A S U H A N K E P E R A W AT A N

LANSIA DENGAN REPRODUKSI

OLEH:
T I M K E P E R A W ATA N K E L U A R G A , K O M U N I TA S , D A N G E R O N T I K
F A K U LTA S K E P E R A W ATA N
U N I V E R S I TA S J E M B E R
POKOK BAHASAN
• Review sistem resproduksi
• Perubahan reproduksi pada Lansia
• Pengkajian keperawatan reproduksi lansia
• Perumusan diagnosis keperawatan pada masalah
reproduksi lansia
• Penyusunan rencana keperawatan pada masalah
reproduksi lansia
• Implementasi keperawatan pada masalah reproduksi lansia
• Evaluasi keperawatan pada masalah reproduksi lansia
REPRODUCTIVE SYSTEM CHANGES
• Decrease of estrogen / progesterone in female
– Thinning of vaginal wall
– Decrease vaginal secretions
– Inflammation of vagina common
• Weakness in supporting tissue:
– Uterus sags downward
(Uterine prolapse)
– Breasts sag when fat redistributed
• Decrease in Testosterone
– Slow production of sperm
– Response to sexual stimuli slower
– Testes smaller less firm
• Male and Female
– Sexual desire may or may not decrease
• Advantages of sex in elderly
– Improves muscle tone & circulation
– Pain from arthritis seems to decrease
 MALE REPRODUCTIVE
SYSTEM
• Notable changes due to aging
– Decrease in testosterone level
– Decrease in sperm production
– Decrease in muscle tone of scrotum
– Decrease in size and firmness of testicles
– Enlargement of prostate gland
BENIGN PROSTATIC
HYPERTROPHY
• Pronounced
– (bee-NYEN pross-TAT-ik high-PER-troh-fee)
• Defined
– Benign enlargement of prostate gland, creating pressure
on upper part of the urethra or neck of bladder,
causing obstruction to flow of urine
• Common condition occurring in men over 50
CARCINOMA OF THE
PROSTATE
• Pronounced
– (car-sin-OH-mah of the PROSS-tayt)
• Defined
– Malignant growth within prostate gland, creating
pressure on upper part of urethra
• Most common cause of cancer among men, and
most common cause of cancer death due to cancer
in men over age 55
FEMALE REPRODUCTIVE
SYSTEM
• Notable changes due to aging
– Physical changes occur after menopause
– Ovaries cease to produce ova
– Less estrogen hormone secreted
– General atrophy of genitalia
• Includes less fat, external hair loss, flattening of
the labia
– Vaginal dryness
– Breast sagging due to changes
ATROPHIC VAGINITIS
• Pronounced
– (ay-TROH-fik vaj-in-EYE-tis)
• Defined
– Degeneration of vaginal mucous membrane after
menopause
– Also known as senile vaginitis
• Common in estrogen-deprived older women
OVARIAN CARCINOMA
• Pronounced
– (oh-VAY-ree-an car-sin-OH-mah)
• Defined
– Malignant tumor of ovaries, most commonly occurring
in women in their 50s
• Rarely detected in early stage
DIAGNOSTIC TECHNIQUES,
TREATMENTS, AND PROCEDURES
• Suprapubic prostatectomy
– Surgical removal of prostate gland by making an incision
into abdominal wall, just above pubis
DIAGNOSTIC TECHNIQUES,
TREATMENTS, AND PROCEDURES
• Transurethral resection of the prostate (TURP)
– Surgical removal of prostate gland by inserting a
resectoscope through urethra and into bladder to
remove small pieces of tissue from the prostate gland
DAYA SEKSUAL
• Tidak ada batasan umur,
• Masih tetap membutuhkan,
• frekuensi berhubungan cenderung semakin menurun
secara bertahap setiap tahun tetapi kapasitas untuk
melakukan dan menikmati jalan terus sampai tua
KLIMAKTERIUM

• Perubahan keseimbangan hormonal yang

menyebabkan berkurangnya libido seksual
• Insomnia, konsentrasi turun, berdebar2,
• Iritabel, cemas, depresi, sakit kepala.
• Disparenia, mamae mengecil, elastisitas vagina
menurun, osteoporosis.
• Ok perasaan kehilangan daya tarik
MENOPAUSE & ANDROPAUSE

