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Chapter 12

Care of the Patient with a


Reproductive Disorder

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Slide 1

Overview of Anatomy and


Physiology
Male reproductive system
Testes
Ductal system
Epididymis
Ductus deferens (vas deferens)
Ejaculatory duct and urethra

Accessory glands
Seminal vesicles
Prostate gland
Cowpers glands

Urethra and penis


Sperm
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Slide 2

Figure 12-1

(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

Longitudinal section of the male pelvis showing the location of the


male reproductive organs.
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Slide 3

Figure 12-2

(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell
(ovum) surrounded by sperm at time of fertilization (right).
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Slide 4

Overview of Anatomy and


Physiology
Female reproductive system

Ovaries
Fallopian tubes
Uterus
Vagina
External genitalia
Accessory glands
Skenes glands
Bartholins glands

Perineum
Mammary glands (breasts)

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Slide 5

Figure 12-3

(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

Longitudinal section of the female pelvis showing the location of the


female reproductive organs.
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Slide 6

Figure 12-4

(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)

Sectioned view of the uterus showing relationship to the ovaries and


vagina.
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Slide 7

Figure 12-6

(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

Lateral view of the breast (sagittal section).


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Slide 8

Figure 12-7

(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)

Mammalian ovary showing successive stages of ovarian (graafian)


follicle and ovum development.
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Slide 9

Figure 12-14

(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosbys guide to physical
examination. [5th ed.]. St. Louis: Mosby.)

A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast.


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Slide 10

Human Sexuality
Sexual identity
The sense of being feminine or masculine

Influences on sexual health


Overall wellness includes sexual health, and sexuality
should be part of the health care program

Illness and sexuality


Illness may cause changes in a patients self-concept
and result in an inability to function sexually

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Slide 11

Laboratory and Diagnostic


Examinations
Diagnostic tests for the female

Colposcopy; culdoscopy; laparoscopy


Papanicolaou (Pap) smear
Biopsies: Breast, cervical, endometrial
Conization; dilation and curettage
Cultures and smears
Schillers iodine test
Hysterograms
Mammography; pelvic ultrasonography
Tubal insufflation (Rubins test)
Human chorionic gonadotropin; serum CA-125

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Slide 12

Laboratory and Diagnostic


Examinations
Diagnostic tests for the male

Testicular biopsy
Semen analysis
Prostatic smears
Cystoscopy
Rectal digital exam
Prostate specific antigen (PSA)

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Slide 13

The Reproductive Cycle


Menarche

The beginning of menses


Follows breast development by 2 to 2 years
Average age range is between 9 and 17 years
Cycle length ranges from 24 to 32 days
The average flow lasts 3 to 5 days
The average flow is 35 mL/cycle

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Slide 14

The Reproductive Cycle


Amenorrhea
Etiology/pathophysiology
Absent or suppressed menstrual flow

Clinical manifestations/assessment
No menstrual flow for at least 3 months

Medical management/nursing interventions


Based on underlying cause
Hormone replacement may be necessary

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Slide 15

The Reproductive Cycle


Dysmenorrhea
Etiology/pathophysiology
Uterine pain with menstruation

Clinical manifestations/assessment

Breast tenderness; headache


Abdominal distention; nausea and vomiting
Vertigo
Palpitations
Excessive perspiration
Colicky, cyclic pain; dull pain in the lower pelvis

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Slide 16

The Reproductive Cycle


Dysmenorrhea (continued)
Medical management/nursing interventions

Exercise
Nutritious foods, high in fiber
Heat to pelvic area
Mild analgesics
Prostaglandin inhibitors

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Slide 17

The Reproductive Cycle


Abnormal uterine bleeding
Menorrhagia
Excessive bleeding during the regular menstrual flow
Causes: Endocrine disorders; inflammatory
disturbances; uterine tumors

Metrorrhagia
Uterine bleeding between regular menstrual periods or
after menopause
May indicate cancer or benign tumors of the uterus

