Female Reproductive Disorders

1. Female Reproductive Disorders

2. Menstrual Disorders

3. Premenstrual Syndrome (PMS) • PMS is a group of physiological and psychological symptoms Causes: • Related to release of serotonin, estrogen and progesterone and nutritional deficiencies

4. Premenstrual SyndromeManifestations • Headache • Breast discomfort • Peripheral edema • Abdominal bloating • Sensation of weight gain • Binge eating • Depression, Anxiety, Irritability

5. Premenstrual SyndromeTreatment and Nursing Care • Stress Reduction Techniques • Initiation of an Exercise Program • Diet Therapy ??

6. Premenstrual SyndromeTreatment and Nursing Care • Drug Therapy • Selective Serotonin reuptake inhibitors • Fluoxetine hydrochloride • Sertraline hydrochloride • Diuretics - Spironolactone • Prostaglandin inhibitors - Ibuprofen • Antidepressants, antianxiety – Alprasalom • Oral contraceptives

7. Dysmenorrhea • Discomfort associated with menstruation • Cause - excessive prostaglandins • Signs and Symptoms • Abdominal pain- colicky, radiates to lower back and upper thighs • Nausea, diarrhea, • Fatigue • Headache, light-headedness

8. Dysmenorrhea • Treatment and Nursing Care • Drug Therapy • NSAIDS • Oral Contraceptives • Relaxation Techniques • Heat Therapy • Exercise • Others

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

10. Complications of Vaginal Bleeding • Anemia • 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 ??

11. Abnormal Vaginal Bleeding • Treatment and Nursing Care • Drug Therapy • Oral Contraceptives • Balloon 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 Perimenopause Menopause Cessation of menses Occasional vasomotor symptoms Atrophy of genitourinary tissue Stress incontinence Osteoporosis Sleep disturbances • Irregular menses • Vasomotor instability • Atrophy of genitourinary tissue • Stress incontinence • Breast Tenderness • Mood changes

15. Menopause • Bleeding becomes irregular rt: • follicles no longer respond to FSH • ovarian production of estrogen and progesterone declines OR • Surgically induced

16. MenopauseTreatment and Nursing Care • Drug Therapy • NO longer use Hormone Replacement Therapy – Why? • Antidepressants • Selective estrogen receptor modulators • raloxifene (Evista)

17. MenopauseTreatment and Nursing Care • Non-hormonal Therapy • Cool environment • Loose fitting clothing • Moisturizing soaps and lotions • Health diet with vitamin D • Calcium supplements; vitamin E and B6 • Exercise – weight bearing and aerobic

18. 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

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

20. 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

21. Pelvic Inflammatory Disease • Complications • Septic Shock • Infertility • Ectopic pregnancy • Treatment and Nursing Care • Drug Therapy – antibiotics • Bedrest in Semi-fowlers position • Force fluids • Heat to abdomen or Sitz bath • Patient teaching – ??

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

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

24. Endometriosis • Treatment and Nursing Care • Drug Therapy • Oral contraceptives • Androgens • Gonadotropin-releasing hormone agonists • leuprolide (Lupron) • Nafarelin (Synarel)

25. Endometriosis • Treatment and Nursing Care • Surgical Therapy • Conservative • Laparoscopic laser surgery / laparotomy • Used in women who ?? • Definitive • Hysterectomy • Used in women who ??

26. As a nurse caring for a patient with endometriosis, what would be expected in the diagnostics? • A. CBC with differential • C. Pelvic ultrasound • D. Exploratory laproscopy • E. Biopsy • F. Ablation

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

28. BENIGN REPRODUCTIVE SYSTEM TUMORS Leiomyomas Polycystic ovary

29. Uterine Fibroids (Leiomyomas) • Benign smooth muscle tumors in uterus diagnosed with Hysteroscopy • Signs and Symptoms • Most do NOT have symptoms • Abnormal uterine bleeding • Pain, pelvic pressure

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

31. Polycystic Ovaries Chronic endocrine disorder resulting in: Insulin resistance Hyperandrogenism Altered gonadotropin functioning

32. Polycystic ovaries Diagnosed – Pelvic Ultrasound

33. Polycystic Ovaries Major complication is Infertility

34. Polycystic ovaries • Treatment and Nursing Care • Drug therapy • Oral contraceptives • GnRH agonist • Metformin (Glucophage) • Surgery • Oophorectomy

35. Cancers of Female Reproductive System

36. Diagnostic Testing

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

38. Pap Test

39. ColposcopyLUMA Cervical Imaging System

40. ConizationLoop Electrosurgery Excision Procedure

41. Endometrial Biopsy

42. Cervical Cancer

43. Cervical cancer • Risk factors • In situ 25-40 years old • Invasive 40-60 years old • Dysplasia • DES exposure • Lifestyle • STD exposure • HPV, HSV II

44. Staging and Treatment

45. Endometrial Cancer

46. Endometrial Cancer • Major Risk factor • Prolonged exposure to Estrogen • Other Risk factors • Age - >60 • Infertility • Diabetes • Family hx, other cancers • Lifestyle – obesity, smoking • Clinical Manifestations • Abnormal vaginal bleeding

47. Endometrial CancerTreatment and Nursing Care • Diagnosed • Endometrial biopsy Treatment: • Surgical Therapy • Hysterectomy – first choice of treatment • Chemotherapy • Radiation - brachytherapy

48. Postop interventions for PanHysterectomy • Analgesia • Ambulation • I & O • Passage of flatus • Heat to abdomen • Psychological support • Teaching for home care

49. Ovarian Cancer

50. Ovarian Cancer • Greatest risk factor is ?? • Other risk factors include • Age • High-fat diet • Greater number of ovulatory cycles • Hormone replacement therapy • Use of infertility drugs • 90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells