissue Prostatic urethra becomes compressed and narrowed Prolonged obstruction Manifestation In early stage there may be no symptoms In later stage Urinary obstruction Nocturia

95. 3/18/2021 95 Incomplete bladder empty Burning micturition Diagnostic Evaluation Urinalysis Serum test S. Creatinine Cystourethroscopy USG Serum PSA (Prostrate specific antigen)

96. Medical Management 3/18/2021 96 Adrenergic blockers Antiandrogenic agents Surgical Management TURP ( Transurethral Resection of Prostrate) Prostatectomy

97. 3/18/2021 97 Erectile Dysfunction Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. Causes Physical cause Heart disease Obesity HTN Spinal cord injury High cholesterol

98. 3/18/2021 98 Diabetes Alcoholism 2. Psychological causes Depression Mental health problem Anxiety

99. Manifestation 3/18/2021 99 Lack of an erection hard enough for penetration Problem keeping an erection Reduced sand desire Diagnostic Evaluation Physical examination Psychological examination Blood test (testosterone levels) Urine test

100. Medical Management 3/18/2021 100 Intraneuronal injections Use vacuum devices Psychotherapy Surgical Management If medication doesn't successfully treat erectile dysfunction, your doctor may recommend surgery or the use of a penile device.

101. Prostate Cancer 3/18/2021 101 Prostate cancer is an uncontrolled (malignant) growth of cells in the prostate gland. Causes: Age above 50 years Hereditary High fatty diet intake Multiple sexual partners Higher fertility Increase testosterone hormone level

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103. Risk Factors: 3/18/2021 103 Infectious agents Dietry Carcinogens Hormonal imbalance Genetics factors

104. 3/18/2021 104 Manifestation Dysuria Difficulty in achieving erection Backache Weight loss Painful ejaculation Oliguria Weakness Diagnostic Evaluation Rectal examination PSA test Ultrasound Trans rectal needle biopsy

105. 3/18/2021 105 Medical Management Antiandrogen therapy Hormonal therapy Surgical Management Radical proctectomy Radiation therapy Cryosurgery of prostate gland

106. Infertility 3/18/2021 106 Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant.

107. Causes 16/02/2021 107 Abnormal sperm production Genetics defects Infections such as chlamydia, gonorrhea, mumps or HIV Varicoceles Unhealthy life style Certain medical conditions

108. Manifestation 3/18/2021 108 Testicular varicose Genital infections Genital infections Heavy smoking Chronic alcohol Smoking Erectile dysfunction

109. Diagnostic Evaluation 3/18/2021 109 Physical examination history Medical history Semen analysis Medical management Sytemic cardicosteroid Cabergoline Clomoid

110. Surgical management 3/18/2021 110 Varicocelectomy Transurethral Ejaculatory Duct Resection Vasectomy reversal

111. Nursing Management for Male reproductive disorders: 16/02/2021 111 Collaborative Care The goals of collaborative care are to: Restore bladder drainage. Relieve the patient’s symptoms. Prevent or treat the complications. Treatment is generally based on the degree to which the symptoms bother the patient or the presence of complications . Alternatives to surgical intervention for some patients now include drug therapy. Give psychological support if needed.

112. 3/18/2021 112 Testicular Cancer Testicular cancer is a disease when testicular cells become abnormal (malignant) in one or both  testicles. Causes : Genetics Age Abnormal development of testicle Undescended testicle

113. Manifestation 3/18/2021 113 Swelling Pain Discomfort feeling of heaviness in the scrotum Endocrine abnormality Headache Low back pain

114. Diagnostic Evaluation 3/18/2021 114 Blood test Ultrasound Medical management C hemotherapy prescribed by physician. Surgical management R adical I nguinal Orchiectomy

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116. THIS CHAPTER IS OVER 16/02/2021 116