FEMALE REPRODUCTIVE DISORDERS Chapters 39 &40

1. FEMALE REPRODUCTIVE DISORDERSChapters 39 &40 By Angie Lawson RN, BSN

2. A&P Review • Internal Structures • Ovaries • Fallopian tubes • Uterus • Vagina • External Structures • Breast • Labia major & Labia minora • Clitoris

3. Baselines History Breast assessment Teach self exam Diagnostic tests Mammograms/ultrasounds MRI’s Biopsy Hormonal tests Pelvic exam Bimanual palpation Cytology Swabs & smears Sonography Radiographic procedures Endoscopic exams Female Assessment

4. Breast Disorders • Cyclic breast discomfort • Swelling tenderness & pain due to hormonal mediated changes • Fibrocystic Breast Disease • Signs & Symptoms – may have no S/S, tenderness or pain, multiple lumps, S/S most notable just menstruation

5. Mastitis • Signs & Symptoms • Fever, malaise, breast tenderness, pain, redness, breast edema, firm and hard, nipple may crack and axillary lymph nodes enlarge • Tx with Antibiotics

6. Breast Cancer Prevention • Long-term Follow-up Therapy • Bilateral Prophylactic Mastectomy • Chemoprevention with Tamoxifen

7. Breast Cancer • Signs & Symptoms • Painless mass, bloody nipple discharge, dimpling of the skin, retraction of the nipple, peau d’orange appearance

8. Metastatic Breast Cancer • Signs & Symptoms • Pain in the new site, pathogenic fractures (if bone involved)

9. Cosmetic Breast Procedures • Mammoplasty • Reduction & Mastopexy • Breast Augmentation • Breast Reconstruction • Artificial implants • Autogenous tissue

10. Menstruation Disorders • Dysmenorrhea • Painful menstruation – not pathological • Premenstrual Syndrome (PMS) • Water retention, headaches, discomfort, changes affect, concentration and coordination

11. Signs & Symptoms Severe dysmenorrhea Copius menstrual bleeding Pain on defecation Dypareunia Endometriosis

12. Menopause • Change of life • Signs and Symptoms • Hot flashes • Sweats • Sleep disturbances • Irritability • Vaginal dryness • Diminished libido • Hormone Replacement Therapy (HRT)

13. Vaginitis • Gardnerella Vaginalis • Trichomonas Vaginalis • Candida Albicans • Signs & Symptoms • Itching, Burning, Redness, Swelling • Medicines • Flagyl, Gynelotrimin, Monistat, Gantrisin

14. Toxic Shock Syndrome(TSS) • Staphylococcus aureus • Streptococcus pyogenes • Clostridium sordellii • Signs & Symptoms • High fever, chills, tenderness, diarrhea, hypotension, hyperemia, disorientation, headache • Treatments • IV fluids, IV oxacillin, nafcillin, methicillin, dopamine, dobutamine, O2

15. Cervicitis • Steptococci • Staphylococci • Gonorrhea • Chlamydia • Signs & Symptoms • Maybe no S&S, Vaginal discharge, Spotting, Painful intercourse • Treatments • Systemic antibiotics, douches, electrocautery, conization

16. Pelvic Inflammatory Disease(PID) • Gonococci • C. Trachomatis • Signs & Symptoms • Malodorous discharge, backache, severe/aching abdominal/pelvic pain, fever, nausea, vomiting, menorrhagia, dysmenorrhea • Treatments • Parenteral/oral antibiotics, IV fluids, antipyretics

17. Uterine Displacement • Signs & Symptoms • Backache • Dysmenorrhea • Dyspareunia

18. Pelvic Organ Prolapse • Signs & Symptoms • Stress incontinence, cystitis, constipation, backache, pelvic pain, “feeling that something is dropping out”

19. Fertility Disorders • Both male and female should be examined • In vitro fertilization – brings sperm and ova together outside the body • Offer a listening ear but do not give advice

20. Reproductive Life Planning • Oral contraceptives • Contraceptive implants • Depot medications • Estrogen-progestogen contraceptive ring • Transdermal contraceptive patch • Barrier methods • Spermicides • IUD’s • Natural Family Planning • Sterilization

21. Pregnancy Termination • Reasons • Ectopic pregnancy • Prenatal abnormalities • Methods • Chemical • morning after pill • RU-486 • Mechanical • Vacuum aspiration • D&C

