1120 FEMALE REPRODUCTION BY DIANA BLUM RN MSN METROPOLITAN COMMUNITY COLLEGE

1. 1120 FEMALE REPRODUCTIONBY DIANA BLUM RN MSNMETROPOLITAN COMMUNITY COLLEGE

2. ANATOMY • EXTERNAL GENITALIA • MONS PUBIS} PAD OF FATTY TISSUE THAT COVERS AND PRTECTS THE SYMPHYSIS PUBIS • LABIA MAJORA} COVER AND PROTECT INNER VULVULAR STRUCTURES (MONS PUBIS TO PERINEUM • LABIA MINORA} THIN FORDS OF SMOOTH SKIN THAT FORM A PREPUCE (HOOD) OVER THE CLITORIS • HAVE SEBACEOUS GLANDS, NERVES, & BLOOD VESSELS • URETHRAL MEATUS} BELOW CLITORIS • VAGINAL OPENING IS COVERED BY THE HYMEN • INTERNAL GENITALIA • VAGINA} CANAL FROM VULVA TO UTERUS • UTERUS} FIRM PEAR SHAPED HOLLOW ORGAN. LOWER SEGMENT IS THE CERVIX • ENDOMETRIUM }INNER LINING OF THE UTERUS • FUNDUS] UPPER SEGMENT OF UTERINE BODY • FALLOPIAN TUBES} 2 THIN HOLLOW CILIA LINES TUBULAR STRUCTURES THAT HAVE FUNNEL SHAPED ENDS • SERVE AS PASSAGE FOR OVA TO TRAVEL FOR FERTILIZATION • OVARIES} 2 ALMOND SHAPED STRUCTURES. HOLD MATURING OVUM AND SECRETE HORMONES (ESTROGEN, PROGESTERONE, ANDROGENS, AND RELAXIN)

3. The Breasts • Accessories to reproductive process • Nourish infants after birth • Inner structure • Gland and duct tissue • Fibrous tissue • Fat • Divided into several lobules • Contain alveoli that produce milk when stimulated by pituitary hormone prolactin • Milk transported to nipple by the lactiferous ducts • Areola} pigmented area that surrounds nipple • Mongomery’s tubercles} small round sebaceous glands that produce a lubricant that protects nipple tissue (visible and under areola)

4. Menstrual Cycle • Result from interaction of hypothalamus, anterior pituitary, and ovary • Interaction causes ovulation • Ovary releases ovum • Prepares uterine lining to receive and nourish ovum if fertilized • Menstruation} passage through the vagina a mixture of blood and other fluids and tissue formed in the lining of the uterus to receive fertilized ovum • Avg.: 28-30 days • Affected by stress, activity, and illness • Cycle progression: • Menstruation day 1-7 • Maturation of ovarian follicle with rupture and release of ovum (days 1-14) • Estrogen production (day 6-14) • Progesterone production (day 15-26) • Uterine prep (day 6-26) • Implantation ( day 14) • Unfertilized does not implant • See pg 1078

6. Menstrual cycle

7. Assessment • Hx: look at s/s, reason for visit • PMH: age menarche (menstruation begins), date of last onset, usual # of days b/w periods, # of days period lasts, ask if any problems like bleed b/w periods, abd pain, cramping mood changes, also look for menopause • Obstetric Hx: # pregnancies, # of live births, # of abortions(spontaneous or induced) and when did it happen in pregnancy • Fam Hx: DM, Ca, pregnancy complications, genetic disorders, congenital anomalies • System Review • Functional Assessment: diet, supplements (calcium, iron), exercise, occupation hazards

8. Diagnostics • Pelvic exam • Smears and cultures • Bx • Cervical bx done to dx cancer • 2 types: multi punch-painful multi specimen taken done outpt :cone- invasive and done as outpt surgery • Colposcopy: inspects cervix under magnification • Culdoscopy: simplest way to directly visualize pelvic cavity, scope inserted into small incisionin posterior vagina. Looks at ectopic pregnancies, masses, infertility, pain • Laparoscopy: done to visualize organs • D & C:diagnostic and tx purpose (cancer , abnormal bleed, abortion) • mammogram

9. http://www.metacafe.com/watch/564612/self_breast_exam/ http://www.youtube.com/watch?v=RNsWzFd1yxw

10. disorders • Breast abcess • Infected area of breast tissue • Becomes filled with pus when body fights infection • Involves breast tissue, nipple milk glands and mild ducts • Assessment: Breast pain, tenderness, redness or hardness,Fever and chills, General ill feeling, Tender lymph glands in the underarm area • Teach: Teach client to clean nipples and breast before and after nursing, Lubricate nipples after nursing with A&D ointment or other recommended topical application, Avoid clothing that irritates the breast, Don’t allow infant to chew nipples

