Reproductive Health

Ch 46, 47

Nursing Role in Womens

Health

Health promotion
Illness prevention
Provide support & counseling
Encourage women in their health goals and
behaviors
personal hygiene, detecting & preventing diseases
(STDs), diet & exercises, sexuality issuesmenopause, contraception, preconception,
pre-/postnatal care, stress management & wellbeing, healthy lifestyles, & avoiding risky behaviors

Nursing Role in Womens Health

Nurses need to model that lifestyle for
patients
Recommend & promote regular
examinations
Non-judgmental, understanding &
sensitive
Screen for/and recognize s/sx. abuse
Recognize cultural differences & beliefs
Respect sexual orientation

External genitals of the female

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Female Reproductive System

oviduct
oviduct
ovary
uterus
urinary bladder
pubic symphysis

fimbriae ovary
cervix
rectum

urethra
vagina

anus

uterus
vagina

Function of Female Reproductive System

Ovulation ova begins to mature & enlarge
until discharged
Migrates toward & enters oviduct where
possible fertilization may take place
Mentrual Cycle involves production of
estrogen & progesterone
Menopausal period end of womans
reproductive capacity.
Early menopause surgical removal of
ovaries, chemotherapy, radiations, unknown
etiology

Assessment
Health Hx. past illnesses, STDs,
treatments, hx sexual/physical abuse,
Sexual Hx. PE findings, lab results
Female genital mutilation
Cutting, partial/total removal of external
genitalia
Cultural passage to womanhood: Africa,
Middle East. Crime in the U.S.
Type I, II, III, IV
p 1620

Assessment
Domestic violence
Physical: for child, elderly; men & women
Emotional degradation, coercive control,
threats, intimidation.
Sexual assaults

The need to maintain control of a partner

is rooted in sex role inequality.
Sensitive care is required if a woman
states that she is being hurt.
Report & provide safety for pt. (p.1621)

Physical Assessment
Periodic examination/ pelvic & breast
Routine cancer screening
Positioning: supine lithotomy, upright
lithotomy vs. Sims position (left side)
Proper equipment
Inspection : lesions of the labia
majora/minora (venereal warts,
melanoma lesions) trauma to the
vaginal wall, cystocele, rectocele,
presence of a hymen

Assessment
Women with disabilities experience
increase risk for abuse
Inquire about barriers to health care
Any healthcare limitations
Cognitive or developmental changes
affecting understanding
Gerontology considerations
Facing health disparities or end-of-life
issues

Physical Assessment
Speculum Examination:
Cervix 2-3 cm, smooth vs. laceration
Malignant changes
cysts, polyps
Discoloration
Cauliflower-like growth (cancer)
Vaginal discharge

Inspection
of the
Cervix

Diagnostic Testing
PAP Smear cytology for detecting cervical
cancer
Atypical cells: Human papillomavirus (HPV)

Colposocpy visual examination with a

portable microscope
Cervical biopsy analysis of cervical tissue
Cryotherapy/laser therapy freezing cervical
tissue with nitrous oxide
Cone Bx Loop Electrosurgical Excision
Procedure (LEEP) surgical procedure using
laser beam

Diagnostic Testing
Endometrial Aspiration Bx. allows for
detection of cellular changes in the
endometrium
Dilation & Curettage (D&C) surgery;
dilation if cervical canal and scraping of
endometrial/endocervical tissue for
cytology
Endoscopic laparoscopy visualization of
the pelvic structures

Diagnostic Testing
Hysteroscopy visualization of all the
parts of the uterine cavity
Hysterosalpingography or
Uterotubography x-ray of uterus &
fallopian tubes.
Computed Tomography (CT) transverse
radiographic images
Ultrasonography ultra sound images.
Magnetic Resonance Images (MRI)
definitive images using magnetic waves

Management of Physiologic
Processes
Menstruation 28-day cycle during
reproductive years
Understand cutural beliefs, customs &
values, psycological consideration, NSAID

Perimenopause 1st sign of menopause:

hot flashes, vaginal dryness, irregular
menses.
Consider issues in sexuality, fertility,
STD,oral contraceptives, breast cancer,

Management of Physiologic
Processes
Menopause permanent physiologic cessation
of menses
Associated with decrease ovarian function,
some breast & genital organ atrophy
Irregular menses, breast tenderness, mood
changes, hot/warm flashes, noc sweats, sleep
disturbances, gradual thinning of pubic hair,
shrinkage, fatigue, forgetfulness
Be sensitive to all possible side effects
Tx hormone therapy

