Female Reproductive

System
Assessment
 Assessment Female Reproductive System

• Complete Health History:

- menstrual hx
- medication hx (exposure to diethylstilbestrol, immunosuppressive agents, etc)
- how many pregnancy?
- do you have sexual transmitted disease? sexual hx?
- have they been expose to toxin?
- how is their diet?
- dysmenorrhea (pain w/menses), dyspareunia (pain w/intercourse), pelvic pain
- probs w/urinary fun (includes frequency, urgency, & incontinence)
• Physical Assessment: breast, perineum, vaginal.
- Yearly breast and pelvic exam are important for 21 years old or older, and for those who are
sexually active
- Pt is asked to empty bladder and provide urine specimen if urine tests are part of total assessment
- supine lithotomy position is used most for pelvic exam
- IT SHOULD NOT PAINFUL WHEN GETTING SAMPLE . Pelvic exam done by NP or doctor
• Functional Assessment: have they use drugs in the past
• Pelvic Exam: Has Three Parts- visual with speculum, palpation and bi-manual the vaginal + abd (internal/
external reproductive structure- look at the problem). The position for pelvic exam is lithosomy position
 Diagnostic Procedures

Pap Smear
• Done Once Per Year. Ppl with hysterectomy doesn’t have to have pap smear
every yr (maybe every 3-5 yr)
• Check for HPV, and look for cervical cancer. Can look for gornorhea, chladimya
• With Precancerous Lesions: Repeat in 4-6 Months
• Results of Pap Smear : Terms Used To Describe
- No abnormal or atypical cells
- Atypical squamous cells of undetermined significance
- Inflammatory reactions and microbes identified
- Positive deoxyribonucleic acid (DNA) test for HPV Precancerous and
cancerous lesions of the cervix identified
• If Abnormal Results: Will Do Colposcopy (go in with the instrument that have
lens to visualize the cervix and obtain a sample of abnormal tissue for analysis)
• If pt has infection, need to treat the infection first. And then the pap smear later.
 Diagnostic Procedures (Cont)

• With Precancerous Cells: Will Do Cryotherapy, Laser or

Cone Biopsy

• For Cryotherapy : Freeze Cervical Tissue with nitrous oxide

(observe for vasovagal response). A watery discharge is
normal in few wks after procedure as cervix heal. Excessive
bleeding, pain or fever should be reported to PCP

• Observe For Vasovagal Response

• Should Not Have Excessive Pain, Bleeding or Fever Post-

Procedure
 Cone Biopsy & Excision
• Do Either Surgically or Loop Electrosurgical Excision

• With Anesthesia: Rest for 24 Hours Post-Procedure

• May Have Vaginal Packing

• Should Report Excessive Bleeding

• Can do as a outpatient

• a pt who has received anesthesia for surgical cone bx is advised to rest

for 24 hrs after procedure and leaves any vaginal packing place until it
is removed

• Avoid interpose until healing complete and verified at fun

 Endometrial / Cervical Biopsy
• Done For Four Reasons: diagnose with uterine cancer.

• Cervical Biopsy To R/O Cancer

• Two Types of Biopsy

• Multiple Punch
• Cone
• Nursing intervention:
- teach what to expect after procedure (no douching, no sexual
activity until follow-up with PCP)
 Procedures (Cont)
• Laparoscopy:
- inserting laprascope into perineal cavity through a 2-cm incision below the umbilicus to allow visualization
of pelvic structure
- diagnostic purposes (i.e. in cases of pelvic pain when no cause can be found) or treatment
- Might have shoulder pain or pain below the rib cage or both R/T the use of CO2 gas
• Dilation and curettage (D&C):
- diagnostic (identifies the cause of irregular bleeding) or therapeutic (often temporarily stops irregular
bleeding)
- secure endometrial or endocervical tissue for cytotoxic exam, control abnormal uterine bleeding, and as
therapeutic measure for incomplete abortion
- carried out under anesthesia and requires surgical asepsis
- nurse explains procedure, preparation and exception regarding postoperative discomfort and bleeding.
Instructed to void before procedure. Placed pt in lithotomy position. No vaginal penetration or use of
tampons for 2 wks
• Mammogram
• American Cancer Society Recommendations
• First One At Age 40 Years
• Breast Self-Exam: circular motion middle to outside (same time each mth or same day each mth. Stand in front
of mirror after shower?)
• Hysteroscopy (transcervical intrauterine endoscopy):
- allow direct visualization of all part of uterine cavity by means of lighted optical instrument
- performed about 5 days after menstruation ceases
- may be adjunct with D&C and laparoscopy in cases of infertility, unexplained bleeding, retained IUD, and
recurrent early pregnancy loss
 Menstruation Problems
PMS
• Cluster of physical, emotional, and behavioral sx R/T luteal phase of menstrual cycle
• Signs & Symptoms: headache, fatigue, lower back pain, painful breasts, feeling of abd
fullness, general irritability, mood swings, fear of losing control, increase appetite,
crying spells
• Premenstrual Dysmorphic Disorder: sever form or PMS with significant severity of
sx
• Treatment: no treatment, keep a record of sx so they can anticipate & cope with
them, avoid caffeine/high-fat foods/refined sugars, increase exercise
• Nursing Interventions:
- obtain health hx and nutritional hx
- encourage pt to exercise, meditation, imagery, and creative activities to reduce
stress
- encourage pt to take med as prescribed and provides instructions about desired
effects of meds
- assess for potential suicidal tendency and violent behavior (risk for suicide)