Transcript Reproductive power point

Chapter 12
Care of the Patient with a
Reproductive Disorder
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Overview of Anatomy and
Physiology
• Male reproductive system
 Testes
 Ductal system
• Epididymis
• Ductus deferens (vas deferens)
• Ejaculatory duct and urethra
 Accessory glands
• Seminal vesicles
• Prostate gland
• Cowper’s glands
 Urethra and penis
 Sperm
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Slide 2
Figure 12-1
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Longitudinal section of the male pelvis showing the location of the
male reproductive organs.
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Slide 3
Figure 12-2
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell
(ovum) surrounded by sperm at time of fertilization (right).
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Slide 4
Overview of Anatomy and
Physiology
• Female reproductive system
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Ovaries
Fallopian tubes
Uterus
Vagina
External genitalia
Accessory glands
• Skene’s glands
• Bartholin’s glands
 Perineum
 Mammary glands (breasts)
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Slide 5
Figure 12-3
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Longitudinal section of the female pelvis showing the location of the
female reproductive organs.
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Slide 6
Figure 12-4
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
Sectioned view of the uterus showing relationship to the ovaries and
vagina.
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Slide 7
Figure 12-6
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Lateral view of the breast (sagittal section).
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Slide 8
Figure 12-7
(From Thibodeau, G.A., Patton, K.T. [2007]. Anatomy and physiology. [6th ed.]. St. Louis: Mosby.)
Mammalian ovary showing successive stages of ovarian (graafian)
follicle and ovum development.
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Slide 9
Figure 12-14
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)
A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast.
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Slide 10
Human Sexuality
• Sexual identity
 The sense of being feminine or masculine
• Influences on sexual health
 Overall wellness includes sexual health, and sexuality
should be part of the health care program
• Illness and sexuality
 Illness may cause changes in a patient’s self-concept
and result in an inability to function sexually
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Slide 11
Laboratory and Diagnostic
Examinations
• Diagnostic tests for the female
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Colposcopy; culdoscopy; laparoscopy
Papanicolaou (Pap) smear
Biopsies: Breast, cervical, endometrial
Conization; dilation and curettage
Cultures and smears
Schiller’s iodine test
Hysterograms
Mammography; pelvic ultrasonography
Tubal insufflation (Rubin’s test)
Human chorionic gonadotropin; serum CA-125
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Slide 12
Laboratory and Diagnostic
Examinations
• Diagnostic tests for the male
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Testicular biopsy
Semen analysis
Prostatic smears
Cystoscopy
Rectal digital exam
Prostate specific antigen (PSA)
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Slide 13
The Reproductive Cycle
• Menarche
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The beginning of menses
Follows breast development by 2 to 2½ years
Average age range is between 9 and 17 years
Cycle length ranges from 24 to 32 days
The average flow lasts 3 to 5 days
The average flow is 35 mL/cycle
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Slide 14
The Reproductive Cycle
• Amenorrhea
 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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Slide 15
The Reproductive Cycle
• Dysmenorrhea
 Etiology/pathophysiology
• Uterine pain with menstruation
 Clinical manifestations/assessment
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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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Slide 16
The Reproductive Cycle
• Dysmenorrhea (continued)
 Medical management/nursing interventions
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Exercise
Nutritious foods, high in fiber
Heat to pelvic area
Mild analgesics
Prostaglandin inhibitors
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Slide 17
The Reproductive Cycle
• Abnormal uterine bleeding
 Menorrhagia
• Excessive bleeding during the regular menstrual flow
• Causes: Endocrine disorders; inflammatory
disturbances; uterine tumors
 Metrorrhagia
• Uterine bleeding between regular menstrual periods or
after menopause
• May indicate cancer or benign tumors of the uterus
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Slide 18
The Reproductive Cycle
• Premenstrual syndrome (PMS)
 Etiology/pathophysiology
• Believed to be related to the neuroendocrine events
occurring within the anterior pituitary gland
 Clinical manifestations/assessment
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Irritability, lethargy, and fatigue
Sleep disturbances; depression
Headache; backache; breast tenderness
Vertigo
Abdominal distention
Acne
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Slide 19
The Reproductive Cycle
• Premenstrual syndrome (PMS) (continued)
 Medical management/nursing interventions
• Pharmacological management
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Analgesics; diuretics; progesterone
• Dietary recommendations
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High in complex carbohydrates
Moderate in protein
Low in refined sugar and sodium
Limit caffeine, chocolate, and alcohol
• Reduce or eliminate smoking
• Exercise; adequate rest, sleep, and relaxation
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Slide 20
The Reproductive Cycle
• Menopause
