GU System - Handout Female Reproduction

Text: Brunner & Suddarth’s Medical Surgical Nursing: Ch. 46-48

Behavioral Objectives: By the end of this lecture the student will be able to:

·  Review the anatomy and physiology of the female genito-urinary systems

·  Describe the physical assessment of the female GU systems

·  Discuss the application of the nursing process as it relates to patients with disorders of the female GU system

·  Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following female GU disorders:

o  Vaginitis

o  Pelvic inflammatory disease (PID)

o  Endometriosis

·  Discuss incidence, prevention and treatment of the patient with cancer of the GU system

·  Discuss the nursing interventions in pre and post-operative care of patients undergoing the following surgeries

o  Hysterectomy

o  Mastectomy

I.  Review the anatomy and physiology of the genito-urinary systems

  1. Brunner and Suddarth’s Medical Surgical Nursing pg 1614
  2. Breast
  3. Female breast development ______- ______years
  4. Tail of ______
  5. ______ligament
  6. 12-20 ______
  7. Nipple
  8. Areola
  9. External Genitalia
  10. Internal Reproductive Structures
  11. Vagina
  12. ______membrane
  13. Posterior to ______& ______
  14. Anterior to ______
  15. Anterior & Posterior walls ______
  16. Upper vagina surrounds ______
  17. “Inferior ______”
  18. Uterus
  19. ______shaped: ______
  20. Size ______variable: ______
  21. Location: posterior to the ______
  22. Ligaments: ______
  23. Cervix: ______into the vagina
  24. Fundus: ______of the uterus
  25. Endometrium: ______of the uterus
  26. Ovaries
  27. Connected to the uterus by ______
  28. Contains: ______
  29. Ova / ovum: ______
  30. Ovulation Process (pg 1615)
  31. Definition: ______of a ______ovum from the ______
  32. Follicular Stage
  33. ovum ______à ______(graafian follicle)
  34. reaches ______(of the ovary)
  35. ovum ______
  36. Ovulation
  37. After ovulation
  38. Ovumà ______à ______
  39. If meets a spermatozoon
  40. ______& ______
  41. Ovum cyst à Corpus Luteum à stays in the ______
  42. Produces ______
  43. Prepares the ______for the ______ovum
  44. The Menstrual Cycle (pg 1615-1616)
  45. Two system control menstruation: ______& ______
  46. Hormones
  47. Ovaries
  48. ______& ______
  49. Pituitary
  50. ______à Stim. ______to ______
  51. ______à Stim. ______à ______
  52. Cyclical Pattern (see table 46-1 pg. 1617)
  53. Changes in ______& ______
  54. ______day cycle

Menstrual Phase / Follicular Phase / Ovulation / Luteal Phase / Premenstrual Phase
Estrogen / Estrogen / Estrogen / Estrogen / Estrogen
Progesterone / Progesterone / Progesterone / Progesterone / Progesterone
FSH / FSH / FSH / FSH / FSH
LH / LH / LH / LH / LH
Ovaries
Endometrium / Endometrium / Endometrium / Endometrium / Endometrium
Day
  1. Menopausal Period: (Pg. 1616)
  2. End of reproductive ______
  3. Age ______- ______yrs
  4. Menstruation ______: No menses ______
  5. ______not active à ______estrogen
  6. Reproductive organs ______
  7. ______ova mature

II.  Describe the physical assessment of the GU system: pg 1616

  1. Health history and clinical manifestations

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  1. Menstrual history
  2. Menarche: ______of menstration
  3. Hx of pregnancies
  4. Hx of medications
  5. ______therapy
  6. Hormonal ______
  7. ______treatment
  8. Pain
  9. Dysmenorrhea: Painful ______
  10. Dyspareunia: Painful ______
  11. Hx of vaginal discharge
  12. Hx of urinary problems
  13. History of B&B control
  14. Sexual history
  15. Hx of abuse
  16. Hx of surgery
  17. Hx of chronic illness or disability
  18. Hx of genetic disorders

