Reproductive d/o 1

Diagnostic Testing for Females

• Colposcopy involves direct visualization of the cervix and vagina using a scope.
• A vaginal speculum is inserted, followed by a colposcope, which is a microscope to visualize the vaginal walls and cervix.
• Walls of the vagina may be swabbed with iodine or vinegar to remove surface mucus for better visualization.
• Observed factors include tissue color, presence of growths or lesions, and condition of vascularity.
• Specimens can be collected during a colposcopy.
• Should not be performed during menstruation.
• Clients should avoid bowel movements prior to the test if possible.
• Douching or sexual intercourse should be avoided for 24 hours before the test to prevent masking issues.
• Culdoscopy involves direct visualization of the uterus, ovaries, and fallopian tubes.
• Culdoscopy can be performed using local, spinal, or general anesthesia.
• The patient is placed in the knee-chest position during the procedure.
• The culdoscope is passed through the posterior vaginal wall.
• Culdoscopy can detect tumors, cysts, and endometriosis.
• Post-test, assess for bleeding and check vital signs.
• Ensure the patient can urinate after the test.
• Conization, the removal of eroded or infected tissue, can be performed during culdoscopy.
• Laparoscopy involves visualizing the uterus, ovaries, and fallopian tubes through the abdominal cavity.
• Tubal ligation can be performed during a laparoscopy.
• A urinary catheter is required during the procedure to decompress the bladder.
• Carbon dioxide is introduced into the abdominal cavity to distend it and improve structure visibility.
• General anesthesia is used for laparoscopy.
• Laparoscopy can detect masses, ectopic pregnancies, adhesions, and pelvic inflammatory disease.
• Patients may report shoulder pain due to the carbon dioxide gas after the test.
• Biopsies can be performed during laparoscopy to obtain tissue samples.

Biopsies and Conization

• Biopsies involve taking tissue samples for evaluation to confirm or locate a lesion.
• Reproductive biopsies include breast, cervical, and endometrial biopsies.
• Types of biopsies include fine needle aspiration, stereotactic or ultrasound-guided needle biopsy, and surgical biopsy.
• Conization is the removal of eroded or infected tissue to confirm cervical cancer.
• A cone-shaped section of tissue is removed from the cervix during conization.
• Conization is commonly performed after an abnormal Pap smear to investigate further.
• The area is packed with gauze after the procedure to decrease bleeding.
• Dilation and curettage (D&C) involves dilating the cervix and scraping material from the uterine wall.
• D&C can be done to remove tumors or abnormal tissue for biopsy.
• General anesthesia may be used for a D&C.
• Monitor for bleeding and foul odor following the procedure.

Smears and Mammography

• Cultures and smears are collected to examine and identify infectious processes, abnormal cells, or hormonal changes.
• Pap smears involve collecting scrapings from the cervix, placing them on a slide with a drop of water, and covering with a slide for microscopic examination.
• Mammography is a radiograph of breast soft tissue used to identify benign or cancerous processes.
• Digital mammography provides more detail.
• Annual mammograms are recommended from ages 40 to 54, and every other year after 54.
• Tumors are usually present for nine years before palpation is possible.
• No body powders, deodorant, or ointments should be used on the breast before mammography to avoid false positives.

Ultrasounds, Pregnancy Tests, and CA-125

• Pelvic ultrasounds detect foreign bodies and differentiate between cysts and solid tumors and evaluate fetal growth and viability.
• A pregnancy test detects human chorionic gonadotropin (HCG).
• Serum CA-125 is a tumor antigen associated with ovarian cancer.
• Elevated CA-125 levels can also be caused by endometriosis, pelvic inflammatory disease, pregnancy, gynecological cancers, and pancreatic cancer.
• Transvaginal ultrasounds use a wand inserted into the vagina for closer visualization of pelvic structures.

Tubal Insufflation

• Tubal insufflation (Rubin's test) assesses the patency of the fallopian tubes.
• Carbon dioxide is introduced into the tubes to check if they are open.
• If the tubes are open, gas will pass into the abdomen, producing a high-pitched bubbling sound detectable with a stethoscope.
• Shoulder pain may occur due to the gas.
• The test typically takes 30 minutes and is performed on an outpatient basis.
• If the tubes are closed, gas cannot pass through, and the patient will report no pain.

Diagnostic Testing for Males

• Testicular biopsy detects abnormal cells or the presence of sperm.
• A testicular biopsy can be performed through aspiration or incision, depending on the anesthesia used.
• Scrotal support, such as snug underwear, is recommended after the biopsy.
• Ice packs reduce swelling, and over-the-counter analgesics and warm sitz baths can provide relief.
• Patients should report any fever or bleeding immediately.
• Semen analysis evaluates fertility, post-vasectomy effectiveness, evidence in rape cases, and paternity.
• Prostatic smears identify microorganisms, tumor cells, or tuberculosis cells of the prostate.
• A provider massages the prostate via the rectum, and the patient voids into a sterile container.
• Cystoscopy involves using a scope to examine the prostate and bladder through the urethra.
• Cystoscopy can detect bladder infections and tumors.
• Patients may experience pink-tinged urine, increased frequency, and burning after the test.
• Warm sitz baths or analgesic medications can help with post-procedure discomfort.
• Prostate-specific antigen (PSA) is found in the bloodstream in cases of cancer and benign prostatic hypertrophy.
• A PSA level of less than four is considered normal; elevated levels require monitoring and possibly biopsy.