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Slide 18

The Reproductive Cycle


Premenstrual syndrome (PMS)
Etiology/pathophysiology
Believed to be related to the neuroendocrine events
occurring within the anterior pituitary gland

Clinical manifestations/assessment

Irritability, lethargy, and fatigue


Sleep disturbances; depression
Headache; backache; breast tenderness
Vertigo
Abdominal distention
Acne

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Slide 19

The Reproductive Cycle


Premenstrual syndrome (PMS) (continued)
Medical management/nursing interventions
Pharmacological management

Analgesics; diuretics; progesterone

Dietary recommendations

High in complex carbohydrates


Moderate in protein
Low in refined sugar and sodium
Limit caffeine, chocolate, and alcohol

Reduce or eliminate smoking


Exercise; adequate rest, sleep, and relaxation

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Slide 20

The Reproductive Cycle


Menopause
Etiology/pathophysiology
The normal decline of ovarian function resulting from
the aging process
May be induced by irradiation of the ovaries or surgical
removal of both ovaries
Not considered complete until 1 year after the last
menstrual period

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Slide 21

The Reproductive Cycle


Menopause
Clinical manifestations/assessment
Decrease in frequency, amount, and duration of the
normal menstrual flow
Shrinkage of vulval structures; shortening of the vagina
Dryness of the vaginal wall; pelvic relaxation
Loss of skin turgor and elasticity
Increased subcutaneous fat; decreased breast tissue;
thinning of hair
Osteoporosis

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Slide 22

The Reproductive Cycle


Menopause (continued)
Medical management/nursing interventions
Estrogen therapy

Premarin
Provera

Calcium supplements

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Slide 23

The Reproductive Cycle


Male climacteric
Etiology/pathophysiology
Gradual decrease of testosterone levels and seminal
fluid production; 55 to 70 years of age

Clinical manifestations/assessment
Decreased erections; decreased seminal fluid
Enlarged prostate gland; decreased muscle tone
Loss or thinning of hair

Medical management/nursing interventions


Emotional support; treatment for impotence

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Slide 24

The Reproductive Cycle


Erectile dysfunction
Etiology/pathophysiology
Inability of an adult man to achieve penile erection
Types

Functional
Anatomical
Atonic

Medical management/nursing interventions

Remove cause if possible


Treat diseases
Viagra
Mechanical devices: penile prosthesis
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Slide 25

The Reproductive Cycle


Infertility
Etiology/pathophysiology
Inability to conceive after 1 year of sexual intercourse
without birth control

Medical management/nursing interventions

Depends on the cause


Hormone therapy
Repair occlusion
Intrauterine insemination
In vitro fertilization

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Slide 26

Infections of the Female


Reproductive Tract
Simple vaginitis
Etiology/pathophysiology
Common vaginal infection
Causative organisms: E. coli; staphylococcal;
streptococcal; T. vaginalis; C. albicans; Gardnerella

Clinical manifestations/assessment
Inflammation of the vagina
Yellow, white, or grayish white, curd-like discharge
Pruritus and vaginal burning

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Slide 27

Infections of the Female


Reproductive Tract
Simple vaginitis (continued)
Medical management/nursing interventions
Douching
Vaginal suppositories, ointments, and creams

Organism-specific

Sitz baths
Abstain from sexual intercourse during treatment
Treat partner if necessary

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Slide 28

Infections of the Female


Reproductive Tract
Cervicitis
Etiology/pathophysiology
Infection of the cervix

Clinical manifestations/assessment
Backache
Whitish exudate
Menstrual irregularities

Medical management/nursing interventions


Vaginal suppositories, ointments, and creams;
organism-specific

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Slide 29

Infections of the Female


Reproductive Tract
Pelvic inflammatory disease (PID)
Etiology/pathophysiology
Any acute, subacute, recurrent, or chronic infection of
the cervix, uterus, fallopian tubes, and ovaries that has
extended to the connective tissues
Most common causative organisms

