Reproductive Health Disorders: Interventions

Key Topics Covered

• The study covers pharmacological and nursing interventions for reproductive health disorders.
• Conditions covered include endometriosis, menopause, benign prostate hyperplasia, and erectile dysfunction.

Endometriosis: Interventions

• Treatment is tailored to the patient's wishes and is influenced by factors such as age, desire for pregnancy, symptom severity, and the extent/location of the disease.
• Infertility issues can expedite the treatment process.
• Drug therapy includes NSAIDs and diclofenac (Voltaren) for pain management.
• Hormone therapy controls the condition, but it isn't curative.
• Estrogen production can be inhibited.
• Ovulation can be suppressed using progestin (medroxyprogesterone).
• Danazol (Cyclomen) is a synthetic androgen that atrophies ectopic endometrial tissue.
• Adverse effects of Danazol include weight gain, acne, hot flashes, and hirsutism; it can also be expensive.
• Initial steps involve lifestyle changes (diet, exercise, good habits).
• Two levels of treatment: prescription drugs and alternative medicine to control hormones such as herbal supplements, phytoestrogenic supplements, hormone-regulating supplements.
• Hormonal contraceptives include pills, patches, and vaginal rings to control hormones responsible for endometrial tissue buildup.
• Gonadotropin-releasing hormone (Gn-RH) agonists/antagonists block ovarian-stimulating hormones, lowering estrogen and preventing menstruation; this can cause endometrial tissue to shrink.
• Side effects of Gn-RH agonists and antagonists like hot flashes and vaginal dryness can be mitigated with low-dose estrogen or progestin.
• Progestin therapy, such as Mirena or Depo-Provera, halts periods, which can relieve endometriosis symptoms.
• Danazol suppresses endometrial growth by blocking ovarian-stimulating hormones.
• Danazol can have serious side effects including being harmful to the baby if you become pregnant while taking this medication
• Diagnostic laparoscopy defines the diagnosis.
• Lesions may be removed during diagnostic laparoscopy.
• Surgical options involve the removal of the uterus (hysterectomy), fallopian tubes (salpingectomy), ovaries (oophorectomy), and endometrial implants.

Menopause: Collaborative Care

• Menarche is the first menstrual cycle, between ages 12-13 when a woman's fertility peaks around age 25.
• Perimenopause is around 8-10 years before menopause, when estrogen declines
• Menopause is when the ovaries stop releasing eggs, and the woman hasn't had a period for 12 consecutive months, the average age of menopause is 51.
• Post menopause follows menopause, estrogen levels decline steadily
• Hormone therapy, including estrogen, is standard for those without ovaries, or estrogen and progesterone for those with a uterus.
• Estrogen plus progestin increases the risk of breast cancer, stroke, heart disease, and emboli, but reduces the risk of hip fractures and colorectal cancer.
• Estrogen alone (Premarin) increases the risk of stroke and emboli.
• It reduces the risk for hip fractures and has no risk of heart disease, breast cancer, or colorectal cancer.
• For symptom management less than 5 years, HT is an option.
• Use the lowest effective dose for the shortest time.
• Common estrogen regime is a daily dose, and the dose is increased for symptom relief.
• Management of Estrogen adverse effects includes nausea, fluid retention, headaches, and breast enlargement.
• Common progesterone regime is indicated for 12 days each month on a cyclical or continuous regimen.
• Common progesterone adverse effects include increased appetite, weight gain, irritability, depression, spotting, and breast tenderness.
• SSRIs like paroxetine (Paxil), fluoxetine (Prozac), venlafaxine (Effexor XR), or gabapentin (Neurontin) may decrease hot flashes, mechanism of action is unknown.
• Selective estrogen receptor modulators (SERMs) like raloxifene (Evista) can prevent bone loss.
• Bisphosphonates decrease osteoporosis risk; examples are Fossamax (alendronate) and Risedronate (Actonel).
• Avoid situations that fluctuate body temperature.
• Maintain a cool environment.
• Limit caffeine and alcohol.
• Wear loose clothing.
• Relaxation techniques are helpful.
• Vitamin E may reduce hot flashes.
• Cessation of smoking is important.
• Bone loss and CVD risk are counteracted by a diet with calcium, vitamin D, complex carbs, and vitamin B complex.
• Black cohosh is a herb that helps with menopause symptoms.

