Reproductive System Evaluation

Reproductive System Assessment

• Obtain the patient's history, including chronic conditions, infections, surgeries, and treatments like radiation and hormone therapy.
• Ask about past childhood conditions, nutrition, and lifestyle habits such as sleep, exercise, and substance use.
• Ask about obesity and its relation to ovarian dysfunction in females.
• Document all medications and supplements, as they can affect fertility and hormonal balance.
• Note the patient's current complaint, because pain related to reproductive disorders may be confused with gastrointestinal or urinary health problems.
• Family history helps determine genetic risks for reproductive conditions like infertility, cancer, or early puberty.
• Patients may seek care for symptoms like pain, bleeding, discharge, or masses needing evaluation.
• Understand characteristic amounts, sizes, natures, timing, and associated symptoms for proper diagnosis and treatment.

Diagnostics

• The PAP test detects precancerous and cancerous cervical cells and should start at age 21.
• Sexually active patients aged 21-29 should get tested every three years.
• Instruct patients to not douche, use vaginal medications, powders, or deodorants, or have sexual intercourse for at least 24 hours before the test to avoid interference with interpretation.
• The HPV test identifies high-risk HPV infections associated with cervical cancer and detects viruses causing cervical cell changes.
• Testing screens for sexually transmitted diseases like gonorrhea and chlamydia.
• Pituitary gonadotropins such as FSH, LH, and prolactin are helpful in diagnosing male and female reproductive tract disorders.
• Steroid hormones detect estrogen, progesterone, and testosterone levels in men.
• STS and VDRL screen for syphilis; PSA tests screen for prostate cancer and determine further interventions; HIV testing.

Tests

• Ultrasounds assess for fibroids, cysts, ectopic pregnancy, and masses, monitor tumor regression after medical treatment, and differentiate solid tumors from cysts.
• CT scans of the abdomen or pelvis help identify disease processes and metastasis.
• Mammograms are X-rays for assessing breast tissue density and should be performed without creams, lotions, powders, or deodorants; avoid use in pregnant patients.
• Biopsy is a definitive test for cancer.
• Colposcopy examines the cervix, vagina, or vulva with magnification and intense light to locate precancerous and cancerous lesions for biopsy.
• Teach patients to avoid douching or using vaginal preparations 24-48 hours before a colposcopy.
• Hysteroscopy uses a fiberoptic telescope to visualize the uterus, and diagnose and treat causes of abnormal bleeding.
• Laparoscopy is a direct examination of the pelvic cavity via an endoscope to rule out ectopic pregnancy, evaluate ovarian disorders and pelvic masses, and diagnose infertility and unexplained pelvic pain.

Gynecomastia

• Gynecomastia is a benign ridge of glandular tissue within the breast that results from an increased estrogen-to-androgen ratio.
• Male breast cancer accounts for less than 1% of cases, risk factors include family history, BRCA1/BCRA2 mutation, age over 50, radiation or HRT, liver disease, and obesity.
• Manifestations of male breast cancer include a hard, painless subareolar mass, gynecomastia, nipple discharge or rash, inverted nipple, ulceration or swelling of chest, and swollen lymph nodes.
• Men often get diagnosed at later stages because they do not suspect breast cancer, ignore symptoms, or delay seeing a healthcare provider.

Breast Cancer Risk Factors

• Increased age is the primary risk factor for developing breast cancer in both women and men >65 y.o..
• Other risk factors are: female gender, family and genetic history, early menarche, late menopause, prolonged exposure to estrogen and progesterone, obesity, radiation exposure, nulliparity, and not breastfeeding.

Breast Cancer Prevention

• Non-modifiable risk factors include gender, age, genetic factors, race, and family history.
• Imaging techniques used are mammograms for revealing lesions, and ultrasounds for differentiating fluid from solid masses.
• Testing for BRCA1 or BCRA2 is a method of prevention.
• Prophylactic mastectomy is a preventative surgical removal of one or both breasts.
• Chemoprevention involves administering medications like tamoxifen to individuals with an increased risk of developing breast cancer.