Gonorrhea; streptococcus; staphylococcus; Chlamydia;


tubercle bacilli

High risk: Surgical and examination procedures; sexual


intercourse (especially with multiple partners);
pregnancy

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Slide 30

Infections of the Female


Reproductive Tract
Pelvic inflammatory disease (PID) (continued)
Clinical manifestations/assessment

Fever and chills


Severe abdominal pain
Malaise
Nausea and vomiting
Malodorous purulent vaginal exudate

Medical management/nursing interventions


Antibiotics; analgesics
Bed rest

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Slide 31

Infections of the Female


Reproductive Tract
Toxic shock syndrome
Etiology/pathophysiology
Acute bacterial infection caused by Staphylococcus
aureus
Usually occurs in women who are menstruating and
using tampons

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Slide 32

Infections of the Female


Reproductive Tract
Toxic shock syndrome (continued)
Clinical manifestations/assessment
Usually occurs between days 2 and 4 of the menstrual
period
Flu-like symptoms; sore throat; headache
Red macular palmar or diffuse rash
Decreased urinary output; BUN elevated
Pulmonary edema

Medical management/nursing interventions


Antibiotics; IV fluid therapy; oxygen

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Slide 33

Disorders of the Female


Reproductive System
Endometriosis
Etiology/pathophysiology
Endometrial tissue appears outside the uterus
The tissue responds to the normal stimulation of the
ovaries; bleeds each month

Clinical manifestations/assessment
Lower abdominal and pelvic pain
May radiate to lower back, legs, and groin

Medical management/nursing interventions


Antiovulatory medications; pregnancy
Laparoscopy; total hysterectomy

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Slide 34

Figure 12-9

Common sites of endometriosis.


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Slide 35

Disorders of the Female


Reproductive System
Vaginal fistula
Etiology/pathophysiology
Abnormal opening between the vagina and another
organ

Clinical manifestations/assessment
Urine and/or feces being expelled from vagina

Medical management/nursing interventions


Oral or parenteral antibiotics
Diet: high protein; increase vitamin C
Surgery: Repair fistula; urinary or fecal diversion

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Slide 36

Figure 12-10

(From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3 rd ed.]. St. Louis: Mosby.)

Types of fistulas that may develop in the vagina and uterus.


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Slide 37

Disorders of the Female


Reproductive System
Displaced uterus
Etiology/pathophysiology
Congenital
Childbirth
Backward displacement

Retroversion
Retroflexion

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Slide 38

Disorders of the Female


Reproductive System
Displaced uterus (continued)
Clinical manifestations/assessment

Backache
Muscle strain
Leukorrheal discharge
Heaviness in the pelvic area

Medical management/nursing interventions


Pessary
Uterine suspension

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Slide 39

Disorders of the Female


Reproductive System
Uterine prolapse
Etiology/pathophysiology
Prolapse of the uterus through the pelvic floor and
vaginal opening

Clinical manifestations/assessment

Fullness in vaginal area


Backache
Bowel or bladder problems
Protrusion of cervix and vaginal walls in perineal area

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Slide 40

Figure 12-11

(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosbys guide to physical
examination. [5th ed.]. St. Louis: Mosby.)

Uterine prolapse.
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Slide 41

Disorders of the Female


Reproductive System
Uterine prolapse (continued)
Medical management/nursing interventions
Pessary
Surgery

Vaginal hysterectomy
Anteroposterior colporrhaphy

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Slide 42

Disorders of the Female


Reproductive System
Cystocele and rectocele
Etiology/pathophysiology
Cystocele

Displacement of the bladder into the vagina

Rectocele

Rectum moves toward posterior vaginal wall

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Slide 43

Figure 12-12

(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)

A, Cystocele. B, Rectocele.
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Slide 44

Disorders of the Female


Reproductive System
Cystocele and rectocele (continued)
Clinical manifestations/assessment
Cystocele

