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Female Reproductive System: * Normal menstruation
* Common abnormalities in female reproductive system
* Menopause
* Cervical cancer
* Breast cancer and self breast exam
Menarche: * First menstrual period
* Average age of onset 12 to 13 years old
* Can range from 9-17 years old and still be within normal limits
* Often anovulatory
Menstruation (continued): * Bleeding occurs in response to hormonal changes
* Average interval between cycles is 28 days (can range from 23-35 days)
* Average duration of flow is 2-7 days
* Average blood loss is 30-80cc
* Requires intact hypothalamus, pituitary gland, ovaries, and uterus
Menstrual Disorders: * Dysmenorrhea: painful menstruation
Can be primary or secondary
Dysmenorrhea: * Primary: no associated pathology, but can be associated with abnormally high levels of prostaglandins, poor hygiene, anxiety related to menstruation
* Secondary: pelvic disease present.
Common causes:
endometriosis, cervical os stenosis, fibroids, cancer
Amenorrhea * What is the most common cause????: Pregnancy
Breastfeeding
Menopause
Other causes of amenorrhea?: anxiety
fatigue
chronic illness
extreme dieting
strenuous exercise
Menorrhagia: abnormally heavy menstrual flow, greater than 80cc per menses
Metorrhagia: bleeding between menstrual periods
Leukorrhea: any vaginal discharge than blood- often a symptom of vaginal or cervical infection
Endometriosis Defined as: abnormal growth of extra uterine endometrial cells, often in cul-de-sac of peritoneal cavity, the uterine ligaments, and the ovaries
* Cause unknown
* Occurs in 30Â’s & 40Â’s, rarely before 20
There are three theories proposed to explain the cause endometriosis: Implantation theory
Vascular, lymphatic theory
Formation theory
Implantation theory: Results from excessive endometrial production and reflux of blood and tissue through the fallopian tubes during menstrual flow
Vascular, lymphatic theory: Endometrial glands are transported through vascular & lymphatic systems to other areas
Formation theory: Endometrial tissue forms spontaneously outside the uterus
Endometriosis: * Causes intense pain
* Can lead to infertility
* Can lead to painful intercourse
* Treatment can be medical or surgical
Medical management: mild analgesics, NSAIDS, OCs
Comfort measures: heating pads, relaxation, biofeedback
Premenstrual Syndrome: * Symptoms occur during the LUTEAL phase of menstrual cycle
* Affects women of all races, socioeconomic levels, and all educational levels
* Most common in 30-40 year olds
* Severity increases with age until menopause
* Risk factors: after pregnancy, childbirth, and tubal ligation; perimenopausal years, and during major life stresses
PMS symptoms occur during the _____: LUTEAL
PMS most common in what age group?: 30-40
PMS risk factors: after pregnancy
childbirth
tubal ligation
perimenopausal years
during major life stresses
PMS emotional symptoms: irritability
easily induced crying spells
low self esteem
anxiety
depression
PMS physical symptoms: breast tenderness
bloating
fluid retention
increased appetite and food cravings
insomnia
fatigue
hot flashes
headaches
musculoskeletal discomfort
PMS cognitive symptoms: short term memory problems
difficulty concentrating
unclear thinking
PMS treatment - Diet & nutritional therapy: * Eat small meals throughout the day
* Limit sugar, red meat, EtOH, coffee, tea & chocolate
* Eliminating caffeine can help w/irritability
* limit sodium intake if edema is a problem
* Ca, MG, Vits A, B6, & C can be helpful
PMS treatment - Medications (most are controversial): * mild K+ sparing diuretics
* Progesterone
* Parlodel
* OCs
* Gonadotropin-releasing hormone agonists
* Antidepressants
* Prostaglandin inhibitors (NSAIDS)
Menopause
* Refers to the end of menstrual periods - the actual date cannot be determined until one year passes without menses
* FSH and LH levels increase
* Decreased estrogen levels affect the reproductive system, CV system, and bone density
* Ave age of onset 50-52
* Preceded by Â“perimenopauseÂ”
Average age of onset of menopause?: 50-52
Effects of Menopause: * Reproductive system: uterus, cervix, ovaries, labia, and clitoris shrink in size; vaginal mucosa becomes thin and dry; pelvic floor relaxes
* Bone density decreases, leading to osteoporosis
* During perimenopausal phase: hot flashes, emotional changes, and fatigue
Cervical Cancer: * Pap smears have decreased the death rate from cervical CA, because of the ability to detect pre-malignant changes
* Risk factors: low socioeconomic status, early age of 1st intercourse or 1st pregnancy, multiple sex partners, intrauterine exposure to DES, cigarette smoking, exposure to HSV/ cytomegalovirus, and HPV