 Etiology/pathophysiology
• 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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Slide 21
The Reproductive Cycle
• Menopause
 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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Slide 22
The Reproductive Cycle
• Menopause (continued)
 Medical management/nursing interventions
• Estrogen therapy
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Premarin
Provera
• Calcium supplements
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Slide 23
The Reproductive Cycle
• Male climacteric
 Etiology/pathophysiology
• Gradual decrease of testosterone levels and seminal
fluid production; 55 to 70 years of age
 Clinical manifestations/assessment
• Decreased erections; decreased seminal fluid
• Enlarged prostate gland; decreased muscle tone
• Loss or thinning of hair
 Medical management/nursing interventions
• Emotional support; treatment for impotence
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Slide 24
The Reproductive Cycle
• Erectile dysfunction
 Etiology/pathophysiology
• Inability of an adult man to achieve penile erection
• Types
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Functional
Anatomical
Atonic
 Medical management/nursing interventions
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Remove cause if possible
Treat diseases
Viagra
Mechanical devices: penile prosthesis
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Slide 25
The Reproductive Cycle
• Infertility
 Etiology/pathophysiology
• Inability to conceive after 1 year of sexual intercourse
without birth control
 Medical management/nursing interventions
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Depends on the cause
Hormone therapy
Repair occlusion
Intrauterine insemination
In vitro fertilization
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Slide 26
Infections of the Female
Reproductive Tract
• Simple vaginitis
 Etiology/pathophysiology
• Common vaginal infection
• Causative organisms: E. coli; staphylococcal;
streptococcal; T. vaginalis; C. albicans; Gardnerella
 Clinical manifestations/assessment
• Inflammation of the vagina
• Yellow, white, or grayish white, curd-like discharge
• Pruritus and vaginal burning
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Slide 27
Infections of the Female
Reproductive Tract
• Simple vaginitis (continued)
 Medical management/nursing interventions
• Douching
• Vaginal suppositories, ointments, and creams
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Organism-specific
• Sitz baths
• Abstain from sexual intercourse during treatment
• Treat partner if necessary
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Slide 28
Infections of the Female
Reproductive Tract
• Cervicitis
 Etiology/pathophysiology
• Infection of the cervix
 Clinical manifestations/assessment
• Backache
• Whitish exudate
• Menstrual irregularities
 Medical management/nursing interventions
• Vaginal suppositories, ointments, and creams;
organism-specific
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Slide 29
Infections of the Female
Reproductive Tract
• Pelvic inflammatory disease (PID)
 Etiology/pathophysiology
• Any acute, subacute, recurrent, or chronic infection of
the cervix, uterus, fallopian tubes, and ovaries that has
extended to the connective tissues
• Most common causative organisms
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Gonorrhea; streptococcus; staphylococcus; Chlamydia;
tubercle bacilli
• High risk: Surgical and examination procedures; sexual
intercourse (especially with multiple partners);
pregnancy
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Slide 30
Infections of the Female
Reproductive Tract
• Pelvic inflammatory disease (PID) (continued)
 Clinical manifestations/assessment
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Fever and chills
Severe abdominal pain
Malaise
Nausea and vomiting
Malodorous purulent vaginal exudate
 Medical management/nursing interventions
• Antibiotics; analgesics
• Bed rest
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Slide 31
Infections of the Female
Reproductive Tract
• Toxic shock syndrome
 Etiology/pathophysiology
• Acute bacterial infection caused by Staphylococcus
aureus
• Usually occurs in women who are menstruating and
using tampons
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Slide 32
Infections of the Female
Reproductive Tract
• Toxic shock syndrome (continued)
 Clinical manifestations/assessment
• Usually occurs between days 2 and 4 of the menstrual
period
• Flu-like symptoms; sore throat; headache
• Red macular palmar or diffuse rash
• Decreased urinary output; BUN elevated
• Pulmonary edema
 Medical management/nursing interventions
• Antibiotics; IV fluid therapy; oxygen
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Slide 33
Disorders of the Female
Reproductive System
• 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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Slide 34
Figure 12-9
Common sites of endometriosis.
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Slide 35
Disorders of the Female
Reproductive System
• Vaginal fistula
 Etiology/pathophysiology
• Abnormal opening between the vagina and another
organ
 Clinical manifestations/assessment
• Urine and/or feces being expelled from vagina
 Medical management/nursing interventions
• Oral or parenteral antibiotics
• Diet: high protein; increase vitamin C
• Surgery: Repair fistula; urinary or fecal diversion
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Slide 36
Figure 12-10
(From Herbst, A.L., et al. [1998]. Comprehensive gynecology. [3rd ed.]. St. Louis: Mosby.)
Types of fistulas that may develop in the vagina and uterus.
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Slide 37
Disorders of the Female
Reproductive System
• Displaced uterus
 Etiology/pathophysiology
• Congenital
• Childbirth
• Backward displacement
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Retroversion
Retroflexion