Urinary urgency, frequency, and incontinence; pelvic


pressure

Rectocele

Constipation; rectal pressure; hemorrhoids

Medical management/nursing interventions


Surgical repair

Anteroposterior colporrhaphy; bladder suspension

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Slide 45

Disorders of the Female


Reproductive System
Leiomyomas of the uterus (fibroids, myomas)
Etiology/pathophysiology
Arise from the muscle tissue of the uterus
Stimulated by ovarian hormones

Clinical manifestations/assessment
Pelvic pressure; pain; backache
Dysmenorrhea; menorrhagia
Constipation; urinary symptoms

Medical management/nursing interventions


Surgery: Myomectomy; hysterectomy

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Slide 46

Figure 12-13

(Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novaks gynecologic and obstetric
pathology. [6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002].
Pathophysiology: the biologic basis for disease in adults and children. [4th ed.]. St. Louis: Mosby.)

Leiomyomas.
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Slide 47

Disorders of the Female


Reproductive System
Ovarian cysts
Etiology/pathophysiology
Benign tumors that arise from dermoid cells of the ovary

Clinical manifestations/assessment

May be no symptoms
Palpable on examination
Disturbance of menstruation
Pelvic heaviness; pain

Medical management/nursing interventions


Ovarian cystectomy

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Slide 48

Cancer of the Female


Reproductive Tract
Cancer of the cervix
Etiology/pathophysiology
Squamous cell carcinoma
Carcinoma in situ
If untreated, invades the vagina, pelvic wall, bladder,
rectum, and regional lymph nodes
High risk

Sexually active during teens


Multiple sexual partners
Multiple births
Chronic cervical infections

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Slide 49

Cancer of the Female


Reproductive Tract
Cancer of the cervix (continued)
Clinical manifestations/assessment

Few symptoms in early stages


Leukorrhea
Irregular vaginal bleeding; spotting
Advanced

Pain in the back, upper thighs, and legs

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Slide 50

Cancer of the Female


Reproductive Tract
Cancer of the cervix (continued)
Medical management/nursing interventions
Carcinoma in situ

Removal of the affected area

Early carcinoma

Hysterectomy
Intracavitary radiation

Advanced carcinoma

Radical hysterectomy with pelvic lymph node dissection

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Slide 51

Cancer of the Female


Reproductive Tract
Cancer of the endometrium
Etiology/pathophysiology
Adenocarcinoma of the uterus

Clinical manifestations/assessment
Postmenopausal bleeding (50% will have cancer)
Abdominal pressure; pelvic fullness

Medical management/nursing interventions


Surgery: total abdominal hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO)
Radiation; chemotherapy

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Slide 52

Cancer of the Female


Reproductive Tract
Cancer of the ovary
Etiology/pathophysiology
Fourth most common cause of cancer death in women
High risk: infertile; anovulatory; nulliparous; habitual
aborters; high-fat diet; exposure to industrial chemicals

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Slide 53

Cancer of the Female


Reproductive Tract
Cancer of the ovary (continued)
Clinical manifestations/assessment
Early

Vague abdominal discomfort


Flatulence; mild gastric disturbance

Advanced

Enlarged abdominal girth


Flatulence; constipation
Urinary frequency
Nausea and vomiting
Weight loss

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Slide 54

Cancer of the Female


Reproductive Tract
Cancer of the ovary (continued)
Medical management/nursing interventions
Surgery

TAH-BSO and omentectomy

Radiation and/or chemotherapy

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Slide 55

Hysterectomy
Total hysterectomy
Removal of the uterus including the cervix

TAH-BSO
Removal of the uterus, fallopian tubes, and ovaries

Radical hysterectomy
TAH-BSO with removal of the pelvic lymph nodes

Vaginal hysterectomy
The uterus is removed through the vagina

Abdominal hysterectomy
Abdominal incision is made to perform procedure

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Slide 56

Disorders of the Female Breast


Fibrocystic breast condition
Etiology/pathophysiology
Hyperplasia and cystic formation in mammary ducts