Pap smears test for?: Cervical cancer
Cervical CA Classic symptom: painless vaginal bleeding (starts as spotting between menstrual periods or after sexÂ– as malignancy grows, the bleeding increases in frequency, duration, and amount)
Other sx of cervical cancer: * leg pain/unilateral swelling of the leg
* wt loss/pelvic pain
* dysuria/hematuria, rectal bleeding
Cervical CA - Nonsurgical: * Laser therapy
* cryosurgery
* radiation therapy
* chemotherapy
Cervical cancer - Sugical: * Conization
* hysterectomy
* pelvic exenteration
Is ovarian cancer often bilateral?: yes
Ovarian Cancer: * Leading cause of death from female reproductive malignancies
* Poor early stage detection rates= low survival rates
* Tumors grow and spread rapidly and are often bilateral
Ovarian cancer - Risk Factors: * Family history of ovarian cancer
* History of breast, bowel, or endometrial cancer
* Nulliparity
* Infertility
Ovarian cancer risk factors -: * History of dysmenorrhea or heavy bleeding
* Diets high in animal fat
* Age older than 40- peaks at age 50-55
Ovarain Cancer Assessment - Sx to look for: * abdominal pain or swelling
* dyspepsia
* indigestion
* gas
* Hx of: ovarian imbalance AEB premenstrual tension, heavy menstrual flow, or dysfunctional bleeding
The only sign of ovarian cancer may be an abdominal mass- may not be identifiable until size reaches _____ inches: 6
Ovarian Cancer Assessment: * Pap only abnormal in 20-30%
* CA-125 may be elevated (not diagnostic- used to eval progress)
* USG and CT can be diagnostic tools
* Exploratory laparotomy used to dx and stage tumors
Ovarian cancer Treatment: * Similar to cervical cancer
* Tx depends on stage of cancer
* Chemotherapy
* Radiation
* Surgery
Breast Cancer: * Early detection is paramount to successful treatment
* If cancer is localized without metastasis, clinical cure rate 75-90%
* When axillary lymph nodes are involved, 5year survival rate 40-50% & 10year rate only 25%
* 2nd leading cause of cancer deaths in women
* Leading cause of cancer deaths in women 35-54 yrs of age
Breast cancer types: * Multiple pathologic types
* Most common: infiltrating ductal carcinoma
* Noninvasive
* invasive
Early detection methods - breast cancer: * Self breast exam needs to be done monthly in women over 20
* Mammography- begin age 40, then annually
* Yearly clinical breast exam- assess for symmetry and size, contour, skin changes (color, texture, venous patterns), nipple changes, and lesions; also assess axillary lymph nodes
Breast Cancer Assessment: * Note location of mass (in clock face method), shape, size, consistency, and fixation to surrounding tissues
* Skin changes: peau dÂ’ orange (dimpling or orange peel appearance), increased vascularity, nipple retraction or ulceration
* Psychosocial: fear of cancer; threats to body image, sexuality, intimate relationships, and survival; and decisional conflict about treatment
Breast Cancer Risk Factors: * Female
* Hx of previous breast cancer
* Age > 40
* Early menarche, late menopause or both
* Nulliparity or 1st child after 30
* Family hx
* Diet
* Alcohol
* Obesity
* Ionizing radiation
* Benign breast disease
* OCs
* Exogenous hormones
Breast cancer in men: * 1% of all cases occur in men
* Ave age of onset 60 yrs
* Common sx
- Hard
- nonpainful mass
- nipple discharge
- retraction
- erosion
- ulceration
Breast Cancer Surgical: 1. Lumpectomy: local excision and resection
2. Partial mastectomy: removal of portion of breast that contains the tumor
3. Modified radical mastectomy: entire affected breast is removed (pectoral muscles and nerves left intact)
Breast CA Â– Nursing Dx: * Anxiety
* Anticipatory grieving
* Acute pain
* Disturbed sleep pattern
* Disturbed body image
* Sexual dysfunction
Male Reproductive Disorders: * Benign Prostatic Hypertrophy
* Prostate Cancer
* Erectile Dysfunction
* Testicular Cancer
Benign Prostatic Hypertrophy: * Saw Palmetto
* Occurs in almost all men with aging
* Prostate tissue begins to have abnormal increase in number of cells which leads to enlargement of the gland
* Leads to narrowing of prostatic urethral channel
* Cause is unknown
BPH symptoms: * Urinary frequency
* Nocturia
* Urinary hesitancy
* Hematuria
* Diminished force of urinary stream
* Post-void dribbling
* Bladder distention
* Possible renal insufficiency (edema, pallor, pruritis)
* Uniform, elastic, nontender palpable prostate
BPH Assessment: * Clinical manifestations
* Distended bladder
* Digital rectal exam
BPH Laboratory assessment: * CBC (infection or anemia)
* BUN & serum creatinine (eval renal function)
* Prostate specific antigen (PSA) to rule out malignancy
* Flowmetry- evaluates flow rate and residual urine