22. Uterine Leiomyoma(Fibroid Tumors) • Signs & Symptoms • Menorrhagia, pressure, dysmenorrhea, anemia & malaise

23. Ovarian Cysts • Signs & Symptoms • Pressure, backache, menstrual irregularities, pain, breast atrophy, sterility, & hirsutism

24. Vaginal Cancer • Signs & Symptoms • Abnormal bleeding, dyspareunia & visual lesions Vulva Cancer • Signs & Symptoms • Pruritus, genital burning, bloody discharge, enlarged lymph nodes, ulceration and swelling of the vulva

25. Cervical & Endometrial Cancer • Signs & Symptom • Spotting (esp. with intercourse), pain, pressure, & generalized wasting.

26. Ovarian Cancer • Signs & Symptoms • Vague lower abd. discomfort, urinary frequency & urgency, ascites, weight loss, severe pain, & GI symptoms.

27. Gynecological Surgeries • Endoscopic • Hysterectomy • Removal of the uterus • Bilateral salpingooophorectomy • uterus and ovaries are removed

28. Pharmacology • Antineoplastics – cancer (pg 584-590) • Alkylating Drugs • Cyclophosphamide (cytoxan) - ovaries & breast • Melphalan (alkeran) – ovaries • Thiotepa (thioplex) – ovaries & breast • Antibiotics • Doxorubicin HCL (adriamycin, rubex) – breast & ovaries • Epirubicin (ellence) - breast

29. Pharmacology Cont: • Antineoplastics drugs cont: • Antimetabolites • Capecitabine (xeloda) – breast • Fluorouracil (5-FU) (adrucil) – breast • Methotrexate (rheumatrex) – breast • Mitotic inhibitors • Docetaxel (taxotere) – breast • Paclitaxel (taxol) – ovaries & breast

30. Pharmacology Cont: • Hormones • Androgens • Testolactone (teslac) – metastatic breast cancer • Progestins • Medroxyprogesterone (depo-provera) – endometrial • Megestrol acetate (megace) – breast & endometrial • Antiestrogens • Tamoxifen (nolvadex) – breast • Toremifene citrate (fareston) – breast

31. Pharmacology Cont: • Gonadotropin-releasing hormone analogs • Goserelin acetate (zoladex) – breast & uterine • Aromastase inhibitors • Anastrazole (arimidex) – advanced breast • Exemestane (aromasin) – advanced breast • Letrozole (femara) – advanced breast • Platinum coordination complex • Carboplatin (paraplatin) – ovaries • Cisplatin (platinol-AQ) - ovaries

32. Pharmacology Cont: • Substituted urea • Hydroxyurea (droxia, hydrea) - ovaries • Cytoprotective agents • Amifostine (ethyol) – advanced ovaries • Dexrazonxane (zinecard) – metastatic breast • DNA topoisomerase inhibitors • Topotecan (hycamtin) – ovaries • Monoclonal antibodies • Trastuzumab (herceptin) - breast

33. Pharmacology Cont: • Hormonal therapy ( pg 540 – 547) • Androgens • Treatment of cancer in women who are 1-5 years past menopause • Assess daily for signs of fluid and electrolyte imbalance & jaundice • Estrogens • The most potent estrogen is estradiol • Used to relieve moderate to relieve moderate to severe vasomotor symptoms of menopause ( flushing, sweating) • Other actions include fluid retention

34. Pharmacology Cont: • Progestins • Provera, norethindrone • Used for amenorrhea, abnormal bleeding • Adverse reactions include breakthrough bleeding, amenorrhea, weight gain • If breakthrough bleeding occurs dosage might be to high • Combination products • Increases the risk of cardovascular side effects the like thromboembolism • Monitor for thromboembolic effects (homan’s sign)

35. Pharmacology Cont: • Oral contraceptives is best taken with the evening meal or at hs • Miss one dose take 2 next day. If 2 missed take 2 the next 2 days. • Antifungals (pg 130) • Fluconazole (diflucan) – vaginal candidiasis • Butoconazole nitrate (femstat 3) • Clotrimazole (lotrimin) • Miconazole nitrate (monistat) • Nystatin • Terconazole (terazol) • Tioconazole (monistat, vagistat)

36. Pharmacology Cont: • Metronidazole (flagyl) • Uses – vaginosis • Adverse reactions- nausea, anorexia, seizures, numbness