Clinical manifestations/assessment
Cysts are soft, well-differentiated, tender, and freely
moveable; often bilateral and multiple

Medical management/nursing interventions


Eliminate methylxanthines
Danazol (danocrine); vitamin E

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Slide 57

Disorders of the Female Breast


Acute mastitis
Etiology/pathophysiology
Acute bacterial infection of the breast

Clinical manifestations/assessment
Breasts are tender, inflamed, and engorged

Medical management/nursing interventions

Keep breasts clean


Application of warm packs
Support: Well-fitting bra
Systemic antibiotics

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Slide 58

Disorders of the Female Breast


Chronic mastitis
Etiology/pathophysiology
Fibrosis and cysts in the breast

Clinical manifestations/assessment
Tender, painful, and palpable cysts
Usually unilateral

Medical management/nursing interventions


Same as for acute mastitis

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Slide 59

Disorders of the Female Breast


Breast cancer
Etiology/pathophysiology
Unknown cause; usually adenocarcinoma

Clinical manifestations/assessment
Small, solitary, irregular-shaped, firm, non-tender, and
non-mobile tumor
Change in skin color
Puckering or dimpling of tissue
Nipple discharge; retraction of nipple
Axillary tenderness

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Slide 60

Disorders of the Female Breast


Breast cancer (continued)
Medical management/nursing interventions
Depends on the stage

Radiation
Chemotherapy
Surgery
o Lumpectomy
o Mastectomysimple, radical

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Slide 61

Inflammatory Disorders of the Male


Reproductive System
Prostatitis
Etiology/pathophysiology
Acute or chronic infection of the prostate gland

Clinical manifestations/assessment

Chills and fever


Dysuria; urgency and frequency of urination
Cloudy urine
Perineal fullness; lower back pain
Arthralgia; myalgia
Tenderness, edema, and firmness of the prostate

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Slide 62

Inflammatory Disorders of the Male


Reproductive System
Prostatitis (continued)
Medical management/nursing interventions

Antibiotics
Digital massage of the prostate
Sitz baths
Monitor I&O

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Slide 63

Inflammatory Disorders of the


Male Reproductive System
Epididymitis
Etiology/pathophysiology
Infection of the epididymis

Clinical manifestations/assessment
Scrotal pain and edema
Pyuria; chills and fever

Medical management/nursing interventions


Bed rest
Elevate scrotum; cold compresses
Antibiotics

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Slide 64

Disorders of Male Genital Organs


Phimosis
Etiology/pathophysiology
Prepuce is too small to allow retraction of the foreskin
over the glans
Usually congenital; may be due to inflammation or
disease

Clinical manifestations/assessment
Infection of foreskin and glans penis
Occasionally causes obstruction of urine flow

Medical management/nursing interventions


Circumcision

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Slide 65

Disorders of the Male Genital


Organs
Paraphimosis
Etiology and pathophysiology
An edematous condition of the retracted uncircumcised
foreskin preventing a normal return over the glans

Medical management/nursing interventions


Warm compresses
Circumcision

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Slide 66

Disorders of Male Genital Organs


Hydrocele
Etiology/pathophysiology
Accumulation of fluid between the membranes of the
testes

Clinical manifestations/assessment
Enlargement of the scrotum; pain

Medical management/nursing interventions


Aspiration of fluid
Surgical removal of testicular sac
Bed rest; elevate scrotum; cold compresses

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Slide 67

Disorders of Male Genital Organs


Varicocele
Etiology/pathophysiology
Dilation of scrotal veins causing obstruction and
malfunction of circulation

Clinical manifestations/assessment
Engorgement and elongation of the scrotum
Pulling sensation in scrotum; dull, aching pain

