Medical Surgical Nursing

(Course Code: NSC 407)

(Course unit:3)
Name: Oyekanmi, M.O.
Department: Nursing
Faculty: Basic Health Science
TOPIC: Caring for female clients with
disrupted reproductive functions
 Unit Objective

• Acquire knowledge in the care of female clients with

disrupted reproductive functions.

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 Topics/Units

• ✔ Disorders of menstruation
• Premenstrual syndrome,
• dysmenorrhoea,
• Dysfunctional uterine bleeding,
• infertility
• Menopause.

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 Topics/Units cont’d

• ✔ Disorders of female reproductive

tissue
• Endometriosis
• Ovarian cysts
• Uterine fibroid

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 Overview of Anatomy and Physiology
(Longitudinal section of the male pelvis showing the location of the male reproductive organs)

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 Sectioned view of the uterus showing
relationship to the ovaries and vagina
 Premenstrual syndrome
(PMS)
• Premenstrual syndrome (PMS) is a group of
physical and emotional symptoms that occur in
some women 7 to 10 days before menstruation.
• Etiology
• Its cause is unknown; however, it has been
proposed that PMS results from excess estrogen,
deficient progesterone, or both; hypothalamic-
pituitary dysregulation; or the effect of
reproductive hormones on brain chemicals such as
endorphins, melatonin, and serotonin.
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 Premenstrual syndrome
(PMS) Cont’d
• Etiology/pathophysiology cont’d
• Its believe to be related to the neuroendocrine events
occurring within the anterior pituitary gland
• Clinical manifestations/assessment
• Irritability, lethargy, and fatigue
• Sleep disturbances; depression
• Headache; backache; breast tenderness
• Vertigo
• Abdominal distention
• Acne
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 Premenstrual syndrome
(PMS) cont’d
– Medical management/nursing interventions
• Pharmacological management
– Analgesics; diuretics; progesterone
• Dietary recommendations
– High in complex carbohydrates
– Moderate in protein
– Low in refined sugar and sodium
– Limit caffeine, chocolate, and alcohol
• Reduce or eliminate smoking
(c) 2012 • Exercise; adequate rest,
Obafemi Awolowo sleep,
University, Ile-If and relaxation
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 Dysmenorrhoea

• Dysmenorrhea is painful menstruation; it may be

primary or secondary.
• Types
• Primary dysmenorrhea usually is idiopathic, and no
abnormality is found.
• Secondary dysmenorrhea is a result of other
disorders such as endometriosis, displacement of
the uterus, or fibroid uterine tumors.

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 Dysmenorrhoea cont’d

Clinical manifestations/assessment
• Breast tenderness; headache
• Abdominal distention; nausea and vomiting
• Vertigo
• Palpitations
• Excessive perspiration
• Colicky, cyclic pain; dull pain in the lower
pelvis

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 Dysmenorrhoea cont'd

– Medical management/nursing interventions

• Exercise
• Nutritious foods, high in fiber
• Heat to pelvic area
• Mild analgesics
• Prostaglandin inhibitors

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 Amenorrhea
• Amenorrhea is the absence of menstrual flow.
• Primary amenorrhea is the term used when a
woman of reproductive age has never menstruated.
• If menstruation stops after menstrual cycles have
occurred, it is called secondary amenorrhea.
• Secondary amenorrhea occurs normally during
pregnancy, after menopause, sometimes throughout
lactation, and when the ovaries or uterus are
surgically removed.

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 Amenorrhea cont’d
– Etiology/pathophysiology
• Absent or suppressed menstrual flow
– Clinical manifestations/assessment
• No menstrual flow for at least 3 months
– Medical management/nursing interventions
• Based on underlying cause
• Hormone replacement may be necessary

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 Dysfunctional Uterine Bleeding

– Menorrhagia
– Menorrhagia is excessive bleeding at the time of normal
menstruation.
– It may be quantified as menstrual flow that lasts more than
7 days, that requires the use of an additional two pads per
day, or that extends 3 or more days longer than usual.