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  1. Physical Assessment (Pg. 1623-1626)
  2. Breast: Frequency of self exam: ______
  3. Assessment question
  4. Palpable ______
  5. ______changes
  6. Pain, swelling, redness
  7. ______changes
  8. Findings
  9. Erythema
  10. Benign local ______or
  11. Superficial ______
  12. Prominent venous pattern
  13. _____ blood supply required by ______
  14. Edema & ______
  15. Neoplasm blocking the ______drainage tubes
  16. ______-peel appearance / Peau D’Oragne (______)
  17. Advanced breast ______
  18. ______inversion
  19. Sign of dimpling, creasing, changes in contour
  20. Palpation – Breast Cancer
  21. ______mass
  22. ______breast
  23. ______, hard, embedded in tissue
  24. ______-______
  25. Mammography
  26. Duration: ______
  27. Recommended frequency
  28. ______
  29. > ______years
  30. Pelvic
  31. Frequency: ______
  32. Initial: Age ______or ______
  33. Positioning: ______
  34. Inspection
  35. Inspects ______genitilia
  36. ______examination
  37. ______canal
  38. ______
  39. Pap smear (pg 1627)
  40. ______sample of the ______
  41. Purpose: Dx. ______
  42. Do not ______before Dr. visit
  43. Bimanual palpation (pg. 1626)
  44. ______palpation
  45. ______palpation
  46. Colposcopy (pg. 1628)
  47. Portable ______
  48. Obtain ______

III.  Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for – Vaginitis: (pg 1661 -6)

  1. Pathophysiology of Vaginitis
  2. Vaginitis : inflammation of the ______
  3. Normal pH ______- ______
  4. Lactobacillus acidophilus,
  5. ______the growth of anaerobes
  6. produces ______à ______pH
  7. Produces: hydrogen ______
  8. h risk if
  9. ______c. Altered ______
  10. ______d. ______
  11. Candida,Trichomonas or other ______invade the vagina.
  12. Clinical manifestations: General
  13. Vaginal discharge +…
  14. Itching e. Edema
  15. Odor f. Aggravated by ______
  16. Redness g. Urethritis
  17. Burning
  18. Candida / Vulvovaginal Candidiasis (pg. 1662)
  19. Fungal or ______infection
  20. Asymptomatic à symptomatic (risk factors)
  21. Use of ______à i bacteria à i protective organisms
  22. ______
  23. Diabetes ______
  24. Human immunodeficiency virus (HIV)
  25. ______treatment
  26. Oral ______therapy
  27. Clinical manifestations
  28. Vaginal discharge
  29. Color: ______, cottage cheese like
  30. The pH of the discharge is ______
  31. ______
  32. Medical Management
  33. ______agents
  34. Miconazole (Monistat); Nystatin (Mycostatin)
  35. Available without prescription
  36. Bacterial Vaginosis
  37. Overgrowth of ______bacteria ______found in the vagina and ______of lactobacilli
  38. Characterized by:
  39. ______-like odor
  40. ______vaginal pH
  41. ______discharge
  42. Color: ______
  43. ______discomfort
  44. Medical Management
  45. Metronidazole (Flagyl)
  46. Clindamycin (Cleocin)
  47. Trichomonas AKA “Trich” (pg 1664)
  48. ______
  49. ______carrier
  50. Clinical manifestations
  51. Vaginal discharge
  52. ______c. ______
  53. ______d. ______
  54. Cervical ______
  55. Multiple small ______
  56. pH ______
  57. Complications
  58. ______life threatening
  59. Medical Management
  60. Metronidazole (Flagyl)
  61. Anti______agent
  62. Anti ______agent
  63. ______partners
  64. Nursing process of Patients with Vulvovaginal infection
  65. Assessment
  66. Examine: Do not ______
  67. Observe the area for:
  68. ______c. ______
  69. ______d. ______
  70. Describe symptoms
  71. __odor______c. ______burn______
  72. __itch______d. _____dysuria______
  73. Prep a ______
  74. Test ______of discharge
  75. Factors that might contribute
  76. Physical /chemical factors
  77. Constant ______; tight / synthetic ______
  78. Perfumes & ______
  79. ______/ ______baths
  80. Poor ______
  81. ______hygiene products
  82. Psychogenic factors
  83. ______
  84. Medical conditions
  85. ______
  86. ______
  87. ______partners
  88. Diagnosis
  89. ______related to burning, odor or itching from the infectious process
  90. ______related to stressful symptoms
  91. Risk for ______or spread of infection
  92. Deficient ______about proper hygiene and preventive measures
  93. Planning and Goals
  94. Nursing Interventions
  95. Admin. ______
  96. ______baths
  97. ______powder
  98. ______patient
  99. ______discouraged
  100. ______fitting underwear = good
  101. ______, ______, non-______, heat-______underwear = bad
  102. Evaluations/Expected patient outcomes