Breast Cancer Health Promotion & Maintenance

• Mammography is recommended for women at average risk, beginning annual screening at age 45 or earlier if a family history of breast cancer exists.
• Breast self-awareness involves becoming familiar with how one's breasts look and feel to recognize and report any differences or abnormalities.
• Breast self-examination should be performed monthly, starting at age 20, one week after the menstrual period.
• Clinical breast exams should be part of a periodic health assessment, at least every 3 years for women in their 20s and 30s, and every year for asymptomatic women at least 40 years of age.
• High-risk groups should undergo close surveillance, with cancer screening starting 10 years younger than the age at which the affected family member was initially diagnosed.
• Assess for signs and symptoms like dimpling, redness/hyperpigmentation, warmth, nipple retraction or ulceration, pain/tenderness of breast, lump, or mass.

Breast Cancer Treatment - Surgery

• Sentinel lymph node biopsy (SLNB) is a minimally invasive approach recommended for early-stage breast cancers with low-to-moderate risk for lymph node involvement.
• Absence of cancer cells in the sentinel nodes indicates that no other nodes in the regional area are involved.
• Breast-conserving surgery involves the surgeon removing the part of the breast that contains cancer, plus some surrounding tissues.
• Total (simple) mastectomy involves removal of the whole breast that has cancer.
• Indications for a mastectomy include multicentric disease, inability to have radiation therapy, presence of a large tumor in a small breast, genetic testing results, and patient preference.
• Modified radical mastectomy removes breast tissue, lymph nodes, and sometimes underlying chest wall muscle.

Breast Cancer Nursing Post-Op Care

• Surgeons may place drainage tubes, which need monitoring for amount & color of drainage.
• Avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood.
• Trauma prevention in the affected arm is critical if lymph nodes are removed.
• Elevate the head of the bed to at least 30 degrees, with the affected arm elevated on a pillow while awake.
• Pain control and post-mastectomy exercises are also important.
• Home care includes assistance with drain care, dressings, and daily activities due to pain and limited arm movement.
• Avoid heavy lifting and stretching temporarily, with support from family or caregivers.
• Patient teaching includes how to care for the incision and recognize signs of infection, which must be reported promptly.
• If lymph nodes were removed, elevate the affected arm to reduce lymphedema risk,.
• Encourage wearing regular clothes at home for a positive self-image.
• Patients should continue hospital-taught exercises; starting full range-of-motion exercises one week after surgery while avoiding movements that cause pain.
• Lymphedema is a serious complication involving fluid buildup in the arm after mastectomy, with risk factors including infection, obesity, and radiation.
• Prevention requires lifelong care, including avoiding arm injuries and reporting symptoms like heaviness, swelling, or tingling.
• Patients may need a specialist for compression therapy and drainage techniques.

Breast Cancer Radiation & Systemic Treatment

• Radiation reduces the risk of local recurrence and destroys cancer cells remaining near the original tumor site.
• Chemotherapy, including neoadjuvant therapy, shrinks the tumor before surgical removal and kills undetected cancer cells that may have spread.
• Complementary and integrative therapies can improve quality of life but should not replace standard treatments (e.g., acupuncture, massage, music, aromatherapy, meditation, and yoga).
• Targeted therapy uses drugs to target specific characteristics of cancer cells, like a protein, enzyme, or the formation of new blood vessels.
• Hormonal therapy blocks the effects of hormones or lowers hormone levels to slow or stop the cancer progression.

Invasive Breast Cancer

• Invasive breast cancer grows into the surrounding breast tissue.
• Invasive ductal carcinoma originates in the mammary ducts, and breaks through the duct walls into the surrounding breast tissue.
• As an invasive ductal carcinoma tumor grows, fibrosis develops around the area which results in skin dimpling.
• Inflammatory breast cancer is characterized by diffuse erythema, hyperpigmentation, and edema with peau d’orange.
• Patients with inflammatory breast cancer often report breast pain or a rapidly growing breast lump, tender firm enlarged breast, breast itching.

Non-Invasive Breast Cancer

• Noninvasive cancer remains within the mammary duct.
• Ductal carcinoma in situ (DCIS) is an early noninvasive cancer where cells are located in the duct without invading surrounding tissue; ducts become distended and filled with cellular debris that activates an inflammatory response.
• Lobular carcinoma in situ (LCIS) consists of cells that look like cancer cells and are contained within the lobules; LCIS increase the patient’s risk for developing invasive breast cancer.