– Etiology

– Menorrhagia can be caused by endocrine, coagulation, or

systemic disorders.
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 Menorrhagia cont’d
• Symptomatic relief is accomplished with NSAIDs, progestins,
and oral contraceptives with combinations of estrogen and
progestin.
• NSAIDs reduce prostaglandins, biologic chemicals that exist
in endometrial tissue, where they exert a stimulating effect on
the uterus.
• Progestins, natural and synthetic forms of progesterone,
transform the proliferative endometrium into a secretory
endometrium that simulates a pregnant state.
• When combination oral contraceptives are administered, they
produce a ‘‘pill period,’’ which is characterized by light
menstrual bleeding.
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 Menorrhagia cont’d

• Dilation and curettage (D and C) is performed for

symptomatic relief; however, effectiveness sometimes
lasts only 1 to 2 months.
• Endometrial ablation (detachment of the lining of the
uterus) by photodynamic therapy or uterine balloon
therapy is a potential nonsurgical alternative.

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 Metrorrhagia
• Metrorrhagia is vaginal bleeding at a time other
than a menstrual period.
• The amount of blood is not important; the fact that
it occurs unexpectedly is significant.
• Irregular bleeding often results from an erratic
stimulation of or response to pituitary or ovarian
hormones, especially in adolescent girls and
perimenopausal women.
• Uterine bleeding between regular menstrual periods
or after menopause
• May indicate cancer or benign tumors of the uterus
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 Metrorrhagia cont’d
• Some women ‘‘spot’’ for a day or two midway between
menstrual periods.
• This functional bleeding is attributed to
ovulation and is not considered abnormal.
• Causes
• Uterine malignancies, cervical irritation, or
breakthrough bleeding that occurs with
hormone replacement therapy or low-dose
oral contraceptives.
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 Metrorrhagia cont’d (Nursing
intervention)
• Intermenstrual or postcoital (after intercourse) bleeding needs
to be evaluated promptly.
• Treatment depends on the underlying cause.
• The nurse advises the client with unexplained bleeding to see a
physician.
• The nurse gather appropriate information; assist with
gynecologic examinations;
• The nurse offer suggestions for relieving discomfort; instruct
clients about their drug therapy;
• The nurse prepare clients for surgical interventions; care for
them during recovery; and provide specific healthteaching
instructions.
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 Infertility

• Infertility is a condition of inability of a woman to get

pregnant after one year of trying to conceive

• Inability to conceive after 1 year of sexual intercourse without

birth control

• Types:
• Primary: A woman who was never pregnant and who can’t
conceive after one year of not using birth control.
• Secondary:This occurs when a woman can’t get pregnant
again after having at least one successful pregnancy.
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 Infertility cont’d

• Risk factors:
• Age (over age 35 for women or over 40 for men)
• Diabetes
• Eating disorder including anorexia nervosa and
bulimia
• Excessive alcohol use
• Exposure to environmental toxins, such as lead and
pesticides.
• Over exercising
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 Infertility cont’d
• Risk factors contd
• Radiation therapy or other cancer treatment
• Sexually transmitted diseases (STDs)
• Smoking
• Stress
• Substance abuse
• Weight problems (Obesity or underweight)

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 Infertility cont’d

– Medical management/nursing interventions

• Depends on the cause
• Hormone therapy
• Repair occlusion
• Intrauterine insemination
• In vitro fertilization

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 Infertility cont'd
• Medical management cont’d

• Intrauterine insemination (IUI)

• In vitro fertilization (IVF)
• Intracytoplasmic sperm injection (ICSI)
• Third-party ART

• Nursing intervention
• Eating well-balanced diet and maintain a healthy weight.
• Cessation of smoking, misuse drugs or alcoholism
• Early treatment of STDs.
• Limit exposure to toxins.
• Staying physically active.
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 Menopause
• Menopause (‘‘change of life’’) is the cessation of the
menstrual cycle.
• The climacteric or perimenopausal period refers to the time
during which ovarian activity gradually ceases.
• The postmenopausal period begins 1 year after menstruation
ceases.
• Menopause normally occurs as a natural physiologic process
between 45 and 55 years of age.
• Surgical menopause, which results when the ovaries are
removed, can occur at any age.