Medical management/nursing interventions


Surgery: Removal of obstruction
Bed rest
Elevate scrotum; cold compresses

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Slide 68

Cancer of the Male Reproductive


Tract
Cancer of the testis
Etiology/pathophysiology
Cause unknown

Clinical manifestations/assessment
Enlarged scrotum; feeling of heaviness
Firm, painless, smooth mass

Medical management/nursing interventions


Radical inguinal orchiectomy
Radiation and/or chemotherapy
Teach testicular self-examination

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Slide 69

Cancer of the Male Reproductive


Tract
Cancer of the penis
Etiology/pathophysiology
Very rare

Clinical manifestations/assessment
Painless, wart-like growth or ulceration, usually on the
glans penis

Medical management/nursing interventions


Surgery

Removal of tissue
Partial or total amputation of the penis
Metastasis: Radical surgical procedures

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Slide 70

Sexually Transmitted Diseases


Genital herpes (HSV)
Etiology/pathophysiology
Infectious viral disease; usually acquired sexually

Clinical manifestations/assessment

Fluid-filled vesicles
Eventually rupture and develop shallow, painful ulcers
Fever; malaise
Dysuria
Leukorrhea (female)

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Slide 71

Figure 12-19

(From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)

Herpes simplex virus type II in a male and female patient.


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Slide 72

Sexually Transmitted Diseases


Genital herpes (HSV) (continued)
Medical management/nursing interventions

No cure; treat symptoms


Acyclovir (Zovirax)
Sitz baths
Local anesthetic; analgesics
Keep lesions clean and dry
GOOD handwashing
No sexual contact while lesions are present
Encourage use of condoms

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Slide 73

Sexually Transmitted Diseases


Syphilis
Etiology/pathophysiology
Treponema pallidum organism
Transmission occurs primarily with sexual contact

Clinical manifestations/assessment
Incubation period

No symptoms

Primary stage

Chancre; headaches; enlarged lymph nodes

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Slide 74

Sexually Transmitted Diseases


Syphilis (continued)
Clinical manifestations/assessment
Secondary stage

Rash on palms of hands and soles of feet


Generalized enlargement of lymph nodes

Latent stage

No symptoms

Tertiary or late stage

Lesions may affect many different systems; may be fatal

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Slide 75

Sexually Transmitted Diseases


Syphilis (continued)
Medical management/nursing interventions
Pharmacological management

Penicillin
Tetracycline or erythromycin, if allergic to penicillin

May be treated in any stage; damage from previous


stages will not be reversed
Treat all sexual contacts

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Slide 76

Sexually Transmitted Diseases


Gonorrhea
Etiology/pathophysiology
N. gonorrhoeae
Transmitted by sexual contact

Clinical manifestations/assessment
Vaginal (female)

Urinary frequency and pain


Yellowish discharge
Nausea and vomiting

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Slide 77

Sexually Transmitted Diseases


Gonorrhea (continued)
Clinical manifestations/assessment (continued)
Urethra (male)

Urethral discomfort; dysuria


Yellowish discharge containing pus
Red and swollen meatus

Rectal (male and female)

Perineal discomfort; purulent rectal discharge

Pharyngitis (male and female)

Sore throat and swallowing discomfort


Edema of the throat

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Slide 78

Sexually Transmitted Diseases


Gonorrhea (continued)
Medical management/nursing interventions
Pharmacological management

Penicillin
Rocephin
Doxycycline or tetracycline

Patient education
TREAT ALL SEXUAL CONTACTS

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Slide 79

Sexually Transmitted Diseases


Trichomoniasis
Etiology/pathophysiology
T. vaginalis protozoan
Usually sexually transmitted

Clinical manifestations/assessment
Most are asymptomatic
Male: Urethritis, dysuria, urinary frequency, pruritus, and
purulent exudate

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Slide 80

Sexually Transmitted Diseases


Trichomoniasis (continued)
Clinical manifestations/assessment (continued)
Female

Frothy, gray, green, or yellow malodorous discharge


Pruritus
Edema
Tenderness of vagina
Dysuria and urinary frequency
Spotting; menorrhagia; dysmenorrhea

