Reproductive Health

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Reproductive Health : 

Reproductive Health Ricci Chapters 4-9

Amenorrhea : 

Amenorrhea Absence of menses Primary- menses not established by 14 no secondary sex, or 16 with secondary sex Primary causes- wgt, fat, stress, pregnancy Secondary causes- pregnancy, tumors, BF Nursing – unusual characteristics, causes, concerns, explain tests Treatment depends on cause

Cause of Discomfort/Primary Dysmenorrhea : 

Cause of Discomfort/Primary Dysmenorrhea Pain during menses Role of prostaglandin Interventions Oral contraceptives Diet- Vitamins Rest exercise Heat Anti-prostaglandin

Secondary Dysmenorrhea : 

Secondary Dysmenorrhea Define- pain with menses after menses well established. Etiology: reproductive tract pathology Assess- reproductive hx Interventions: DX and treat cause

Abnormal Bleeding : 

Abnormal Bleeding Amenorrhea- lack of menses Menorrhagia- excessive bleeding- 5 days Metrorrhagia- bleeding between cycles Oligomenorrhea-infrequent periods Polymenorrhea-too frequent Menometrorrhagia-irregular with heavy flow Risk for anemia- causes-hormones, fibroids, weight

Dysfunctional Uterine Bleeding : 

Dysfunctional Uterine Bleeding Extremes of reproductive years Progesterone- estrogen imbalance Tx- hormones, OC,NSAIDS IUD Nursing- Education, information, if untreated can lead to infertility

PMS : 

PMS Exact etiology unknown Thought to be: Hormonal imbalance Nutritional deficiency Prostaglandin excess Serotonin

Symptoms of Syndrome : 

Symptoms of Syndrome DX takes 3-5 months Physical symptoms include: fluid retention-weight gain-H/A- backache-N/V- diarrhea-constipation- craving- sleep disturbance Emotional- Mood changes-hostility- depression-labile-anxiety- lethargy Resolves with onset of menses

Endometriosis : 

Endometriosis Endometrial tissue outside of endometrium Hormonal changes cause bleeding and inflammation, scarring S/S- pain, bleeding, painful intercourse. Tx- remove tissue, OC Nursing- explain tests, pain management

Infertility : 

Infertility Definition unable to conceive after 1 yr Female - blocked tubes, endometriosis, 40% of cases attributed to women Dx-hystosalpingography Tx- surgery medications Male- sperm problems, 40% attributed to male DX- semen analysis Tx- artificial insemination- donor

Health promotion Related to Infertility : 

Health promotion Related to Infertility Physiological Psychological- self esteem, scheduled intercourse, expense Sociocultural expectations Developmental expectations Spiritual- grieving

Behavioral Contraception : 

Behavioral Contraception Abstinence- other activities beside intercourse Fertility awareness-know cycle and S/S of fertility BBT-post ovulation increase in temp,temp before rising Sympothermal- BBT,cervical mucosa+ positioning

Behavioral Contraception : 

Behavioral Contraception Coitus Interuptus-withdraw before ejaculation. First few drops of sperm have high concentration of sperm Lactation Amenorrhea-prolactin inhibits gonadatropin Effectiveness depends on exclusivity of BF

Barrier Methods : 

Barrier Methods Condoms-placed correctly, STI protection Diaphragm- covers cervix Must be refitted for weight loss or gain Cervical cap-smaller, insert 12 hours before intercourse Sponge- no protection against STI

Hormonal Contraceptive : 

Hormonal Contraceptive Oral-combination of estrogen or progestin Suppresses FSH- LH makes mucosa hostile Take at same time each day Contraindicated- women over 35 & smokers Can take for up to 3 months Report to HCP if side effects occur

Hormonal Contraceptives : 

Hormonal Contraceptives Lunelle injection- once a month Depo provera-progesterone every 12 weeks Vaginal Ring-place for 3 weeks Norplant-implantable- last 5 years, same S/E as the pill IUD- endometrium hostile to implantation Emergency Contraception- within 72 hrs

Permanent Sterilization : 

Permanent Sterilization Tubal ligation- dissect piece of fallopian tube Trancervically- coil blocks fallopian tube Vasectomy-cut vas defrens Need 2 ejaculates with no sperm Use alternative form of birth control