IV.  Describe etiology, pathophysiology, clinical manifestations, nursing management & patient ed. for – Pelvic Inflammatory disease (pg. 1670-71)

  1. Pelvic Inflammatory Disease – Pathophysiology
  2. AKA: Pelvic ______
  3. PID is an inflammatory condition of the pelvic cavity that begins with cervicitis and may involve the ______, ______, ______pelvic peritoneum or pelvic vascular system
  4. Infection is usually caused by ______
  5. ______and ______
  6. PID is the most common STD but ______
  7. Enters through ______à ______canal & ______à ______à ______tubes & ovaries à ______
  8. Risk factors
  9. Early age ______
  10. ______# sexual partners
  11. Sex with a partner with an ______
  12. ______of STD’s
  13. Previous ______infection
  14. ______procedures
  15. Clinical manifestation
  16. Vaginal discharge
  17. ______
  18. ______pain
  19. ______after menses.
  20. Pain h while ______
  21. Other S&S:

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  1. Fever
  2. Gen. malaise
  3. N/V
  4. H/A

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  1. Complications
  2. Peritonitis
  3. ______
  4. ______/ adhesions
  5. Chronic pelvic ______
  6. Fallopian tube obstruction à
  7. ______pregnancy
  8. Occlude tubes à______
  9. Bacteremia à ______
  10. Thrombophlebitis à ______
  11. Medical management
  12. ______Antibiotics
  13. Treat ______
  14. Treatment at home: ______
  15. Intensive Therapy / Hospital: ______; ______; ______
  16. Nursing process of Patients with PID
  17. Activity: ______
  18. Position : ______
  19. Vital signs
  20. Assess: ______
  21. Administer: ______
  22. Pain Relief: ______

V.  Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for – Endometriosis (pg. 1680)

  1. Endometriosis – etiology
  2. “A benign lesion or lesions with cells similar to those lining the uterus grow aberrantly in the pelvic cavity outside the uterus.”
  3. ______pelvic pain & ______
  4. Pathophysiology
  5. Misplaced endometrial tissue responds to ______
  6. During______, the extopic tissue bleeds, mostly into areas having no ______à ______and ______
  7. Causes______, ______and/or ______
  8. Clinical manifestations

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  1. Dysmenorrhea
  2. Dyspareunia
  3. Pelvic pain
  4. Depression
  5. Loss of work
  6. Relationship
  7. Infertility

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  1. Assessment and diagnostic findings
  2. ______
  3. ______exam
  4. ______exam (pg 1630)
  5. Medical managements
  6. ______
  7. ______
  8. Side effects: ______retention, weight ______, ______
  9. Surgery
  10. Pregnancy
  11. Nursing process of Patients with Endometriosis
  12. Assessment
  13. Hx & PE focus on specific symptoms, effects of meds, reproductive plans
  14. Diagnosis Planning and Goals
  15. Relief of pain, Dysmenorrhea, dyspareunia
  16. Avoidance of infertility
  17. Nursing Interventions
  18. Dispel myths and encourage the patient to seek care if Dysmenorrhea or dyspareunia occurs
  19. Evaluations/Expected patient outcomes

VI.  Discuss incidence, prevention and treatment of the patient with cancer of the female GU system:

a.  Cancer of the Cervix (pg 1682-85)

