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Sexuality-Reproductive Pattern

Alice Pangemanan
March 5-6, 2019
Learning Objectives
1. Mengidentifikasi komponen kumpulan data subyektif dan
objektif

2. Mengidentifikasi dan menjelaskan temuan normal dan


abnormal dari pengkajian reproduktif

3. Mengidentifikasi masalah keperawatan yang mungkin


muncul

4. Mendeskripsikan peran perawat terkait masalah sistem


reproduksi
Scientific Knowledge
• Sexual Development
– Infancy & Early Childhood
– School-Age Years
– Puberty/Adolescence
– Young Adulthood
– Middle Adulthood
– Older Adulthood

• Sexual Orientation

• Contraception
• Nonprescription (abstinence, barrier, & timing of intercourse)
• Prescription (hormonal, IUDs, diapraghm, cervical cap, sterilization)
Scientific Knowledge (Cont’d)
• Sexually Transmitted Infections (STIs)
– HIV
– HPV
– Chlamydia
Nursing Knowledge
• Sociocultural Dimensions of Sexuality
– Impact of pregnancy and menstruation on sexuality
– Discussing sexual issues

• Decisional Issues
– Contraception
– Abortion
– Prevention of STIs

• Alterations in Sexual Health


– Infertility
– Sexual abuse
– Personal & emotional conflicts
– Sexual dysfunction
(Potter, Perry, Stockert, & Hall, 2013, p. 681)
Male Genital Structures

(Jarvis, 2012a)
Male Genital Structures

(Jarvis, 2012b)
Female External Genitalia

(Jarvis, 2012b)
Female Internal Genitalia

(Jarvis, 2012a)
Sexual Health
“… a state of physical, emotional, mental and social
well-being in relation to sexuality; it is not merely the
absence of disease, dysfunction or infirmity.

Sexual health requires


1) a positive and respectful approach to sexuality and
sexual relationships,
2) the possibility of having pleasurable and safe
sexual experiences, and
3) free of coercion, discrimination and violence
(World Health Organization [WHO], 2006).”
Reproductive Health
“…a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity, in all matters relating to the reproductive
system and to its functions and processes.
1) able to have a satisfying and safe sex life
2) have the capacity to reproduce and the freedom
to decide when & how, incl. right to be informed,
have access to methods of family planning and
health-care services in increasing the chance to
have a healthy infant” (WHO, 2006).
Data Subjektif
1. Penis – nyeri, lesi, haluaran
2. Skrotum, perilaku self-care, lump (bengkak)
3. Aktivitas seksual dan penggunaan
kontrasepsi
4. Kontak infeksi menular seksual (sexually
transmitted infection [STI])

Use therapeutic communication!!


Data Objektif (DO)
1) Penis
• Perkembangan penis dan kulit serta rambut
pada bagian dasarnya
• Prepusium Fimosis
• Glens
Data Objektif (DO)
1) Penis
Normal Abnormal
• Kulit berkerut, tanpa rambut, dan luka. Vena Inflamasi.
dorsalis mungkin terlihat. Lesi (lihat slide berikutnya)

• Glans (kepala penis) tampak licin, tanpa luka. Inflamasi.


Lesi pada glans atau corona

• Meatus uretra terletak di tengah Phimosis, Paraphimosis, Hypospadias,


Epispadias.

• Distribusi rambut sesuai usia Kutu atau telur kutu dapat terlihat.

• Batas meatus tampak berwarna merah muda, Striktur – bukaan meatus menyempit
licin, dan tanpa haluaran (discharge) Tampak merah, bengkak, bernanah – urethritis

• Penis teraba licin, agak keras, dan tidak nyeri Nodul


tekan Nyeri tekan
DO : Lesi & abnormalitas pada Penis
Tinea Cruris Genital Herpes Syphilitic Carcinoma
(HSV 2) Chancre

Genital Warts
DO (Cont’d)
2) Skrotum
Normal Abnormal
• Ukuran bervariasi sesuai suhu ruangan. Edema – gagal jantung, gagal ginjal, inflamasi
Skrotum kiri lebih rendah dibanding kanan. lokal
Lesi

• Tidak nampak luka Inflamasi.

• Isi dari skrotum dapat bergerak dengan


gampang. Testis teraba oval, keras, dan
elastis, licin, dan sama, gampang bergerak
dan sedikit nyeri tekan.

• Akan teraba

• Tidak terdapat massa Hernia, tumor, orchitis, epididymitis,


hydrocele, spermatocele, varicocele
DO (Cont’d)
3) Hernia
Normal Abnormal
• Inspeksi jika terdapat tonjolan di daerah Tampak ada tonjolan
inguinal saat pasien berdiri

• Palpasi kanal pada inguinal Massa hernia teraba pada ujung jari
DO (Cont’d)
4) Prostat
Prostate Exam

Ukuran : Panjang 2.5 cm,


Lebar 4 cm
Bentuk : Seperti hati
Permukaan : Licin
Konsistensi : Elastis
Mobilitas : Sedikit dapat
bergerak
Sensitivitas : Tidak nyeri tekan
Data Subjektif
1. Riwayat menstruasi 7. Aktivitas seksual
2. Riw. kehamilan 8. Penggunaan
3. Menopause kontrasepsi
4. Perilaku self-care 9. Kontak STI
5. Haluaran per vagina 10.Reduksi risiko STI
6. Riw. masa lalu
Use therapeutic
communication!!
Data Objektif
A. Genitalia Eksternal
Normal Abnormal
1) Inspeksi
• Warna kulit merata; labia minora Lesi
berwarna pink gelap

• Distribusi rambut membentuk pola Kutu atau telur kutu


segitiga

• Labia mayora nampak simestris, plump, Swelling


well formed.

• Tidak tampak lesi

• Bukaan uretra tampak stellate dan terletak Polyp


di tengah

• Bukaan vagina tampak sempit Bau, iritating discharge


Data Objektif
A. Genitalia Eksternal (Cont’d)
Normal Abnormal

1) Inspeksi (Cont’d)
• Perineum tampak licin

• Kulit anus nampak coarse karena


meningkatnya pigmentasi

2) Palpasi
Nyeri tekan
• Kaji uretra & Skene’s glands
Diagnosa Keperawatan
• Disfungsi seksual
• Inefektif pola seksualitas
• Inefektif proses childbearing
• Readiness for enhanced childbearing process
• Risk for ineffective childbearing process
• Risk for disturbed maternal fetal dyad
References
Jarvis, C. (2012a). Physical examination & health
assessment (6th ed.). St. Louis: Elsevier Saunders.

Jarvis, C. (2012b). Pocket companion for physical


examination & health assessment (6th ed.). St.
Louis: Elsevier Saunders.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M.


(2013). Fundamentals of nursing (8th ed.). St. Louis:
Elsevier Mosby.