Female Reproductive Disorders

1. Female Reproductive Disorders

2. Menstrual Disorders

3. Premenstrual Syndrome • Why is PMS know as a syndrome and not a disease? a Group of physiological and psychological symptoms

4. Premenstrual Syndrome • What are the symptoms? • Remember – these can vary from month to month?

5. Premenstrual SyndromeTreatment and Nursing Care • Stress Reduction Techniques • Initiation of an Exercise Program • Diet Therapy • Avoid caffeine and alcohol • Eat complex carbohydrates, high-fiber • Reduce salt intake • Increase vitamin B12 , calcium and magnesium

6. Premenstrual SyndromeTreatment and Nursing Care • Drug Therapy • Selective Serotonin reuptake inhibitors • Prozac • Zoloft • Diuretics - spironolactone • Prostaglandin inhibitors - ibuprofen • Antidepressants, antianxiety - Xanax • Oral contraceptives

7. Dysmenorrhea • Discomfort associated with menstruation • Cause - excessive prostaglandins * What is the action of prostaglandins on smooth muscles? • Signs and Symptoms • In addition to Abdominal what will the patient complain of?

8. Dysmenorrhea • Treatment and Nursing Care • Drug Therapy • NSAIDS/ Prostaglandin blockers - • Oral Contraceptives • Relaxation Techniques • Heat Therapy • Exercise • Other • Acupuncture • Transcutaneous nerve stimulation

9. Abnormal Vaginal Bleeding • Oligomenorrhea – long interval between menses • Amenorrhea - absence of menses • Menorrhagia – prolonged menstrual bleeding • Metrorrhagia – irregular bleeding

10. Complications of Vaginal Bleeding • Anemia • Order lab work – CBC, Hgb, Hct • Assess for excessive fatigue • Monitor vital signs • Provide for safety with the weak patient • Toxic Shock Syndrome (TSS) • Assess for high fever, vomiting, diarrhea, weakness, myalgia, and sunburn-like rash • Patient teaching – avoid use of superabsorbent tampons and pads; change pads and tampons frequently

11. Abnormal Vaginal Bleeding • Treatment and Nursing Care • Drug Therapy • Oral Contraceptives • Baloon Thermotherapy • Myomectomy

12. Endometrial Ablation • A resectoscope is a special type of telescope inserted inside the uterus.  It has a built in wire loop that uses high-frequency electrical energy to cut or coagulate or ablate tissue. • The resectoscope has the advantage of being able to remove polyps and some fibroids at the time of ablation. 

13. Menopause Cessation of menses

14. Menopause • Menopause is related to a decrease in the production of _______ and ___________. or Surgically induced

15. Menopause Clinical Manifestations Cessation of menses Occasional vasomotor symptoms Atrophy of genitourinary tissue Stress incontinence Osteoporosis Sleep disturbances

16. What laboratory tests would confirm the diagnosis of menopause?

17. MenopauseTreatment and Nursing Care • Drug Therapy • NO longer encourage the use of Hormone Replacement Therapy – related to increase in risk for development of breast cancer, stroke, heart disease, DVT, pulmonary emboli • Antidepressants • Selective estrogen receptor modulators • raloxifene (Evista) • Bisphosphonates • Fosamax or Actonel

18. MenopauseTreatment and Nursing Care • Non-hormonal Therapy • Cool environment • Loose fitting clothing • Moisturizing soaps and lotions • Healthy diet with vitamin D • Vitamin and mineral supplements • Exercise

19. Review • To prevent or decrease age-related changes that occur after menopause in a patient who chooses not to take HRT, the nurse teaches the patient that the most important self-care measure is • Maintain sexual activity • Increase intake of dairy products • Performing regular aerobic, weight-bearing exercise • Taking vitamin E and B6 supplements

20. Pelvic Inflammatory Disease Infection of uterus, fallopian tubes, ovaries, and peritoneal cavity

21. Pelvic Inflammatory Disease • Cause – gonorrhea and chlamydial infections spread up the reproductive system into the peritoneal cavity • Manifestation • Abdominal pain • Fever • Vaginal discharge • Diagnosis • Vaginal culture