Amenorrhea

• Amenorrhea is the absence of menstrual flow.
• Primary amenorrhea is when menarche has not occurred by age 17 or 18, typically due to hormone imbalance, genetics, or structural issues.
• Secondary amenorrhea is when flow has ceased for six months in someone who has previously menstruated.
• Pregnancy, breastfeeding, and menopause are excluded from this definition.
• Causes include frequent vigorous exercise, emotional disorders, low body fat, contraceptives, pituitary tumors, hyperactive thyroid, and polycystic ovarian syndrome.
• Treatment involves addressing the underlying cause, possibly with hormone therapy.
• The first step is to confirm the person is not pregnant before further investigation.

Dysmenorrhea

• Dysmenorrhea is painful menstruation/menstrual cramps.
• Primary dysmenorrhea is not associated with pelvic disorders.
• Secondary dysmenorrhea is caused by diseases like PID, endometriosis, STIs, or fibroid tumors.
• Primary dysmenorrhea often improves after pregnancy or in the 30s.
• Secondary dysmenorrhea is typically found in people greater than 20 years of age.
• Pain usually starts 24-48 hours before menses or with onset.
• Diet high in complex carbohydrates and fiber with limited caffeine, sugar, and alcohol is recommended.
• Otherwise, manageable with heat and over-the-counter analgesics (Advil, Tylenol).
• Medications like Celebrex and Aleve can also help.
• Vitamins, oral contraceptives, physical activity, and sexual intercourse may provide relief.
• Treat the underlying cause if secondary to another disorder.

Abnormal Uterine Bleeding

• Menorrhagia is excessive bleeding during regular menstrual flow.
• It may involve an increase in duration greater than seven days or an increased amount of blood that is greater than 80 mL.
• Metrorrhagia is bleeding between regular menstrual periods.
• In postmenopausal women, metrorrhagia may indicate cancer or a benign tumor of the uterus.
• Endometrial biopsy and D&C may be used to diagnose the cause.
• Assess the bleeding, pain, and have the client keep a diary of bleeding characteristics.

Premenstrual Syndrome (PMS)

• PMS occurs due to hormonal changes during the menstrual cycle.
• Risk factors include being female, being 25-40 years of age, increasing symptoms near menopause, diet high in sugar, personal/family history of depression, or history of postpartum depression.
• Symptoms begin 5-10 days before the menstrual period and subside 1-2 days after onset.
• 90% of women have PMS.
• Premenstrual dysphoric disorder (PMDD) as PMS symptoms with severe mood disorders.
• PMDD involves an excessive response to hormonal changes.
• Depression, hopelessness, anger, anxiety, or tension.

Clinical Manifestations and Treatment of PMS/PMDD

• Irritability, lethargy, fatigue, sleep disturbances, depression, headache, anxiety, mood swings, vertigo, backaches, breast tenderness, bloating, acne, paresthesias, difficulty concentrating, forgetfulness, and worsened allergies.
• Treatment involves addressing specific symptoms.
• Analgesics, diuretics, and oral contraceptives.
• Antidepressants may be prescribed.
• Cessation of smoking and alcohol, dietary changes (small frequent meals, limiting sugar/sodium/caffeine, whole grains and fiber), exercise, stress reduction (yoga or meditation), and adequate sleep.

Menopause

• Menopause (climacteric) is a phase of aging transitioning from reproductive to non-reproductive.
• Normal cessation of menstruation.
• Perimenopause can last up to four years with infrequent/abnormal periods and possible conception.
• Average age is 42-58 with an average of 51.
• Menopause is complete after one full year without a period.
• Hormonal menopause decreases hormone levels in middle adulthood.
• Surgical menopause is loss of hormone production after surgery (bilateral salpingo-oophorectomy).
• Pharmacological menopause can be induced by medications like Lupron that decrease estrogen and progesterone.
• Increased risk of cardiovascular disease, thinning hair, bone loss, dry/rough skin, drooping breasts, smaller nipples, loosening teeth, receding gums, and urinary incontinence.

Signs, Symptoms, and Post-Menopause considerations

• Headaches, hot flashes, fatigue, vertigo, nausea, diaphoresis, weight gain, vomiting, palpitations, chest/neck pain, dyspareunia, and tachycardia.
• After menopause, estrogen-affected body parts change.
• Shrinking of vulval/perineal/genital structures, atrophic vaginitis, shortening of vagina, dry vaginal walls.
• KY Jelly or lubricant can help with sex.
• Relaxation of pelvic structures, urinary frequency, cystitis, and urgency.
• Decreased breast tissue and increased subcutaneous fat.

Treatment for Menopause

• Hormone replacement therapy (HRT) can help with moderate to severe symptoms.
• Use the lowest effective dose for the shortest duration.
• Vitamin D and calcium supplements, decreasing caffeine and alcohol, and increasing air circulation, using light covers, wearing loose clothing, and using cool cloths.
• Exercise programs with weight bearing decrease the risk of osteoporosis.
• Nutritious diet and weight control, breast self-exams, watching calcium intake, contraceptive use for one year after the last menstrual period, and performing Kegel exercises.
• Teach side effects of medications and encourage the patient to have annual physical exams.
• Kegel exercises strengthen pelvic structures.
• Patient needs to squeeze muscles down there, hold for 10 seconds, and relax; repeat 20-40 times a day.