11. disorders • Mastitis} Infection based inflammation of breast tissue in lactating woman (page 1096) • Caused by staph aureus, E-Coli, and streptococci that enter through cracked nipples • Assessment: Localized pain,fever, tachycardia, general malaise, purulent discharge from nipple • Client teaching about application of heat, and drug therapies

12. disorders • Breast Cancer 3 types • Ductal • Lobular • Nipple • Treatment: • Breast bx • Lumpectomy • Radiaton • chemo • Mastectomy and reconstruction • Assess: • Physical manifestations of the disease like lumps, redness , etc. • Review of body systems • Psychological and physical effect of treatment • Psychosocial factors • Level of knowledge • s/s: • Nipple dc or retraction • Skin retraction • Breast thickening or lump • Dimpling of the skin • Breast edema • Dilated blood vessels • Ulceration & hemorrhage • Dry patchy skin (Paget’s disease)

13. disorders • Breast cancer continued • Nursing Interventions • Allow expression of feeling • If has rad. mastectomy, take BP on unaffected side • Help client with mobility exercises • Contact Reach for Recovery volunteer and make sure client hasinfoabout prosthesis and bras • Teach about follow-up care, and chemo & radiation if needed

14. Surgical procedures • Breast Biopsy • Lumpectomy • Tumor of the breast is removed that contains the cancerous tissue with a margin of healthy tissue • Preserves breast • Take as little tissue as needed • Followed by chemo and/or radiation • Lumpectomy with Node Dissection • Tumor of the breast is removed that contains the cancerous tissue with a margin of healthy tissue • Preserves breast • Take as little tissue as needed • Followed by chemo and/or radiation • Mastectomy • Diagnosis by inspection, palpitation, mammography, ultrasound, needle biopsy

15. Preop lumpectomy • Same as breast bx, done under general anesthesia • Responsibility for consent and vitals • Client NPO for 8 hours if having a general anesthetic • Have client Turn. Cough .Deep breath after surgery

16. Post op lumpectomy • Look at dressings and drains • Monitor vitals every 15 min until stable • Management of pain • I&O • Inspection of dressings • Monitor for bleeding and infection

17. mastectomy • Removal of entire breast • Radical-removal of breast tissue, skin, axillary lymph nodes and underlying pectoral muscle • Modified Radical-removal of breast tissue and axillary lymph nodes • Post op • Same as for lumpectomy • Client teaching and emotional support imperative • Otherwise, post –op interventions as in lumpectomy

18. disorders • Cysts • Fibrocystic Disease • DX: palpation, mammography, ultrasound • Treatment: oral analgesics, heat applications, caffeine and salt restrictions and vitamin supplements (E) • Hormone therapy with low dose estrogen and progestins

19. Common Uterine Therapies see page 1086 • Douching • Cauterization • Heat • Topical meds

20. disorders • Uterine bleed • Metrorrhagia} bleed b/w periods • Menorrhagia} profuse or prolonged period • amenorrhea} pregnancy, wt loss, stress, gland disorders • Risk Factors • Hormone dysfunction, tumor, coagulation problems, contraceptives, etc • TX: depends on cause • NSG Dx: Anxiety, knowledge deficit • NSG interventions: teach about tx, encourage feeling expression, listen, explain procedures

21. disorders • Infection • Physiological effect} infertility • Psychological effect} change in relationships, distrust, shame, embarrassment, low self esteem, denial, defensive, etc • Interventions: show acceptance, educate about hygiene and sex practice, teach about creams, jellies, and suppositories

22. Vulvitis and vaginitis • Difference is that vaginal discharge is present with vulvitis • s/s: pruritis is the most common • 2 most comon causes: candida albicans (cottage cheese discharge) and trichomonias vaginalis (profuse, frothy, yellow grey discharge with fish odor) • Both are sexually transmitted • Tx: topical antifungals, oral antiprotozoal, antibiotics, vaginal suppositories • Advise client not to scratch, avoid sex during tx • See pg 1093

23. Uterine Displacement • Cystocele: weakened support between vagina and bladder • Rectocele: weakened support between vagina and rectum • Causes: pregnancy • s/s: pain, infections, etc, see page 1103 • Uterine prolapse: uterus descends into the vagina • 3 degrees (read page 1107-1109)

24. infertility • Inability to conceive within 1 year of regular unprotected sex or inability to deliver live infant • 40% r/t female problems • 40% r/t male problems • 20% unknown • Conception is based on: timing, ovum production, sperm ejaculated, patent fallopian tubes, temperature etc. • see page 1121-1122

25. The end or is it the beginning