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Slide 38
Disorders of the Female
Reproductive System
• Displaced uterus (continued)
 Clinical manifestations/assessment
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Backache
Muscle strain
Leukorrheal discharge
Heaviness in the pelvic area
 Medical management/nursing interventions
• Pessary
• Uterine suspension
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Slide 39
Disorders of the Female
Reproductive System
• Uterine prolapse
 Etiology/pathophysiology
• Prolapse of the uterus through the pelvic floor and
vaginal opening
 Clinical manifestations/assessment
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Fullness in vaginal area
Backache
Bowel or bladder problems
Protrusion of cervix and vaginal walls in perineal area
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Slide 40
Figure 12-11
(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)
Uterine prolapse.
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Slide 41
Disorders of the Female
Reproductive System
• Uterine prolapse (continued)
 Medical management/nursing interventions
• Pessary
• Surgery
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Vaginal hysterectomy
Anteroposterior colporrhaphy
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Slide 42
Disorders of the Female
Reproductive System
• Cystocele and rectocele
 Etiology/pathophysiology
• Cystocele
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Displacement of the bladder into the vagina
• Rectocele
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Rectum moves toward posterior vaginal wall
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Slide 43
Figure 12-12
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)
A, Cystocele. B, Rectocele.
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Slide 44
Disorders of the Female
Reproductive System
• Cystocele and rectocele (continued)
 Clinical manifestations/assessment
• Cystocele
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Urinary urgency, frequency, and incontinence; pelvic
pressure
• Rectocele
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Constipation; rectal pressure; hemorrhoids
 Medical management/nursing interventions
• Surgical repair
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Anteroposterior colporrhaphy; bladder suspension
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Slide 45
Disorders of the Female
Reproductive System
• 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
• Surgery: Myomectomy; hysterectomy
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Slide 46
Figure 12-13
(Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak’s gynecologic and obstetric pathology.
[6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the
biologic basis for disease in adults and children. [4th ed.]. St. Louis: Mosby.)
Leiomyomas.
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Slide 47
Disorders of the Female
Reproductive System
• Ovarian cysts
 Etiology/pathophysiology
• Benign tumors that arise from dermoid cells of the ovary
 Clinical manifestations/assessment
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May be no symptoms
Palpable on examination
Disturbance of menstruation
Pelvic heaviness; pain
 Medical management/nursing interventions
• Ovarian cystectomy
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Slide 48
Cancer of the Female
Reproductive Tract
• Cancer of the cervix
 Etiology/pathophysiology
• Squamous cell carcinoma
• Carcinoma in situ
• If untreated, invades the vagina, pelvic wall, bladder,
rectum, and regional lymph nodes
• High risk
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Sexually active during teens
Multiple sexual partners
Multiple births
Chronic cervical infections
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Slide 49
Cancer of the Female
Reproductive Tract
• Cancer of the cervix (continued)
 Clinical manifestations/assessment
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Few symptoms in early stages
Leukorrhea
Irregular vaginal bleeding; spotting
Advanced
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Pain in the back, upper thighs, and legs
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Slide 50
Cancer of the Female
Reproductive Tract
• Cancer of the cervix (continued)
 Medical management/nursing interventions
• Carcinoma in situ
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Removal of the affected area
• Early carcinoma
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Hysterectomy
Intracavitary radiation
• Advanced carcinoma
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Radical hysterectomy with pelvic lymph node dissection
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Slide 51
Cancer of the Female
Reproductive Tract
• Cancer of the endometrium
 Etiology/pathophysiology
• Adenocarcinoma of the uterus
 Clinical manifestations/assessment
• Postmenopausal bleeding (50% will have cancer)
• Abdominal pressure; pelvic fullness
 Medical management/nursing interventions
• Surgery: total abdominal hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO)
• Radiation; chemotherapy
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Slide 52
Cancer of the Female
Reproductive Tract
• Cancer of the ovary
 Etiology/pathophysiology
• Fourth most common cause of cancer death in women
• High risk: infertile; anovulatory; nulliparous; habitual
aborters; high-fat diet; exposure to industrial chemicals
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Slide 53
Cancer of the Female
Reproductive Tract
• Cancer of the ovary (continued)
 Clinical manifestations/assessment
• Early
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Vague abdominal discomfort
Flatulence; mild gastric disturbance
• Advanced
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Enlarged abdominal girth
Flatulence; constipation
Urinary frequency
Nausea and vomiting
Weight loss
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Slide 54
Cancer of the Female
Reproductive Tract
• Cancer of the ovary (continued)