Benign Prostatic Hyperplasia (BPH): Care

• Goals: restore bladder drainage, relieve symptoms, and prevent/treat complications.
• Dietary changes can help with mild symptoms.
• Evening fluids should be restricted with mild symptoms.
• "Watchful waiting" regarding your symptoms
• Diuretics should be avoided.
• A timed voiding schedule may be required.
• α-Adrenergic receptor blockers like tamsulosin (Flomax) relax prostate muscles and facilitate urinary flow.
• α-Adrenergic receptor blockers improve symptoms in 2-3 weeks.
• Side effects of a-Adrenergic receptor blockers include orthostatic hypotension, dizziness, retrograde ejaculation, and nasal congestion.
• 5α-Reductase inhibitors (inhibits type 2 isoenzyme) finasteride (proscar), reduces size of prostate gland, takes 6 months for improvement, decreases libido, decreases volume of ejaculation, ED.
• 5α-Reductase inhibitors (inhibits type 1 & 2 isoenzyme) dutasteride (Duragen), decreases libido, decreases volume of ejaculate, and causes erectile dysfunction.
• A Minimally invasive therapy includes transurethral needle ablation - instead of radiofrequency being used.
• A Minimally invasive therapy includes transurethral needle ablation that is higher precision.
• A Minimally invasive therapy includes transurethral needle ablation that does not typically result in pain.
• A Minimally invasive therapy includes transurethral needle ablation's complications include UTI, urinary retention, irritative voiding symptoms, and hematuria for 1 week.
• Transurethral microwave thermotherapy is an outpatient procedure uses microwaves to destroy prostate tissue, and involves a rectal T probe as a safety measure.
• Complications occur from Transurethral microwave thermotherapy because of urinary retention that causes a urinary catheter which will lead to dysuria, hematuria, and retention.
• Transurethral microwave thermotherapy requires pain medication, and bladder antispasmodics.
• Laser prostatectomy is an effective alternative to TURP
• During Laser prostatectomy compared to TURP, it has minimal bleeding and faster recovery time, can stay on anticoagulants
• Transurethral resection (TURP) involves the removal of obstructing prostate tissue via a resectoscope in the urethra with excellent outcomes (80-90%).
• Transurethral resection (TURP) is relatively low risk and is performed under spinal or general anesthesia with a hospital stay.
• Postoperative care should include close monitoring, bladder irrigation to remove blood clots, and administration of antispasmodics (Belladonna and Opium).
• Postoperative care should include that the team teaches the patients Kegel exercises.
• Nursing implementation includes postoperative care, observing for signs of infection, dietary intervention, and stool softeners to prevent straining.
• Nursing implementation includes discharge instructions on in-dwelling catheter, and managing incontinence.
• Nursing implementation includes patients intaking 2 to 3 L of fluids per day and education on the Signs and symptoms of a UTI.
• Nursing implementation includes preventing constipation, avoiding heavy lifting, and refraining from driving and intercourse after surgery as directed.

Erectile Dysfunction (ED): Care

• Treatments include oral drug therapy, vacuum constriction devices, intra-urethral devices, penile implants, and sexual counseling.
• Phosphodiesterase inhibitors such sildenafil (Viagra) are used to treat ED and are the first oral drugs to treat ED.
• Phosphodiesterase inhibitors relax smooth muscle in corpora cavernosa and permit blood inflow.
• Vardenafil (Levitra) is another drug similar to sildenafil.
• Tadalafil (Cialis) has a similar action to sildenafil but a longer duration.
• Sildenafil and tadalafil, under the trade names Revatio® and Adcirca®, are also used to treat pulmonary hypertension.
• Viagra has a Time to onset of 30min
• Viagra has a Duration of 4hrs
• Cialis has a Time to onset of 15min
• Cialis has a Duration of 36hrs
• Levitra has a Time to onset of 30min
• Levitra has a Duration of 5hrs

Infertility

• Female testing involves ovulatory studies (basal body temperatures), tubal patency studies (visualization of uterus and tubes), and postcoital studies (examining cervical environment and sperm).
• In male testing, disorders of the hypothalamic-pituitary system, testes, and ejaculatory system are examined.
• Physical causes for males can be classified as pretesticular, testicular, or post-testicular
• Both male and female infertility may link to issues like infection, medication use, radiation exposure, or substance abuse.
• Male history is evaluated for surgery, injuries, hot tub use, sexual practices (masturbation 20+/day), weight training, tight undergarments, and stress levels.
• IUI (Intrauterine insemination) which is the artifical insemination with sperm from a partner or donor
• ART (artificial reproductive technology) where IVF (in vitro fertilization) is used.
• In ART with IVF a Mature oocyte is removed from uterus and fertilized with the sperm.
• In ART with IVF an Embryo is transferred to the uterus.
• Infertility can cause couples to be emotionally and financially exhausted.