  1. Pathophysiology
  2. Predominantly ______cell cancer
  3. Age ______- ______
  4. Risk factors
  5. ______sex partners
  6. ______age at first coitus
  7. Sex with men whose partner have had ______
  8. ______virus
  9. ______
  10. Causes ______growths
  11. ______
  12. Clinical Manifestations
  13. Early à ______
  14. Late symptoms
  15. Discharge: ______, ______, ______, ______
  16. Irregular ______
  17. Leg ______
  18. Dysuria
  19. ______bleeding
  20. ______of extremities
  21. Assessment and diagnostic findings
  22. ______smear
  23. ______
  24. Colposcopy
  25. ______
  26. Medical management
  27. CRYOTHERAPY
  28. Surgery: ______
  29. Radiation

b.  Cancer of the uterus (pg 1685)

  1. Pathophysiology
  2. Risk factors
  3. Age: ______
  4. Postmenopausal ______
  5. ______
  6. Unopposed ______
  7. Nulliparity /Infertility
  8. Assessment
  9. Irregular ______should be evaluated
  10. Endometrium aspirations
  11. Ultrasound
  12. Medical management
  13. ______

c.  Cancer of the Ovary (pg. 1689)

  1. Pathophysiology
  2. About ______detected in the late stage – with metastasized
  3. Age ______- ______
  4. Risk factors: ______& ______
  5. Clinical Manifestations
  6. ______abdominal girth
  7. pelvic ______
  8. ______
  9. ______
  10. ______waist size
  11. ______pain
  12. Assessment and diagnostic findings
  13. NONE
  14. Medical management

VII.  Discuss the nursing interventions in pre and post-operative care of patients undergoing hysterectomy (pg 1691)

  1. Pathophysiology
  2. Hysterectomy is the surgical removal of the ______
  3. Total Hysterectomy: removal of the ______& ______
  4. Sub-total or supra-cervical hysterectomy: removal of the ______but not the ______
  5. Radical hysterectomy: removal of the uterus & , ______(upper 1/3) pelvic ______nodes, ______tubes; and ______
  6. Usually performed due to ______condition
  7. Variety of approaches
  8. ______
  9. ______
  10. ______
  11. Pre-op management
  12. ______?
  13. Empty ______
  14. Empty ______
  15. ______
  16. Nursing Diagnosis/interventions
  17. Anxiety related to the diagnosis of cancer, fear of pain, possible perception of loss of femininity, and disfigurement
  18. ______
  19. ______
  20. Disturbed body image related to altered fertility and fear about sexuality and relationships with partner and family
  21. Discuss ______
  22. Orgasm
  23. Acute pain related to surgery and other adjuvant therapy
  24. Assess: ______
  25. Administer: ______
  26. Teach alternatives
  27. ______techniques
  28. Early ______
  29. ______
  30. Potential complications
  31. Hemorrhage
  32. Assess ______pads
  33. Assess ______
  34. Educate on ______restrictions
  35. Deep vein thrombosis
  36. Prevention
  37. Elastic compression ______
  38. Early ______
  39. Assess for DVT’s
  40. ______( ______; ______; ______; ______)
  41. Assess of PE
  42. ______pain
  43. ______pulse
  44. ______
  45. Bladder dysfunction / Urinary ______
  46. ______
  47. Assess bladder ______
  48. Stim. bladder: ______
  49. ______

VIII.  Breast Cancer

  1. Risk Factors
  2. Gender ______
  3. Age: ______
  4. Personal History ______
  5. Hormonal factors
  6. Early ______
  7. ______parity
  8. ______menopause
  9. ______
  10. ______use
  11. **No evidence that oral ______increase risk!
  12. Characteristics
  13. Most common location: ______
  14. ______-tender
  15. ______, ______, Irregular boarders
  16. Advanced signs
  17. ______dimpling
  18. Nipple ______
  19. ______ulceration
  20. Types of surgeries
  21. Modified Radical Mastectomy
  22. Removal of
  23. ______
  24. Nipple –areola
  25. ______lymph nodes
  26. Not removed
  27. Pectoralis major and pectoralis minor ______
  28. Total mastectomy
  29. Removal of
  30. ______
  31. Nipple-areola
  32. Not removed
  33. Axillary ______nodes
  34. ______groups
  35. Breast Conservation Treatment / AKA (______)
  36. ______or segmental mastectomy
  37. Removal of ______
  38. May include axillary ______