What is an important disticntion betwenn BPH and Proatate Cancer when assesseing?: BPH = uniform, elastic, nontender palpaplbe prostate

Prostate cancer = hard, irregular prostate
BPH Interventions Pharmacologic: 1. finasteride (Proscar) shrinks prostate gland and improves urine flow by decreasing the level of dihydrotestosterone (DHT), which is responsible for prostate growth
2. alpha-adrenergic agonists (Cardura & Flomax) cause constriction of prostate gland, which reduces urethral pressure, improves urine flow, and decreases residual mass
BPH Interventions Nonsurgical: * measures that minimize obstructive symptoms, by causing a release of prostatic fluid (prostatic massage, frequent sexual intercourse, and masturbation)
* Avoid large amounts of fluid in a short time
* Avoid alcohol, caffeine, and diuretics
* Void as soon as urge is felt
***Prevent overdistention of bladder, which leads to loss of tone
***Avoid meds that cause urinary retention: anticholinergics, antihistamines, and decongestants
BPH Operative interventions: * Most common is transurethral resection of the prostate (TURP) to relieve obstruction caused by hypertrophy- only removes part of the enlarged prostate
* Prostatectomy
- Suprapubic
- Transvesical
- Retropubic
- Perineal
Prostate Cancer: * Most common cancer among American men; second leading cause of cancer deaths in this population
* Screening is done with digital rectal exam (DRE) and PSA--annually after age 50
* If at risk (prostate CA in 1st degree relative or African American), need screening earlier
* DRE yields hard, irregular prostate
Prostate Cancer
* One of the slowest growing malignancies & metastasizes in a fairly predictable manner
* Most commonly metastasizes to the prostatic & perivesicular lymph nodes, pelvic lymph nodes, bone marrow, & bones of the pelvis, sacrum, & lumbar spine
* Involvement of visceral organs occurs later in progression of disease, usu spreads to the lungs, liver, adrenals, & kidneys
Prostate Cancer Grading of the tumor is done with: Gleason grading system
____ pain is associated with prostete cancer...: bone
Prostate Cancer risk: * Advancing age
* Incidence increases 75% in men > 65 yo
* Heavy metal exposure
* Hx of vasectomy or STD
* Uncertain link between BPH & prostate cancer
* Screening
- Most effective procedures are DRE & PSA
Prostate Cancer - DRE: * a hard, irregular mass is felt & presumed to be malignant
PSA: * Immunogenic glycoprotein secreted by the prostate
* Normal level is 4ng/mL
* Levels can be increased by prostate CA, BPH, prostatic infarction, and prostatitis
* PSA needs to be done in combination with DRE (25% of men with prostate CA have normal PSA)
* Normal PSA level is slightly higher in older adults & in African-American
Other Prostate screening: * Transrectal USG
* If malignancy suspected, need biopsy
* After dx made, need CT & MRI of pelvis & abdomen to assess nodes
* Bone scan can determine metastasis
* Most pts with prostate CA have elevated serum acid phosphatase; and elevated serum alkaline phosphatase if mets to bone
Prostate Cancer Interventions: * Management includes surgery, radiation therapy, & drug therapy
* Surgery is the standard treatment
* Surgical approaches similar to BPH
* Advanced cases require pelvic lymphadenectomy
* Radical Prostatectomy
* Cryosurgical ablation
* Newer, less invasive procedure
* Chemotherapy
* Radiation
* Hormonal therapies
Radical Prostatectomy: * removal of prostate gland, prostatic capsule, the cuff at the bladder neck, seminal vesicles, and regional lymph nodes
* Patient is sterile, but ability to have erection and orgasm shouldnÂ’t be permanently impaired
* May have erectile dysfunction if damage is done to pudendal nerve during surgery
* Urinary incontinence possible complication- need to learn perineal strengthening exercises after surgery and removal of foley
Cryosurgical ablation: * Newer, less invasive procedure
- A transrectal US probe is placed to determine the size of the prostate & the number of cryoprobes to be placed around the prostate gland
- Liquid nitrogen freezes the gland & the dead cells are absorbed by the body
* Advantages
- Minimal blood loss
- Minimal postoperative pain
- Dec risk of incontinence after surgery
Â– A shorter hospital stay
Â– Procedure can be repeated as needed
Prostate Cancer Nonsurgical: * Chemotherapy
* Radiation
* Hormonal therapies- can be accomplished by bilateral testicle removal, administering estrogens, gonadotropin-releasing hormone agonist, or Depo-Provera
* Estrogens, & GnRH agonists, & Depo inhibit the release of LH from the pituitary
Erectile Dysfunction: * Inability to maintain an erection for sexual intercourse
* Can be organic or functional
Organic ED: * Gradual deterioration of function- first diminishing firmness, then decrease in frequency of erections
