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Female Reproductive Disorders

Megan Dickman, Ashley Hight, Jacy Penrose

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Prolapse

Structural Disorders

  • bladder
  • uterus
  • urethra
  • vaginal vault
  • rectum

Clinical Manifestations

  • Ineffective elimination
  • Asymptomatic
  • Pain with intercourse
  • Urinary incontinence or inability to void

Clinical Manifestations

Medical Management

  • Pessary device
  • Reconstructive surgery
  • Transvaginal mesh

Medical Management

Nursing Management

  • Lying flat reduces pressure
  • Kegal Exercises
  • Lose Weight
  • Smoking Cessation
  • Refrain from physical activity

Nursing Management

Benign Disorders

  • Uterine Fibroids
  • Ovarian Cysts
  • Endometrosis

Visuals

Uterine Fibroids

Ovarian Cysts

Clinical Manifestations of Endometriosis

  • asymptomatic
  • present with chronic incapacitating pelvic pain
  • low back pain
  • dyschezia (Pain w/Defacation)
  • dysuria
  • dyspareunia (Pain w/Intercourse)
  • infertility

Medical Management of Endometriosis

  • Difficult to diagnose
  • Nsaids & Hormone Therapy -First Line
  • GnRH agonists, androgenic agents and antiprogestogens which suppress ovulation & menses
  • laparoscopy & biopsies

Nursing Management

  • Pain is what the patient says it is
  • Educate about a typical menstrual cycle
  • Know that it may affect adolescents or women in menopausal transition
  • Obtain a comprehensive history of menstrual cycles and DOCUMENT
  • providing resources for:
  • support groups
  • stress reduction
  • physical therapy
  • pain management
  • Infertility treatment
  • educating family members and teaching the patient about nutritional therapy

Endometriosis Diet & Women's Health Diet

HPV

  • Has the ability to change normal cells to abnormal cells over a long period of time

  • Over 100 different strains
  • By age 50, 80% of women have been infected with some form of HPV

  • 90% of HPV strains resolve on their own, while others cause warts or cancer

Malignant Disorders

Nursing Management

  • Patient teaching
  • Vaccine
  • Safe Sex
  • Halthy Lifestyle
  • Regular check ups
  • Procedure precautions

Nursing Management

Medical Management

  • Pap smear

  • Colposcopy with biopsy

  • Loop Electrosurgical ExcisionProcdure (LEEP)
  • Low-High Grade Squamous Intraepithelial Lesions (LGSIL/HGSIL)

  • Cervical Conization/ Cone Biopsy

Clinical Manifestations

  • Multiple sexual partners
  • Sex without comdoms
  • Oral contraceptives
  • Immunocomprosided
  • Gential/Oral Warts

Clinical Manifestations

Case Study

Meet Quinn Fabray...

Case Study

  • Female
  • Age: 16
  • Cheerleader at WMHS
  • Loved Puck so much she had HIS baby
  • She also loves Finn because Puck gave her HPV
  • Uses Oral Contraceptives
  • Smokes during practice breaks

.........20 years later @ 36 years old...

Objective data

BP 105/80

Temp 98.7 F

HR 105

RR 19

O2 Sat 99%

Objective data

A & O x 4

CBC

Hemoglobin 12.0 g/dL

Hematocrit 41%

Platelets 150,000/mm3

WBC 14,000/mm3

RBC 5.1 cells/microliter

PAP smear: Positive for HPV

Subjective data

Subjective data

  • Pain 6/10
  • Tolerable: 3/10
  • Pain is in Pelvic region
  • Intermittant Pain
  • Describes as Super Crampy

Patient statements:

  • "I can't remember last time I had a Pap smear"

History of:

  • HPV
  • Childbirth
  • Multiple Sex Partners
  • Smoker
  • Poor diet

What's going on with Quinn?

Cervical Cancer

  • Second most common cancer, yet it is the most preventable
  • Pap smear best for early prevention and detection
  • HPV is found in 99% of all cervical cancers

Risk factors

  • HPV
  • Smoker
  • Oral Contraceptives
  • Poor Diet
  • Multiple Partners
  • Gave Birth

Diagnostics

Diagnostics

  • Papsmear - Abnormal cells found

  • Then... Colposcopy - uses an acetic acid solution which is used to make abnormal cells stand out

  • With... biopsy to determine:
  • Cervical Intraepithelial Neoplams (CIN)

Treatment

Treatment

  • LEEP
  • Cold Knife Conization
  • Trachelectomy
  • Hysterectomy (Partial, Total, Radical)
  • Chemoradiation
  • Chemical removal of warts

Treatment depends on stage of cancer

Now that cancer has been detected...

Nursing Management

Medical Management

  • Support Groups

  • Teach pt. importance of pelvic rest, report if she has a fever, foul vaginal discharge odor

  • Caution pt. if she chooses to have another child

Outcomes

Best Possible Outcome:

  • Caner is detected early through annual screening and does not spread to other parts of the body.

Worst Possible Outcome:

  • Cancer is not dected and spreads to other organs.

Early detection is KEY!! Keep up with annual Pap smearts, and vaccinate if poissible

NCLEX Question

A client, age 41, visits the gynocologist. After examining her, the physician suspects cervical cancer. The nurse reviews the clients hitory for risk factors for this disease. Which history finding is a risk factor for cervical cancer?

A. Onset of sporadic sexual activity at age 17

B. Spontaneous abortion at age 19

C. Pregnancy complicated with eclampsia at age 27

D. HPV infection at age 32

A. Onset of sporadic sexual activity at age 17

B. Spontaneous abortion at age 19

C. Pregnancy complicated with eclampsia at age 27

D. HPV infection at age 32

NCLEX Answer

References

  • Bento, P. A., & Cristina Moreira, M. (2014). Even silence has an end: Informative study on endometriosis and its signs/symptoms. Journal Of Nursing UFPE / Revista De Enfermagem UFPE. February 2014; 8(2), 457-463. doi:10.5205/reuol.4688-38583-1-RV.0802201429
  • “Cervical Cancer Causes, Diagnosis and Symptoms.” NCCC, www.nccc-online.org/hpvcervical-cancer/cervical-cancer-overview/.
  • Chavarro J, Rich-Edwards J, Missmer S, et al.(2016) Contributions of the Nurses' Health Studies to Reproductive Health Research. American Journal Of Public Health. September 2016;106(9):1669-1676.
  • Nutt, B. S., Chaney, S., & Hill, C. (2016). Diagnosis and management of pelvic organ prolapse: The basics. Women's Healthcare: A Clinical Journal For Nps. 4(2), 38-42.
  • Pellico, Linda Honan. (2013). Focus on Adult Health: Medical-Surgical Nursing Chapter 33: Problems Related to Reproductive Function p 935-975
  • Leo & Gloria Rosen - http://www.cancer.org/docroot/home/index.asp
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