IX.  Discuss the nursing interventions in pre and post-operative care of patients undergoing mastectomy: (pg. 1716-1725)

  1. Postoperative nursing diagnosis and interventions
  2. Pain
  3. Assess
  4. Administer
  5. Analgesics
  6. Oxycodone & acetominaphen (Percocet)
  7. Propoxyphene & acetominaphen (Darvocet)
  8. Non-pharmaceutical measures
  9. ______
  10. Position ______
  11. ______techniques
  12. Report
  13. ______
  14. Impaired skin integrity
  15. ______tubes in place
  16. ______of tubes
  17. Hematoma’s
  18. ______packs
  19. Risk for infection
  20. Drainage tubes duration: ______
  21. Teach:
  22. ______, ______, ______
  23. ______care
  24. S&S of ______
  25. ______drainage
  26. ______
  27. No ______until completely healed
  28. Disturbed body image
  29. Support
  30. Impaired sensory perception related to sensations in arm, breast, or side
  31. Tightness, pulling, burning, tingling in the chest wall, axilla, upper arm
  32. ______with healing à lasts ______à diminishes
  33. Teach “this is ______”
  34. exercise à ______sensation
  35. Knowledge deficit: Prevent complications from surgery – lymphedema
  36. Results when lymphatic ______are inadequate to return flow of lymph fluid.
  37. Transient ______
  38. Medication: ______
  39. ______
  40. Manual lymph drainage:
  41. Light______,
  42. performed by a ______
  43. assists moving the ______to other parts of the body
  44. Compression bandaging:
  45. multi-layered ______after massage
  46. keep the fluid out of the arm
  47. ______
  48. Do not perform ______on affected arm
  49. Do not take ______on affected arm
  50. Avoid ______arm position
  51. Compression garment:
  52. ______
  53. helps maintain ______swelling achieved during treatment

X.  Study questions for Female GU

  1. Describe anatomically the location of the vagina, uterus and ovaries
  2. Describe the processes of ovulation
  3. What hormones are involved with menstruation
  4. What happens to the ovum after ovulation?
  5. What happens to the ovum cyst after ovulation?
  6. Where does fertilization take place?
  7. What are the hormonal changes during the follicular phase of menstruation?
  8. What physiological changes happen during the proliferative phase of menstruation?
  9. What are the hormonal changes during the ovulation phase of menstruation?
  10. What physiological changes happen during the phase of menstruation?
  11. What are the hormonal changes during the Luteal phase of menstruation?
  12. What physiological changes happen during the luteal phase of menstruation?
  13. Define menopause.
  14. What is the average age of menopause
  15. Name 10 questions you would ask a women during a GU assessment?
  16. What two exams should be done annually on a women?
  17. What is a pap smear? What is it used to diagnose?
  18. Bimanual palpation is palpation of what two things?
  19. What is vaginitis?
  20. What is the normal pH of the vagina? What maintains this pH?
  21. Describe the common S&S of vaginitis.
  22. What increases the risk of developing Candida?
  23. What is the typical vaginal discharge like for a patient with candida?
  24. How is Candida treated pharmacologically?
  25. What increases the risk of developing Trichomonas?
  26. What is the typical vaginal discharge like for a patient with Trichomonas?
  27. How is Trichomonas treated pharmacologically?
  28. Identify 8 nursing measures/interventions for a patient with vaginitis
  29. Define PID
  30. What are risk factors for PID
  31. Name 6 clinical manifestations of PID
  32. What is peritonitis
  33. Name 6 complications of PID
  34. What medications are used to treat PID?
  35. Name 6 nursing interventions for a patient with PID
  36. Define/describe endometriosis
  37. What are the clinical manifestations of endometriosis? (name 4)
  38. What is the medical management of a patient with endometriosis?
  39. What are the risk factors for cervical cancer?
  40. What are the S&S for cervical cancer? Early and late stage
  41. What are the risk factors for uterine cancer?
  42. What are the S&S for uterine cancer?
  43. What are the risk factors for ovarian cancer?
  44. What are the S&S for ovarian cancer? Early and late

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