 Medical management/nursing interventions
• Surgery
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TAH-BSO and omentectomy
• Radiation and/or chemotherapy
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Slide 55
Hysterectomy
• Total hysterectomy
 Removal of the uterus including the cervix
• TAH-BSO
 Removal of the uterus, fallopian tubes, and ovaries
• Radical hysterectomy
 TAH-BSO with removal of the pelvic lymph nodes
• Vaginal hysterectomy
 The uterus is removed through the vagina
• Abdominal hysterectomy
 Abdominal incision is made to perform procedure
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Slide 56
Disorders of the Female Breast
• Fibrocystic breast condition
 Etiology/pathophysiology
• Hyperplasia and cystic formation in mammary ducts
 Clinical manifestations/assessment
• Cysts are soft, well-differentiated, tender, and freely
moveable; often bilateral and multiple
 Medical management/nursing interventions
• Eliminate methylxanthines
• Danazol (danocrine); vitamin E
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Slide 57
Disorders of the Female Breast
• Acute mastitis
 Etiology/pathophysiology
• Acute bacterial infection of the breast
 Clinical manifestations/assessment
• Breasts are tender, inflamed, and engorged
 Medical management/nursing interventions
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Keep breasts clean
Application of warm packs
Support: Well-fitting bra
Systemic antibiotics
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Slide 58
Disorders of the Female Breast
• Chronic mastitis
 Etiology/pathophysiology
• Fibrosis and cysts in the breast
 Clinical manifestations/assessment
• Tender, painful, and palpable cysts
• Usually unilateral
 Medical management/nursing interventions
• Same as for acute mastitis
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Slide 59
Disorders of the Female Breast
• Breast cancer
 Etiology/pathophysiology
• Unknown cause; usually adenocarcinoma
 Clinical manifestations/assessment
• Small, solitary, irregular-shaped, firm, non-tender, and
non-mobile tumor
• Change in skin color
• Puckering or dimpling of tissue
• Nipple discharge; retraction of nipple
• Axillary tenderness
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Slide 60
Disorders of the Female Breast
• Breast cancer (continued)
 Medical management/nursing interventions
• Depends on the stage
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Radiation
Chemotherapy
Surgery
o Lumpectomy
o Mastectomy—simple, radical
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Slide 61
Inflammatory Disorders of the Male
Reproductive System
• Prostatitis
 Etiology/pathophysiology
• Acute or chronic infection of the prostate gland
 Clinical manifestations/assessment
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Chills and fever
Dysuria; urgency and frequency of urination
Cloudy urine
Perineal fullness; lower back pain
Arthralgia; myalgia
Tenderness, edema, and firmness of the prostate
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Slide 62
Inflammatory Disorders of the Male
Reproductive System
• Prostatitis (continued)
 Medical management/nursing interventions
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Antibiotics
Digital massage of the prostate
Sitz baths
Monitor I&O
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Slide 63
Inflammatory Disorders of the
Male Reproductive System
• Epididymitis
 Etiology/pathophysiology
• Infection of the epididymis
 Clinical manifestations/assessment
• Scrotal pain and edema
• Pyuria; chills and fever
 Medical management/nursing interventions
• Bed rest
• Elevate scrotum; cold compresses
• Antibiotics
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Slide 64
Disorders of Male Genital Organs
• Phimosis
 Etiology/pathophysiology
• Prepuce is too small to allow retraction of the foreskin
over the glans
• Usually congenital; may be due to inflammation or
disease
 Clinical manifestations/assessment
• Infection of foreskin and glans penis
• Occasionally causes obstruction of urine flow
 Medical management/nursing interventions
• Circumcision
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 65
Disorders of the Male Genital
Organs
• Paraphimosis
 Etiology and pathophysiology
• An edematous condition of the retracted uncircumcised
foreskin preventing a normal return over the glans
 Medical management/nursing interventions
• Warm compresses
• Circumcision
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 66
Disorders of Male Genital Organs
• Hydrocele
 Etiology/pathophysiology
• Accumulation of fluid between the membranes of the
testes
 Clinical manifestations/assessment
• Enlargement of the scrotum; pain
 Medical management/nursing interventions
• Aspiration of fluid
• Surgical removal of testicular sac
• Bed rest; elevate scrotum; cold compresses
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 67
Disorders of Male Genital Organs
• Varicocele
 Etiology/pathophysiology
• Dilation of scrotal veins causing obstruction and
malfunction of circulation
 Clinical manifestations/assessment
• Engorgement and elongation of the scrotum
• Pulling sensation in scrotum; dull, aching pain
 Medical management/nursing interventions
• Surgery: Removal of obstruction
• Bed rest
• Elevate scrotum; cold compresses
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 68
Cancer of the Male Reproductive
Tract
• Cancer of the testis
 Etiology/pathophysiology
• Cause unknown
 Clinical manifestations/assessment
• Enlarged scrotum; feeling of heaviness
• Firm, painless, smooth mass
 Medical management/nursing interventions
• Radical inguinal orchiectomy
• Radiation and/or chemotherapy
• Teach testicular self-examination
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 69
Cancer of the Male Reproductive
Tract
• Cancer of the penis
 Etiology/pathophysiology
• Very rare
 Clinical manifestations/assessment
• Painless, wart-like growth or ulceration, usually on the
glans penis
 Medical management/nursing interventions
• Surgery