Malignant Neoplasms - Ovaries

• Ovarian cancer is often caught later due to vague symptoms and disordered growth in response to excessive exposure to estrogen.
• Risk factors include older age, family history of ovarian or breast cancer, nulliparity, breast or colorectal cancer, infertility, difficulty getting pregnant, and BRCA1+2 gene mutation.
• As prevention, nurses should educate women to "think ovarian".
• S/S include abdominal pain or swelling, GI disturbances, urinary frequency and incontinence, unexplained weight loss, and vaginal bleeding-menstrual irregularities.
• Diagnosis includes BRCA1 + 2, CA-125, and transvaginal ultrasound.
• Treatment includes radiation, chemo, surgery such as total abdominal hysterectomy, BSO, pelvic & para-aortic lymph node dissection.
• Patients need VS & pain control, catheter care, anti-embolism socks, ambulation, and evaluation for respiratory or urinary infection, I/O.
• Patients should avoid tampons, douches, and sex.

Malignant Neoplasms - Cervical

• Cervical cancer originates in the lower part of the uterus.
• Risk factors are HPV infection, multiparity, first pregnancy before age 17, smoking, family history of cervical cancer, oral contraceptive use, history of STDs/many sexual partners, and being immunocompromised.
• Screening and prevention involves annual Pap smears starting at 21 years old, HPV vaccination, pelvic exams, and colposcopy.
• Painless, vaginal bleeding can be a symptom.
• Other symptoms include pelvic or back pain, hematuria/dysuria, unexplained weight loss, and rectal bleeding.
• Treatment interventions include radiation, chemotherapy, loop electrosurgical excision procedure (LEEP), cervical ablation/laser surgery, cryosurgery, conization, and hysterectomy.
• LEEP involves excising affected tissue in cervix with a thin loop-wire electrode ~10-30 minutes as an outpatient procedure: ~3 weeks no sex, no tampon use, no douching, take showers rather than baths, avoid heavy lifting, report vaginal bleeding/foul-smelling drainage/fever.
• Cervical ablation/laser surgery targets abnormal cells with a laser beam ~10-15 min: slight discharge for week, avoid tampon + sex.
• Cryosurgery freezes the cancer, heavy, watery brown discharge for several weeks after procedure
• Conization removal of affected tissue while preserving fertility, long-term follow up care needed.
• Hysterectomy is a tx option of microinvasive cancer if the woman does not wish to become pregnant in the future.

Malignant Neoplasms - Uterine

• Endometrial cancer occurs in the lining of the uterus
• Risk factors include prolonged exposure to estrogen after menopause, nulliparity, early menarche or late menopause, use of BCP or tamoxifen, history of T2DM, ovarian tumors, PCOS, or ovarian cancer, radiation therapy, and age.
• The main sign of endometrial cancer is abnormal uterine bleeding, especially after menopause as well as pain.
• Diagnostic tests/labs include CBC, serum tumor markers, transvaginal ultrasound, and endometrial biopsy.
• Treatment options include radiation, chemotherapy, and total hysterectomy with bilateral salpingo-oophorectomy.
• Surgery includes lab tests, antibiotics, TCDB teaching, IS use, early ambulation, and pain control.
• Psychological and professional approach including core care values are important.
• Post-op includes VS, pain level, incision characteristics, dressing & drains, I/O, CBC, vaginal discharge or bleeding monitoring.
• Discharge instructions include expected physical changes such as no longer having a period, not being able to get pregnant, and possibly experiencing menopausal symptoms. Also limit climbing stairs, heavy lifting, sitting for long and crossing legs, driving after surgery, avoid hot baths and swimming pools. No sex for at least 6 weeks. Report increased vaginal discharge, infection onsite, pain, swelling etc.