22. Pelvic Inflammatory Disease • Complications • Septic Shock • Infertility • Ectopic pregnancy • Treatment and Nursing Care • Drug Therapy • Positioning • Force fluids • Heat to abdomen or Sitz bath • Patient teaching – prevention of re-infection

23. Ask Yourself? • The nurse caring for a patient with PID places her in a semi-fowlers position in order to: • Relieve pain • Prevent the complication of sterility • Promote drainage and prevent abscess • Improve circulation and promote healing

24. Endometriosis Presence of normal Endometrial Tissue outside the uterine cavity

25. Answer this! • What is the big deal about endometrial tissue being outside the uterus?

26. Endometriosis • What is the main symptom of endometriosis?

27. Endometriosis • Clinical Manifestations • Dysmenorrhea, pelvic pain • Dyspareunia, dysuria • Infertility • Chocolate cysts in ovaries • Diagnosis • Laproscopy

28. EndometriosisHow do these medications help in treatment? • Ibuprofen (Advil) • Oral contraceptives • medroxyprogesterone (Depo-Provera) • danazol - Danocrine • Gonadotropin-releasing hormone agonists • leuprolide (Lupron) • Nafarelin (Synarel)

29. Endometriosis • Treatment and Nursing Care • Surgical Therapy • Conservative • Laparoscopic laser surgery / laparotomy • Used in women who desire to bear children • Definitive • Hysterectomy • Used in women who no longer desire children

30. Which of these diagnostic measures is used most often to confirm the diagnosis of endometriosis? • A. CBC with differential • C. Pelvic ultrasound • D. Exploratory laproscopy • E. Biopsy • F. Ablation

31. Tutorial on endometriosis • Go to the following website for a tutorial on endometriosis: • http://www.nlm.nih.gov/medlineplus/tutorials/endometriosis/htm/index.htm

32. BENIGN REPRODUCTIVE SYSTEM TUMORS Leiomyomas Polycystic ovary

33. Uterine Fibroids (Leiomyomas) • Benign smooth muscle tumors in uterus diagnosed with Hysteroscopy • Do they grow fast or slow? • What makes them grow?

34. Leiomyomas • Signs and Symptoms • Most do NOT have symptoms If they do: • Abnormal uterine bleeding- menorrhagia and metrorrhagia • Pain, pelvic pressure

35. Uterine Fibroids (Leiomyomas) • Diagnosis • Enlarged uterus distorted with nodular masses • Treatment and Nursing Care • Myeomectomy, Myeolysis • hysterectomy • Cryosurgery • ExAblate 2000 system

36. Answer this! • A 26 y/o woman who wishes to have children is diagnosed with uterine fibroids (leiomyoma). Which of the following is likely to be the treatment of choice? • A hysterectomy will be necessary to remove the tumor • A myomectomy may be performed • Aspirin and NSAID’s will be used to control the pain • Hormonal therapy will be used to shrink the tumor and maintain sterility

37. Polycystic Ovaries Chronic endocrine disorder resulting in: Insulin resistence Hyperandrogenism Altered gonadotropin functioning

38. Polycystic ovaries Estrogen/ testosterone progesterone Diagnosed – Pelvic Ultrasound

39. Polycystic Ovaries • Signs and Symptoms • Irregular menstrual periods – infrequent or absent • Hirsutism • Obesity • Acne • No ovulation • These manifestations are related to estrogen and high levels of ____________ and no ________________.

40. Polycystic ovaries • How do each of these medications assist in treatment? a. oral contraceptives – b. spironolactone (Aldactone) - c. leuprolide (Lupron) - d. Metformin (glucophage) - e. clomiphene (Clomid) – • Surgery • Oophorectomy

41. Additional Treatment Options • Weight management • Exercise • Monitor lipid profile • Monitor glucose levels

42. Polycystic Ovaries Long-term complication is Infertility

43. Cancers of Female Reproductive System

44. Diagnostic Testing

45. Pelvic Examination • What are the duties of the nurse in assisting with a pelvic exam?

46. Pap Test

47. ColposcopyLUMA Cervical Imaging System

48. What happens if the pap test Or colposcopy indicate abnormal cells?

49. ConizationLoop Electrosurgery Excision Procedure

50. Endometrial Biopsy Teach what to “Call the Doctor” for.