Removal of tissue
Partial or total amputation of the penis
Metastasis: Radical surgical procedures
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 70
Sexually Transmitted Diseases
• Genital herpes (HSV)
 Etiology/pathophysiology
• Infectious viral disease; usually acquired sexually
 Clinical manifestations/assessment
•
•
•
•
•
Fluid-filled vesicles
Eventually rupture and develop shallow, painful ulcers
Fever; malaise
Dysuria
Leukorrhea (female)
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Slide 71
Figure 12-19
(From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)
Herpes simplex virus type II in a male and female patient.
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Slide 72
Sexually Transmitted Diseases
• Genital herpes (HSV) (continued)
 Medical management/nursing interventions
•
•
•
•
•
•
•
•
No cure; treat symptoms
Acyclovir (Zovirax)
Sitz baths
Local anesthetic; analgesics
Keep lesions clean and dry
GOOD handwashing
No sexual contact while lesions are present
Encourage use of condoms
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Slide 73
Sexually Transmitted Diseases
• Syphilis
 Etiology/pathophysiology
• Treponema pallidum organism
• Transmission occurs primarily with sexual contact
 Clinical manifestations/assessment
• Incubation period

No symptoms
• Primary stage

Chancre; headaches; enlarged lymph nodes
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Slide 74
Sexually Transmitted Diseases
• Syphilis (continued)
 Clinical manifestations/assessment
• Secondary stage


Rash on palms of hands and soles of feet
Generalized enlargement of lymph nodes
• Latent stage

No symptoms
• Tertiary or late stage

Lesions may affect many different systems; may be fatal
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 75
Sexually Transmitted Diseases
• Syphilis (continued)
 Medical management/nursing interventions
• Pharmacological management


Penicillin
Tetracycline or erythromycin, if allergic to penicillin
• May be treated in any stage; damage from previous
stages will not be reversed
• Treat all sexual contacts
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 76
Sexually Transmitted Diseases
• Gonorrhea
 Etiology/pathophysiology
• N. gonorrhoeae
• Transmitted by sexual contact
 Clinical manifestations/assessment
• Vaginal (female)



Urinary frequency and pain
Yellowish discharge
Nausea and vomiting
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 77
Sexually Transmitted Diseases
• Gonorrhea (continued)
 Clinical manifestations/assessment (continued)
• Urethra (male)



Urethral discomfort; dysuria
Yellowish discharge containing pus
Red and swollen meatus
• Rectal (male and female)

Perineal discomfort; purulent rectal discharge
• Pharyngitis (male and female)


Sore throat and swallowing discomfort
Edema of the throat
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 78
Sexually Transmitted Diseases
• Gonorrhea (continued)
 Medical management/nursing interventions
• Pharmacological management