• Berhentinya haid ok aktivitas Ovarium yang menurun disertai gejala

yang sangat hingga 2 thn. Pada pria relatif tanpa gejala.
• Pada pria ok menurunnya kadar hormon testosteron
• Gejala premenopause mirip dengan keganasan.
GEJALA MENOPAUSE
Gangguan haid
Hot flush, panas pd muka, leher, dada atas,
Keringat banyak
Psikologik : takut, tegang, depresi, mudah marah, sedih, tersinggung,
gugup, mental kurang mantap
Fatiq, rasa lelah,
Atropi ok kemunduran gizi
• Gatal pada genetalia, ok kering dan keriput
• Sakit-sakit seluruh tubuh
• Pusing dan sakit kepala
• Insomnia, palpitasi
• Perubahan gairah seksual, libido
• Perasaan takut tdk berguna sbg wanita
• Kecemasan perannya sbg istri akan digantikan orang lain.
 REPRODUCTIVE CARE
• Understand physical and psychological sexual needs of the elderly
– Allow married couples to be in the same room
– Give privacy to consenting elderly
SIX NURSING CARE PLANS
(NCP) FOR MENOPAUSE:
• Disturbed Sleep Pattern
• Sexual Dysfunction
• Risk for Injury
• Stress Urinary Incontinence
• Risk for Infection
• Situational Low Self-Esteem

• https://nurseslabs.com/menopause-nursing-care-plans/2/
DISTURBED SLEEP PATTERN
TIME-LIMITED DISRUPTION OF SLEEP (NATURAL
PERIODIC SUSPENSION OF CONSCIOUSNESS)
MAY BE RELATED POSSIBLY
TO EVIDENCED BY
• symptoms of menopause • hot flashes
• insomnia • interrupted sleep
• psychological stress • insomnia
• stress • nervousness
• headache • anxiety
• depression
• emotional mood swings
• decreased REM sleep
DESIRED OUTCOMES
• Patient will be able to sleep without interruption and will
express feelings of being rested.
• Patient will be able to perform techniques to promote
sleep.
• Patient will identify factors that prevent restful sleep or
disrupt sleep.
• Patient will be able to achieve and maintain an adequate
amount of sleep to facilitate maximal functioning.
• Patient will be able to establish a sound sleep pattern.
NURSING INTERVENTION
Nursing Interventions Rationale

Assess patient’s sleep pattern and changes, naps, amount of

Provides information to alleviate sleep deprivation in relation
activity, awakenings and frequency, and patient’s complaints of
to age-related changes and identify and establish plan of care.
lack of rest.
Identification of causative factors of frequent awakenings helps
Monitor for complaints of pain or discomfort.
facilitate changes in sleep pattern.

Helps to promote conducive atmosphere for restful sleep.

Provide calm, quiet environment, closing curtains, adjusting External stimulus may interfere with going to sleep and
lighting, and so forth. increase awakenings in elderly patient because sleep is usually
of less intensity.

Medications may be required to achieve rest during

Administer medications to promote normal sleep patterns as
hospitalization. Hypnoticsinduce sleep, while tranquilizers
ordered.
reduce anxiety.

Instruct the patient to practice slow deep breathing whenever Relaxation and deep breathing may help alleviate the
a hot flash starts; instruct also on other relaxation techniques. discomfort caused by a hot flash.

Provide warm drinks, extra cover, warm bath prior to bedtime Ritualistic procedures may prevent breaks in established
and so forth. routines and promote comfort and relaxation prior to sleep.