Malignant Neoplasms - Testicular Cancer

• Testicular cancer is usually confined to one testicle and has a high cure rate with treatment and testicular self-exam.
• Self-exams should be done monthly after a warm bath or shower.
• To self exam, roll each testicle gently between the thumbs and fingers and feel for any lumps, smooth rounded masses, or any change in size, shape, or firmness and report any lump or swelling to your primary health care provider ASAP.
• Risk factors include cryptorchidism, age between 20-35, HIV/AIDS, and history of testicular cancer.
• Symptoms include painless hard swelling or enlargement of testicle, testicular pain, lymph node swelling, abdominal masses, sudden hydrocele, gynecomastia, oligospermia, and azoospermia.
• Diagnostics include AFP, hCG, LDH, US, CT, and MRI.
• Treatments include sperm banking, surgery in the form of a radical unilateral orchiectomy, radiation, chemo, and post-op care.
• Post-op care includes scrotal support, dry dressing to prevent friction, suture removal 7-10 days after surgery, and to continue self testicular exams on remaining testicle with the option of a prosthesis.

Malignant Neoplasms - Prostate

• Slow growing type of cancer, and androgen sensitive.
• Primary risk factor is Advanced age , have first degree relative w/ the disease, African American, diet high in animal fat (red meat).
• Assess for sings of BPH which are urinary retention, straining to void, weak urine stream, urgency and frequency and difficulty starting urination, Nocturia, Dysuria, Hematuria, Painful intercourse, Pain in multiple areas, Swollen lymph nodes, and irregular nodules in prostate on DRE.
• Take a digital rectal Exam done 2nd to a PSA, be aware increase can also be from other prostate issues.
• Treatements can range from TURP, Orchiectomy, Laparoscopic Radical Prostatectomy, or Open Radical Prostatectomy removal of prostate tumor, prostate gland, bladder neck, seminal vesicle and regional lymph nodes.
• Recontstruction w/ urethra + bladder. May experience retrograde ejaculation, NC: encourage PCA, assist w/ moving, compression device until ambulation, monitor for embolus, I/O, avoid straining, common complication is ED and urinary incontinence, pt will go home with catheter

Medication

• Tamoxifen (Soltamox) is a hormone agonist used in cancer treatment, monitor adverse effects endometrial cancer.
• Cyclophosphamide (Cytoxan) - nephrotoxic, monitor BUN + Cr, observe s/s.
• Doxorubicin (Adriamycin) – affects cardiac cycle, monitor EKG + arrythmias.
• Paclitaxel (Taxol) tx for ovarian + Breast CA, hypersensitivity rxns.
• Methotrexate (Mexate)- pregnancy test prior to initiation.

Liver

• First sign of liver dysfunction is thrombocytopenia secondary to an enlarge speen breaking down too many cells.

Liver - Splanchnic Circulation Information

• The celiac artery, superior mesenteric artery, and inferior mesenteric artery supply oxygen-rich blood to GI organs.
• The hepatic artery supplies oxygen rich blood to the liver.
• The portal vein drains oxygen-poor, nutrient-rich blood from the GI organs to the liver.
• Blood enters the liver through hepatic artery and vein.
• Blood enters sinusoids for filtering.
• Blood that exits the liver travels thru the hepatic vein into IVC into the heart.

Liver - Circulation Pathways

• Oxygenated blood travels from the aorta to the celiac artery, SMA, and IMA to GI organs.
• Nutrient-rich, deoxygenated blood travels from GI organs to the hepatic portal vein.
• From the hepatic portal vein it goes to the liver for filtration.
• Filtered blood leaves the liver via hepatic veins → IVC → Right atrium.
• Blood then circulates to the lungs for oxygenation and then pumped to systemic circulation.

Liver - Functions

• Filter for drugs, chemicals, and alcohol.
• Nutrient Metabolism: stores vitamins A,D,E,K, that requires bile production to absorb/breakdown product. Then produces the energy when needed.
• Production of bile, which breaks down fats and excreting excess bile stores.
• Protects via use of Kupffer cells which are the first defense against bacteria, and removes cell debris.
• Metabolism of bilirubin which is a biproduct of RBC breakdown.
• Synthesizes plasma proteins which helps keep fluids in and reduces fluids leaking out.
• Converts Ammonia to Urea from protein breakdown and excreting the Urea in blood.**ammonia is a toxic byproduct of protein metabolism.
• Regulates glucose levels by storing glucose as glycogen.
• Also stores iron, vitamins, and processes harmful substances.