Penicillin
Rocephin
Doxycycline or tetracycline
• Patient education
• TREAT ALL SEXUAL CONTACTS
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 79
Sexually Transmitted Diseases
• Trichomoniasis
 Etiology/pathophysiology
• T. vaginalis protozoan
• Usually sexually transmitted
 Clinical manifestations/assessment
• Most are asymptomatic
• Male: Urethritis, dysuria, urinary frequency, pruritus,
and purulent exudate
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 80
Sexually Transmitted Diseases
• Trichomoniasis (continued)
 Clinical manifestations/assessment (continued)
• Female






Frothy, gray, green, or yellow malodorous discharge
Pruritus
Edema
Tenderness of vagina
Dysuria and urinary frequency
Spotting; menorrhagia; dysmenorrhea
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Slide 81
Sexually Transmitted Diseases
• Trichomoniasis (continued)
 Medical management/nursing interventions
• Pharmacological management

Metronidazole (Flagyl)
• Patient education
• TREAT ALL SEXUAL CONTACTS
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 82
Sexually Transmitted Diseases
• Candidiasis
 Etiology/pathophysiology
• C. albicans and C. tropicalis
 Clinical manifestations/assessment
• Mouth: Edema; white patches
• Nails: Edematous, darkened, erythematous nail base;
purulent exudate
• Vaginal: Cheesy, tenacious white discharge; pruritus;
inflammation of the vagina
• Penis: Purulent exudate
• Systemic: Chills; fever; general malaise
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 83
Sexually Transmitted Diseases
• Candidiasis (continued)
 Medical management/nursing interventions
• Pharmacological management


Nystatin (Mycostatin)
Topical amphotericin B
• Treat underlying condition
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 84
Sexually Transmitted Diseases
• Chlamydia
 Etiology/pathophysiology
• Chlamydia trachomatis
 Clinical manifestations/assessment
• Usually asymptomatic
• Male



Scanty white or clear exudate
Burning or pruritus
Urinary frequency; mild dysuria
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 85
Sexually Transmitted Diseases
• Chlamydia (continued)
 Clinical manifestations/assessment
• Female




Vaginal pruritus or burning
Dull pelvic pain
Low-grade fever
Vaginal discharge; irregular bleeding
 Medical management/nursing interventions
• Pharmacological management

Tetracycline; doxycycline; Zithromax
• TREAT ALL SEXUAL CONTACTS
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 86
Nursing Process
• Nursing diagnoses






Anxiety
Body image, disturbed
Coping, ineffective
Fear
Fluid volume, deficient
Health maintenance,
ineffective
 Infection, risk for
 Knowledge, deficient
 Pain, acute and
chronic
 Self-esteem,
situational low
 Sexual dysfunction
 Skin integrity, impaired
 Tissue perfusion,
ineffective
 Urinary elimination,
impaired
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 87
Sex Hormones



Production influenced by the anterior pituitary
Male: testosterone; androgens
Female: estrogen; progesterone
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
88
Androgens
Actions

Development of secondary sex characteristics; tissue
building
Uses

Hypogonadism, hypopituitarism, dwarfism, eunuchism,
cryptorchidism, oligospermia, and male androgen
deficiency
Adverse Reactions

Edema due to sodium retention, acne, hirsutism, male
pattern baldness, cholestatic hepatitis with jaundice,
buccal irritation, nausea and vomiting, diarrhea
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89
Androgens (cont.)
Drug Interactions



Increased effects – anticoagulants, antidiabetic agents,
and other drugs
Decreased effects – barbiturates
Concurrent use with corticosteroids increase edema
Nursing Implications

Assessment, diagnosis, planning, implementation, and
evaluation
Drug Table 21-9
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90
Androgens (cont.)
Patient and Family Teaching
 Administration
 Response time
 Diet
 Symptoms to report
 Administration considerations
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Female Sex Hormones



Estrogens
Progestins
Table 21-10
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92
Estrogens
Action and Uses

Used for hormone replacement therapy in menopause
and other conditions (ovarian failure); infertility workups; palliative breast cancer treatment
Adverse Reactions
Drug Interactions
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93
Progestins
Action
Uses

Contraception, control excessive uterine bleeding,
treatment of secondary amenorrhea, dysmenorrhea,
premenstrual tension, and control of pain in
endometriosis
Drug Interactions
Nursing Implications and Patient Teaching
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Oral Contraceptives
Combination Drugs: Estrogen and Progestin

Table 21-11
Action

Prevent ovulation
Use

Contraception
Adverse Reactions

Estrogen excess, progestin excess, androgen excess,
estrogen deficiency, progestin deficiency
Contraindications for Oral Contraceptives
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95