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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 & well-being, 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 urethra vagina anus

fimbriae ovary cervix rectum

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