Management of Menstrual Disorders

PMS - prementstrual syndrome:
Irritability, fatigue, bloating, edema, HA,
depression, low back pain, painful breast, mood
swings
Tx symptoms, promote exercise, avoid caffeine &
high-fat diets
Vit. B, E, magnesium, oil of primrose are used but
show no evidence of effectiveness
Selective serotonin reuptake inhibitors (Prozac,
Sarafem, Fluoxetime, Ibuprofen, Naproxenk
Anaprox, diuretics, antianxiety, calcium
supplements

Management of Menstrual Disorders

Nursing management:
Establish nurse/pt rapport, for good
health history
Nutrition history
Minimize side effects, stress-coping
strategies
Pt educ: avoid caffeine, alcohol, eating
diet low in essential nutrients. Teach how
to record timing & intensity of symptoms

Menstrual Disorders
Dysmenorrhea: painful menstruation,
severe crampings
Tx: relieve discomfort, A.S.A. NSAIDs,
low level local heat
Contraindicated with peptic ulcers
Amenorrhea absence of menstrual cycle

Allow pt to express concerns, PE,

medical hx., stress level, pregnancy,
eating disorders, anorexia & bulimia

Menstrual Disorders
Menorrhagie excessive menstruation;
profuse, prolong flow during regular
periods
Related to endocrine distrubances,
inflammatory disturbances, uterine tumors
Can result in anemia; need to see MD
Count # pads, & saturation (absorbency)

Menstrual Disorders
Metrorrhagie heavy uterine bleeding between
periods; irregular
May signal cancer, benign tumors of the
uterus
Health hx., taking oral contraceptives or HR?
Hypomenorrhea scanty flow
Oligomenrrhea reduced frequency of periods

Contraception
Abstinenece practice celibacy; only
effective method
Sterilization
Bilateral tubal ligation: laparoscopy
procedure
Fellopian tubes are coagulated,
sutured, or ligated with bands/clips.
Transcervical tubal occlusion
Vasectomy excision of the vas
deferens

Contraception
More than half of pregnancies in the U.S.
are unintended
Nurses can assist in providing information
and support
Family planning resources
Listen, educate and take time to answer
questions
Be unbiased and nonjudgmental
Understand the risks & benefits

Contraception
Hormonal use of estrogens & progestins by
women.
Block ovarian stimulation, prevent release of
FSH from the anterior pituitary gland.
Benefits: reduce incidence of benign breast
disease, uterine & ovarian cancers, anemia,
pelvic infections; Improves acne.
Risks: DVT, breast soreness, HA, nausea, leg
cramps
** Inform pts that hormonal contraception protects
against pregnancy but not from STD of HIV

Contraception
Intrauterine device (IUD) a plastic, t-shaped
device inserted into the uterine cavity to prevent
pregnancy.
Causes local inflammation, which is toxic to
sperm & blastocysts; therefore prevents
fertilization
May cause excessive bleeding, cramps,
backaches, slight risk of tubal pregnancy,
perforation of cervix and uterus is rare

Contraception

Mechanical barriers diaphragm

Cervical cap
Contraceptive spong
Female condom (p1645)
Male condom
Spermicides
Coitus interruptus (withdrawal)
Rhythm & natural method safe period
Emergency contraception morning after pill

Contraception
Abortion
Spontaneous abortion
Habitual (recurrent) abortion
After 2 consecutive abortion, pt is referred
to genetic counseling and testing

Elective abortion voluntary

Pt education & counseling on choices
Explore pts fears, feelings and options
Review use of birth controls methods

Nursing management
For spontaneous abortion - provide bed
rest, sexual abstinence, no straining on
defecation
Allow expression of feelings: listen
Pt education: available forms of
contraception, community resources
Counseling
Pelvic exam, lab studies, RhoGAM,
STD screening

Infertility
The couples inability to achieve
pregnancy after 1 yr. of unprotected
intercourse.
Ovarian/ovulation factors
Tubal factors
Uterine factors
Semen & other male factors

Artificial Insemination
Deposit of semen into the female genital tract
by artificial means

Sperm cannot penetrate the cervical canal

Donor or partner/husband semen is frozen
Written consent
Safeguards set in place for legal, ethical, emotional &
religious issues

Must meet certain condition: the women should

have no genital abnormalities, require patent
fallopian tubes, available ovum.
Viable sperm: normal shape, amount, motility
and endurance

Ectopic Pregnancy
Decreasing in rate, but remains the
leading cause of pregnancy related
dealth in 1st trimester
Acute condition require surgery
Relieve acute pain
Monitor potential complications
prevent hemorrhage, shock.
Provide emotional support