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Slide 81

Sexually Transmitted Diseases


Trichomoniasis (continued)
Medical management/nursing interventions
Pharmacological management

Metronidazole (Flagyl)

Patient education
TREAT ALL SEXUAL CONTACTS

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Slide 82

Sexually Transmitted Diseases


Candidiasis
Etiology/pathophysiology
C. albicans and C. tropicalis

Clinical manifestations/assessment
Mouth: Edema; white patches
Nails: Edematous, darkened, erythematous nail base;
purulent exudate
Vaginal: Cheesy, tenacious white discharge; pruritus;
inflammation of the vagina
Penis: Purulent exudate
Systemic: Chills; fever; general malaise

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Slide 83

Sexually Transmitted Diseases


Candidiasis (continued)
Medical management/nursing interventions
Pharmacological management

Nystatin (Mycostatin)
Topical amphotericin B

Treat underlying condition

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Slide 84

Sexually Transmitted Diseases


Chlamydia
Etiology/pathophysiology
Chlamydia trachomatis

Clinical manifestations/assessment
Usually asymptomatic
Male

Scanty white or clear exudate


Burning or pruritus
Urinary frequency; mild dysuria

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Slide 85

Sexually Transmitted Diseases


Chlamydia (continued)
Clinical manifestations/assessment
Female

Vaginal pruritus or burning


Dull pelvic pain
Low-grade fever
Vaginal discharge; irregular bleeding

Medical management/nursing interventions


Pharmacological management

Tetracycline; doxycycline; Zithromax

TREAT ALL SEXUAL CONTACTS

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Slide 86

Nursing Process
Nursing diagnoses
Anxiety
Body image, disturbed
Coping, ineffective
Fear
Fluid volume, deficient
Health maintenance,
ineffective
Infection, risk for

Knowledge, deficient
Pain, acute and
chronic
Self-esteem,
situational low
Sexual dysfunction
Skin integrity, impaired
Tissue perfusion,
ineffective
Urinary elimination,
impaired

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Slide 87

Sex Hormones

Production influenced by the anterior pituitary


Male: testosterone; androgens
Female: estrogen; progesterone

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88

Androgens
Actions

Development of secondary sex characteristics; tissue


building

Uses

Hypogonadism, hypopituitarism, dwarfism, eunuchism,


cryptorchidism, oligospermia, and male androgen
deficiency

Adverse Reactions

Edema due to sodium retention, acne, hirsutism, male


pattern baldness, cholestatic hepatitis with jaundice,
buccal irritation, nausea and vomiting, diarrhea
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Androgens (cont.)
Drug Interactions

Increased effects anticoagulants, antidiabetic agents,


and other drugs
Decreased effects barbiturates
Concurrent use with corticosteroids increase edema

Nursing Implications

Assessment, diagnosis, planning, implementation, and


evaluation

Drug Table 21-9

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Androgens (cont.)
Patient and Family Teaching
Administration
Response time
Diet
Symptoms to report
Administration considerations

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Female Sex Hormones

Estrogens
Progestins
Table 21-10

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Estrogens
Action and Uses

Used for hormone replacement therapy in menopause


and other conditions (ovarian failure); infertility workups; palliative breast cancer treatment

Adverse Reactions
Drug Interactions

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Progestins
Action
Uses

Contraception, control excessive uterine bleeding,


treatment of secondary amenorrhea, dysmenorrhea,
premenstrual tension, and control of pain in
endometriosis

Drug Interactions
Nursing Implications and Patient Teaching

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Oral Contraceptives
Combination Drugs: Estrogen and Progestin

Table 21-11

Action

Prevent ovulation

Use

Contraception

Adverse Reactions

Estrogen excess, progestin excess, androgen excess,


estrogen deficiency, progestin deficiency

Contraindications for Oral Contraceptives


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