Termination of Pregnancy : 

Termination of Pregnancy Physiological Surgical vs. medical Mode of termination dependent upon gestation Psychological tasks of the trimester Informed consent Legal parameters Age Religious ethical

Nursing Considerations : 

Nursing Considerations Cost Will both use Religion- Culture Medical History Reproductive History Consent

Menopause : 

Menopause Ovaries decrease production of estrogen Cessation of menses before menopause Peri menopausal 3-5 years Average age is 51 Estrogen produced by fat replaced by estrone

Characteristics of Menopause : 

Characteristics of Menopause Physiologic Hot flashes-CV-osteoporosis-skin-urogenital changes Psychological- empty nest-new beginning- not hot flashes------power surges

Physiological Changes R/T Menopause : 

Physiological Changes R/T Menopause Osteoporosis- bone loss related to aging Risk factors- familial hx, steroids, smoking, lack of exercise Nursing-Increase calcium (1200mg), exercise, eval for height change Cardiovascular- loose protection of estrogen Nursing- Promote healthy lifestyle

Interventions : 

Interventions Estrogen replacement at risk for Ca Hormonal replacement at risk for breast Ca Calcium- 1200mg-1500mg Natural sources of estrogen

STI : 

STI Vulvovaginal candidiasis-change in flora Nsg-hygiene, cotton underwear, douching Trichamonis-bacterial Nsg-condoms, do not share towels BV-alteration in flora Nsg- treat partner for reoccurrence

STI : 

STI Chlamydia-men/women asympomatic Nsg- treat both, no intercourse until TOC Genital Herpes-itching/burning lesion Nsg-need C/S for outbreak Syphilis-progressive -at risk for HIV Nsg- RPR, VDRL,Pen G

Pelvic Inflammatory Disease : 

Pelvic Inflammatory Disease Bacterial infection of pelvic organs Leading cause of infertility S/S-cramping, painful intercourse, temp, bleeding, foul smelling discharge Nsg- assess for sexual activity, risk for infection, STI, full course ABX

HIV : 

HIV World wide epidemic Women of color at risk Dx based upon CD4 count less than 200 Antiviral decrease of transmission to newborn Nsg- understand illness, stay on meds, help with side effects

STI : 

STI HPV- genital warts, most common viral infection Some strains=95% relationship with cervical ca Nsg- can have removed, virus remains Hep A/B-viral infection Nsg- safe sex, immunizations Scabies/ lice- tx with OTC meds

Breast Disorders : 

Breast Disorders Fibrocystic breast- common benign tumor S/S- lumpy, pain tenderness Nsg-Diet changes, analgesic Fibroadenoma-moveable cyst, benign Nsg- mammogram, biopsy Intraductal papilloma- may be cancerous S/S- discharge from nipple Nsg-excision to r/o ca.

Breast Disorders : 

Breast Disorders Mammary duct ectasia-inflammation of duct Common in women with children, have not breast feed S/S- discharge, pain, puritis Nsg- take ABX, warm compress

Breast Cancer : 

Breast Cancer Hereditary component Usually over 50- under 50 aggressive Ca Upper outer quadrant Family hx- prolonged exposure to estrogen-nullipara-early menarche- late menopause- HRT-ERT- breast d/o-obesity- alcohol

Detection : 

Detection Breast self exam- one week past menses Ab. Finding- lump –dimpling-vein-nipple discharge or retraction Mammogram- biopsy Baseline at 40 1-2 years 40-50 Yearly past 50 Earlier if family hx

Cancer Staging : 

Cancer Staging Stage 1- less than 2cm and in breast only Stage 2- less than 5cm, mobile lymph node- not attached Stage 3-greater than 5 cm/ fixed lymph/ local extension Stage 4- distant metastases

Treatment Options : 

Treatment Options Surgical Radical vs. partial Lumpectomy Chemotherapy Radiation Hormonal suppression Immunotherapy

Nursing- Mastectomy : 

Nursing- Mastectomy Preoperative- Discuss tx options Support decision Reduce fear- improve coping Postoperative Pain control Maintain skin integrity Self care Coping Sexual adjustment Prevent lymph edema Promote screening and prevention

Types of Prolapse : 

Types of Prolapse Cystocele-posterior bladder protrudes towards ant wall of vagina Rectocele-rectum sags into post. Wall of vagina Enterocele- Sm. intestine bulges posterior wall of vagina Uterine prolapse- through pelvic floor and out vagina

Risk Factors : 

Risk Factors Children Gravity Atrophy Weak muscles Lifting, coughing, straining can exacerbate

Nursing : 

Nursing Assess degree of discomfort Degree of incontinence Diet and lifestyle-Kegels, straining,fiber, weight, girdle, no lifting Pessary- can support structures Surgical-colporrhaphy-hysterectomy

Incontinence : 

Incontinence Embarrassing, reluctance to discuss, can cause emotional problems Cause- weakness in pelvic floor- aging Urge-urgency, frequency, nocturia Stress- coughing, laughing, exertion Tx- Kegels, anticholinergic,estrogen lifestyle changes

Polyps/Fibroids : 

Polyps/Fibroids Appear on reproductive organs-benign Will remove with forceps or laser Fibroids- masses inside uterus Pain, pressure, bleeding, infertility Tx- hormones, myomectomy, hysterectomy

Female Reproductive Surgeries : 

Female Reproductive Surgeries Hysterectomy- vaginal vs. abdominal Laproscopic- visualize abdominally remove through vagina Abdominal more trauma and longer recovery

Nursing Care : 

Nursing Care Nursing Diagnosis Pre-op- pain, deep breath, and cough Give information, loss of childbearing Post operative interventions Pelvic rest, no lifting, S/S of infection, rest, good diet

Cysts : 

Cysts Follicular cyst-failure of ovarian follicle to rupture Corpus luteum-failure of C.L to degenerate Theca Lutein-high levels of hCG Polycystic ovaries-hyperandrogenism, insulin resistance, hirsituism, infertile OC to suppress androgen, restore reproductive fx

Reproductive Cancers : 

Reproductive Cancers Cervical- most preventable-Pap smear R/T-HPV, early intercourse, multiple partners, STI, HIV Coploscopy- stained cells sent for biopsy Cone biopsy-remove precancerous cells LEEP-heated or electrical current Laser

Endometrial Cancer : 

Endometrial Cancer Most caught early- post menopausal bleeding Risk factors- nulliparity, obesity, infertility Dx- biopsy-UTZ Tx- hysterectomy, ovaries and tubes Need follow-up chance or reoccurence

Ovarian : 

Ovarian Bad outcomes due to late diagnosis Risk factors-nulliparity, late menarche and menopause, obesity Postmenopasusal cyst- must evaluate Tx- hysterectomy Nursing is primary prevention-early symptoms

Vaginal/Vulvar : 

Vaginal/Vulvar Rare slow developing Risk factors-HPV, HIV, age S/S- painful intercourse, discharge, pain Tx- laser, radiation, hysterectomy Vulvar-ext genitalia Risk factor- HPV, smoking, age Tx-laser, cryo, may need skin graft

Violence : 

Violence Not always physical Abusers are from all SES Violence is learned and perpetuated Children develop mistrust of world

Phases of Violence : 

Phases of Violence Tension building- unresolved issues Violence-physical and emotional abuse Reconciliation-apologetic Types of abuse Mental-threatening, demeaning, controlling Physical- hitting, grabbing Sexual- forced sex

Violence During Pregnancy : 

Violence During Pregnancy Can escalate during pregnancy Should screen during PNC and ER Spouse may feel threatened She is vulnerable More likely to have mental health issues

Sexual Violence : 

Sexual Violence May be under reported Sexual violence is about power and control Person abused more likely to abused again Incest- forced by family members Aquaintance rape- under reported, feel guilty

Female Genital Mutilation : 

Female Genital Mutilation Female circumsicion- practiced in other countries Leave opening for urine and menstrual flow May need reconstructive surgery

Violence : 

Violence Human trafficking-mostly children, sold into prostitution, porn PTSD-re-experience event, flashbacks, avoidance

Nursing : 

Nursing Evaluate for injuries Is partners behavior suspicious Use non-judgmental approach Educate Support decisions Use community resources Help to develop coping skills Help to break cycle of violence