Instruct patient to avoid stimulants like caffeinated drinks,

Overstimulation prevents patient from falling asleep.
stressful activity, and so forth prior to sleep.
Help patient in relaxation techniques, guided
Relaxation techniques frequently help promote sleep.
imagery, muscle relaxation, meditation, and so forth.
Although alcohol may cause sleepiness, it interrupts sleep later
Instruct patient to avoid alcohol prior to bedtime.
in the night.
SEXUAL DYSFUNCTION:
THE STATE IN WHICH AN INDIVIDUAL EXPERIENCES, OR IS AT
RISK OF EXPERIENCING, A CHANGE IN SEXUAL FUNCTION
THAT IS VIEWED AS UNREWARDING OR INADEQUATE.
POSSIBLY EVIDENCED
MAY BE RELATED TO BY
• changes in body structure and • thin, dry vaginal mucosa
function from • dyspareunia
decreased estrogen secretion • slight bleeding during intercourse
• verbalization of problems with
sexual function
DESIRED OUTCOMES
• avoidance of engaging in sexual
• Patient will have a satisfying intercourse
sexual function. • need for confirmation of desirability
• decreased vaginal lubrication
 NURSING INTERVENTION
Nursing Interventions Rationale
Changes related to aging, such as slower arousal time, reduced
lubrication of the vagina, and atrophy of the vaginal lining, results in
Assess presence of impotence, dyspareunia, feelings of
painful intercourse, may be responsible for sexual problems. Chronic
inadequacy, or fear of sexual function and failure.
illness compromise sexual functioning due to fear of recurrence of
symptoms.
Assess patient’s sexual interest, desire, affect of health status
Several factors including chronic illness, drugs, lack of or an impaired
on sexuality, and psychosocial factors affecting sexual
relationship with partner, cultural belief can affect sexual function.
function.
May be embarrassed to have partner present or even approach the
Include partner in discuss if appropriate. subject. Patient may be more comfortable and open discussing the
subject alone.
Discuss past sexual experiences and practices, interests, and
satisfaction, and medications taken for control of chronic Provides individual needs regarding sexual behavior based on history.
diseases that affect sexual function.
This helps in preserving vaginal elasticity. Water-based lubricants can
If patient is sexually active, tell her to remain sexually active.
be used during sexual interocurse to decrease dryness.
Performing Kegel exercises can help strengthen the vaginal and pelvic
Instruct patient to perform Kegel exercises daily.
muscles.
Discuss importance of maintaining sexual functioning by
Maintains interest and sexual function.
intercourse or masturbation.
Pain and dyspnea may be exacerbated during exertion and a more
Encourage to vary positions during intercourse.
passive position may promote participation in safe sexual activity.
Provide privacy. Elderly may lack the privacy needed.
Use exercise and pain tolerance in changes in VS caused by
Provide baseline to promote sexual activity without symptoms that
activity as guidelines for progressive sexual activity plan
create fear or interfere with sexual activity.
based on physical limits.
Anxiety and reduced self-esteem resulting from altered sexuality are
Suggest sexual or psychological therapy, if appropriate.
common problems that can be helped by counseling.
Clears meatus of infectious organisms that may
Instruct to void before and after intercourse.
ANDROPAUSE
• Male menopause” is the more common term for andropause.
It describes age-related changes in male hormone levels. The
same group of symptoms is also known as testosterone
deficiency, androgen deficiency, and late-onset hypogonadism.
• Male menopause involves a drop in testosterone production
in men who are age 50 or older. It’s often affiliated with
hypogonadism. Both conditions involve lowered testosterone
levels and similar symptoms.
• Male menopause differs from female menopause in several
ways. For one thing, not all men experience it. For another, it
doesn’t involve a complete shutdown of your reproductive
organs. However, sexual complications may arise as a result
of your lowered hormone levels.
MALE ANROPOUSE SYMPTOMS SELF QUESTIONNAIRE (MASSQ)
SYMPTOMS OF MALE MENOPAUSE
• Male menopause can cause physical, sexual, and psychological problems.
They typically worsen as you get older. They can include:
• low energy
• depression or sadness
• decreased motivation
• lowered self-confidence
• difficulty concentrating
• insomnia or difficulty sleeping
• increased body fat
• reduced muscle mass and feelings of physical weakness
• gynecomastia, or development of breasts
• decreased bone density
• erectile dysfunction
• reduced libido
• infertility
PREVENTION ANDROPAUSE

• eat a healthy diet

• get regular exercise
• get enough sleep
• reduce your stress