Assessment Findings

• Alk Phos isn’t 100%v indicator, can be in liver or bones.
• AST, ALT, LDH enzymes will indicate liver is inflamed, more specifically ALT. Bilirubin should be excreted from liver (Tea urine, Pale/clay light), so BUN+ Creatine will increase.
• Ammonia levels will indicate decreased breakdown to urea, monitor nueor satus and bowel movements. Monitor fluid and electrolyte. Give patient Lactulose.
• Coagulation studies PT/INR will increase due to decrease of prothrombin and time to clot, cause high risk for bleeding.
• Platelets will decrease due to thrombopoietin production decrease.
• Serum protein increase in acute disease due to liver detecting decrease in aluminum, then cause decrease do to cells not being able to.
• Coagulation Defects -> decreased synthesis of bile in liver prevents the absorption of fat, that can lead to increased bleeding risk and easy brusing.
• bile in yellow green fluid secreted from liver and stored in gallbladder, bile obstruction can be identified when high unabsorbed fats in feces cause Jaundice.

Diagnostic

• US- Detect ascites, hepatomegaly, slpenomegaly.
• Prescence amount liver fiseas present. Look for lesion and masses via MRI visualization. -EGD- Visual Upper GI.

Portal Hypertension

• A persistent increase in pressure within the portal vein that results from increased resistance to or obstruction.
• Tx: Octreotide vaso constriction and Beta Blockers. (Vasoconstriction will reduce fluid flow)

Types of Ascites

• Not having enough albumin can lead to increase of water and sodium levels. Causes: Portal Hypertension, Vasodilation and movement of Fluid causing increased presure.
• Tx:Fix the P, provide albumin, Diuretic. (Monitor IO and wight, position patients HOB with a low sodium diet)

###Shunts

• Shunts are a tube that help move fluids to relieve pressure to help reduce fluid overload.
• Hepititis
• causes- viruses (pathology leads to defuse inflammatory, infiltration) elevated clothing levels bilirubin or PT, Monitor to help

Viral Hepatitis

• Hepititus A
• Transmission fecal oral / Tx HAV- dose prevention if exposed given a HAIG
• sparingly and give K supplement.
• Hepititus B
• s/s- mild flue w/ in blood and or body fluids.
• TX- help give patient HBIG within 7 days of percutaneous exposure w/2weeks of sexual. Give antivirals.
• Most effective in 12 to 24 hours for prevention.
• Hepititus C
• spread (blood and or blood) Chronic. *Tx with antiviral therapy.
• combo therapy can be managed (pagaSys+rebetol pill).

Pancreatitis

• Is a inflammatory process that can affect the liver if inflammation spreads. This is because its a close atomic and physically relationship.
• GallBlader is the leading cause of billary diseases that affects bile ducks.
• Main cause is from Alchol or Bile ducks.

Liver - Pancreaitis - What is it?

• Pancreaitis acute- leads to issues with the Pancreas becoming more activated instead of active duodenum. Leads to hypocalcemia and/or hypomagnesia.

What does the Pancreais Produce?

• The enzymes Trypsin, Lipase Elastase, Kallikrein, and Amylase.

4 major processes

1. Lipolysis: Enzyme lipase breakdown and fat cells bind to calcium reduced. Leads to hypocalcemia
2. Proteolysis: Where Typsin activates causes clots in the damaged site. This can be fatal in the case of bleeding.
3. Necrosis of Blood Vessels: Break down damage by enyme activation, causing breakdown in vessels.
4. Inflammation- Injury, damage that triggers a release.

Liver - Pancreas

• S and S severe abdominal pain, guarding, Cullens and turners sign. Increase in bilirubin decrease in glucose.

What help maintain it

• Try to REST, use NPO, provide strict pain medicine.

• Chronic Pancreitis: Not reversible, periods w exacerbations of flare ups.

• Malabsorption if facts w/ pale boulky frothing odor s fools from Alchol /auto immue attacks. (What we use it for)

• Cancer can occur from Necortic Panreatic tumors that increase, leads to hypercoagulable state.

• May need a Whpple: to fix, but make sure pt is under care, monitor and give meds by HCOP.