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 Menopause cont’d
• Physiology
• Menopause occurs when ovarian function diminishes.
• Levels of estrogen and progesterone are reduced, ovulation
gradually ceases, menstruation becomes irregular until it stops,
and natural reproductive capacity ends.
• As the levels of estrogen and progesterone drop, the
hypothalamus attempts to raise them by releasing GnRH,
which stimulates the anterior pituitary gland to release FSH
and luteinizing hormone (LH)

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 Menopause cont’d

• The surge of hypothalamic-pituitary stimulation is

thought to be responsible for alterations in
temperature regulation, sleep disturbances, and
disequilibrium in mood.
• Estrogen deficiency causes thinning of the vaginal
walls, breast and uterine atrophy, and loss of bone
density.
• The risks of heart disease and stroke increase with
estrogen reduction

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 Menopause cont’d

• The normal decline of ovarian function

resulting from the aging process
• May be induced by irradiation of the ovaries or
surgical removal of both ovaries
• Not considered complete until 1 year after the
last menstrual period

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 Menopause cont’d

– Clinical manifestations/assessment
• Decrease in frequency, amount, and duration of
the normal menstrual flow
• Shrinkage of vulval structures; shortening of the
vagina
• Dryness of the vaginal wall; pelvic relaxation
• Loss of skin turgor and elasticity
• Increased subcutaneous fat; decreased breast
tissue; thinning of hair
• Osteoporosis
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 Menopause cont’d
– Medical management/nursing interventions
• Estrogen therapy
– Premarin
– Provera
• Calcium supplements

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 Disorders of female reproductive tissue

• Endometriosis
• Ovarian cysts
• Uterine fibroid

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 Endometriosis
• Endometriosis
– Etiology/pathophysiology
• Endometrial tissue appears outside the uterus
• The tissue responds to the normal stimulation of the
ovaries; bleeds each month
– Clinical manifestations/assessment
• Lower abdominal and pelvic pain
• May radiate to lower back, legs, and groin
– Medical management/nursing interventions
• Antiovulatory medications; pregnancy
• Laparoscopy; total hysterectomy
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 Endometriosis cont’d
( Common sites of endometriosis)

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 Ovarian cysts

• Definition:

– Etiology/pathophysiology
• Benign tumors that arise from dermoid cells of the
ovary
– Clinical manifestations/assessment
• May be no symptoms
• Palpable on examination
• Disturbance of menstruation
• Pelvic heaviness; pain
– Medical management/nursing
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•
 Uterine fibroid (Leiomyomas of
the uterus)
• Leiomyomas of the uterus (fibroids, myomas)
– Etiology/pathophysiology
• Arise from the muscle tissue of the uterus
• Stimulated by ovarian hormones
– Clinical manifestations/assessment
• Pelvic pressure; pain; backache
• Dysmenorrhea; menorrhagia
• Constipation; urinary symptoms
– Medical management/nursing interventions
(c) 2012 • Surgery: Myomectomy; hysterectomy
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Leiomyomas of the uterus
 Assignment: Group
• Discuss 3 nursing diagnosis and draw plan of care for
patient with the following disorders:
1. Premenstrual syndrome
2. Dysmenorrhoea
3. Dysfunctional uterine bleeding
4. Infertility
5. Menopause

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 Assignment: Group cont'd

6. Endometriosis
7. Ovarian cysts
8. Uterine fibroid

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 References

• Babara, K.T & Nancy, E.S. (2016). Introductory

Medical Surgical Nursing; 10th ed. Pg. 823-842
• Hinkle, J.L. & Cheever, K.H. (2015). Brunner &
Suddarth's Textbook of Medical-Surgical Nursing "Vol
1 & Vol 2" (14th Edition); Chapter 57 Management of
Patients with Female Reproductive Disorders; Page 1647-
1708
• NANDA-I (2018). Nursing Diagnosis Definitions and
Classifications 2018-2020 11th Edition
• Moorhead, S., Swanson, E., Johnson, M., Maas, M.L. (Ed.)
(2018). Nursing Classification (NOC) 6th Edition