* Multiple causes: inflammation of prostate, urethra, or seminal vesicles; prostate surgeries; pelvic fx; HTN; neurologic disorders; DM; thyroid dysfunction; priapism; smoking; ETOH; certain medications; poor overall health
Functional ED: * Psychologic cause
* Have normal nocturnal and morning erections
* Usually precipitated by stress
Assessment
* Medical, social, sexual history are needed
* Complete PE, lab tests
* Need to determine if ED is organic or functional in nature
* If ED is functional the pt is referred to a certified sexual therapist
men taking _____ cannot take Viagra because of vasodilatation effects: nitrates
Testicular Cancer: * Most common malignancy in men ages 15-35; peak incidence between 18-40 yo
* Risk is increased in men with undescended testes; having a brother or close male relative with testicular CA; hx of testicular trauma or infection
* Occurs more often in caucasians, rarely African-Americans
* Testicular CA rarely bilateral- if it is, usually metastatic
* Early detection aided by self exam
Is testicular cancer usually bilateral?: rarely, if it is usually metastatic
Testicular Cancer Assessment: * Testes, lymph nodes, and abdomen are thoroughly examined
* Palpate for lumps or swelling
* Psychosocial assessment is done to determine pts feelings about disease/outcomes
Testicular cancer Diagnostic Assessment: * Primary tumor markers are alpha-fetoprotein and hCG
* Also used to evaluate responses to therapy
* Continued elevated levels after orchiectomy is evidence of metastatic disease
* Reappearance of elevated levels shows recurrence
* Benign testicular tumors NEVER cause an increase in these markers
Primary tumor markers of testicular cancer are: * alpha-fetoprotein
* hCG
Diagnostic Assessment Testicular Cancer: After dx a pt should have:
Â– CT scan of the abdomen & chest
Â– MRI
Â– CXR & bones scans if metastasis is suspected
Hydrocele: * A cystic mass that forms around the testis
* Disorder in the lymphatic draining of the scrotum
* No treatment is needed unless swelling becomes severe
* Treatment
Â– Aspiration or removal
Spermatocele: * Sperm-containing cystic mass that develops on the epididymis by the tesicle
* No treatment needed if remains small & assymptomatic
* Can be removed if becomes uncomfortable
Variocele: * Cluster of dilated veins posterior to and above the testis
* Dx by palpation, the scrotum feels Â‘wormlikeÂ’
* Most unilateral & on L side of scrotum
* Not treatment necessary unless painful and then they are surgically removed
* May cause infertility
Scrotal trauma: * Rare because of mobility of the scrotum
* Torsion
- Twisting of the spermatic cord
- Occurs most often during puberty
- Occurs after strenuous exercise, trauma, or spontaneously
- A medical emergency Â– cuts off blood supply and can cause irreparable testicular damage
Scrotal trauma - Torsion: - Pt c/o pain (sudden onset,extreme), n/v, erythema, & edema
- Surgery straightens and fixates the affected testicle and fixates the other testicle as well
- If necrotic the testicle is removed
- Keep ice on scrotum for 72 hrs, elevate
- Avoid heavy lifting for 4-6 wks
- No strenuous activity for 1 mo
- Wear scrotal support for at least 3 wks
Cryptochidism: * Undescended testis
* Mainly a pediatric problem
* 3% full-term & 20% pre-term
* 80% descend spontaneously in 1st year
* In an adult the testicle can be surgically placed into the scrotum (ochidopexy)
Cancer of the penis: * Rare, < 1% of all malignancies in men
* Presents as a painless, wart-like growth or ulcer on the glans under the forskin
* May appear as a reddened lesion w/plaque
* If lesion only involves skin it will be removed
* If not curable w/excision or radiation a penectomy will be done
* Circumcision as an infant almost eliminates the risk of penile cancer
Epididymitis: * Cold compresses, sitz baths will help w/comfort
* Avoid lifting, straining, or sexual activity until infection is under control
* Testicular tumor should be r/o
* If chronic the epididymis can be removed from the testicle
Orchitis: * Acute testicular inflammation
* Can result from infection or trauma
* Can be unilateral or bilateral
* c/o scrotal pain & edema, n/v, & pain that radiates to the inguinal canal
* Tx similar to epididymitis
- Bedrest w/scrotal elevation
- Application of ice
- Pain meds, antibiotics
Bacterial Vaginoses: pH >4.5
Thin, white discharge
Fishy odor
c/o discharge, bad smells, itchy
Trichamonas: pH >4.5
yellow-green forthy discharge
may have fishy odor
c/o frothy discharge, bad odor, itchy
Candidas: pH < 4.5
white cottage cheese-like discarhge
no odr
c/o dischrging discharging, itchy, burning

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Number of cards 91