Reproductive System Function and Data Collection PDF

Chapter 41: Genitourinary and Reproductive Systems Function and Data Collection NORMAL GENITOURINARY AND REPRODUCTIVE SYSTEMS ANATOMY AND PHYSIOLOGY FEMALE REPRODUCTIVE SYSTEM Ovaries: Produce eggs cells by oogenesis (meiosis), which begins and then pauses in...

Chapter 41: Genitourinary and Reproductive Systems Function and Data Collection NORMAL GENITOURINARY AND REPRODUCTIVE SYSTEMS ANATOMY AND PHYSIOLOGY FEMALE REPRODUCTIVE SYSTEM Ovaries: Produce eggs cells by oogenesis (meiosis), which begins and then pauses in the fetus, resumes at puberty, and ends at menopause. - Eggs are released every 28 days - Ovarian follicles produce estrogen and later as the corpus luteum, secrete progesterone as well Fallopian Tubes: The fimbriae of the fallopian tube draws an ovum into the tube, and ciliated epithelium transports the ovum (or zygote if fertilized) toward the uterus. Uterus: Increases in size during pregnancy and contains the placenta which nourishes the fetus until birth. It is divided into three layers: perimetrium (external), the mayo Teri up, and the internal endometrium. The endometrium is a vascular mucous membrane that is lost and regenerated with each menstrual cycle and during pregnancy, it forms the maternal side of the placenta. Vagina: Has an acidic pH to prevent microbial growth and while present, the hymen provides mechanical protection. External genitalia (Vulva): Includes the clitoris, mons pubis, and labia majora and minora. Mammary Glands: Enclosed within the breasts and surrounded by adipose tissue. They produce milk after pregnancy. - Estrogen and progesterone prepare the glands for milk production - Prolactin causes production of milk after pregnancy - Breastfeeding stimulates release of oxytocin, which stimulates the release of milk and contraction of the uterine muscle. Ovarian and Menstrual Cycles: Depends on FSH, LH, estrogen, and progesterone - Follicle stimulating hormone (FSH): Initiates development of ovarian follicles and stimulates the secretion of estrogen by follicle cells. - Luteinizing hormone (LH): Causes ovulation. Converts ruptured ovarian follicle into corpus luteum and stimulates secretion of progesterone by corpus luteum. - Estrogen: Promotes maturation of ovarian follicles and the growth of blood vessels in the endometrium. Initiates development of secondary sex characteristics and promotes growth of duct system of mammary glands. - Progesterone: Promotes further growth of blood vessels in endometrium and inhibits contraction of the myometrium during pregnancy. Promotes growth of secretory cells of mammary glands. - Inhibin: Decreases secretion of FSH toward end of cycle. - Prolactin: Promotes production of milk after birth. - Oxytocin: Promotes uterine contractions during labor and the release of breast milk. The cycle begins with the loss of the endometrium during menstruation, which lasts 5 days. After the endometrium begins to reproduce due to estrogen, FSH increases and several ovarian follicles begin to develop, only one will dominate. The secretion of LH increases and at its peak, it will cause ovulation. After ovulation the ruptured follicle becomes the corpus luteum and will secrete progesterone and estrogen to develop the endometrium. If the ovum is not fertilized, progesterone secretion decreases and the endometrium begins to slough off in menstruation. As progesterone and estrogen decrease, FSH begins to increase and the cycle begins again. The average cycle is 28 days. MALE REPRODUCTIVE SYSTEM Testes: Contains the seminiferous tubules where spermatogenesis (meiosis) takes place. Spermatogenesis is a constant process that continues throughout life. FSH initiates spermatogenesis. LH stimulates the secretion of testosterone which contributes to the maturation of sperm. Secretion of inhibin is stimulated by testosterone and decreases the secretion of FSH, keeping the rate of spermatogenesis constant. Epididymis, Ductus Deferens, and Ejaculatory Ducts: Series of ducts leading sperm into and through the pelvic cavity where secretions are added. Semen then exits via the urethra. - Epididymis: Propels sperm from the testes into the ductus deferens - Ductus Deferens (Vans deferens): Extends from epididymis in the scrotum to the ejaculatory duct within the pelvic cavity. - Ejaculatory ducts: Propel semen through the urethra. Seminal Vesicles, Prostate Gland, and Bulbourethral Glands: The mostly alkaline secretions of the male reproductive glands ensure that many sperm remain viable in the acidic environment of the vagina. The pH of the vagina is 7.4 and allows the sperm to remain motile. Urethra and Penis: Culmination of sexual stimulation is ejaculation and is brought about by peristalsis of the reproductive ducts and contraction of the prostate gland. Spermatozoa: Sperm form in the seminiferous tubules of a testis and are stored in the epididymis. AGING AND THE REPRODUCTIVE SYSTEM: - Women have a definite end to reproductive capability called menopause, which occurs when periods have ended for 12 months. Usually occurring between the ages of 45 and 55. - Estrogen secretion decreases - Ceases ovulation and menstraution - Atrophy of vaginal epithelium - Increased cholesterol level - Increased risk for coronary artery disease - Atrophy of urinary meats and decreased urethral tone - Increased incontinence - Increase in bone loss - Risk for osteoporosis and fractures. - For men, testosterone secretion continues throughout life, as does sperm production. The most common problem for older men is enlargement of the prostate gland, called benign prostatic hyperplasia - Decrease in testosterone secretion  - Decreased spermatogenesis - Gradual decrease in muscle size and strength - Increase in bone loss (less than women) - Risk for fracture - Hypertrophy of prostate gland - Urine retention FEMALE REPRODUCTIVE SYSTEM DATA COLLECTION NORMAL FUNCTION BASELINES - Regular, relatively pain-free shedding of the endometrial lining of the uterus (menstruation) is expected from puberty through midlife. - Intercourse free of pain and infection and generally results in pregnancy within a few months and should last 40 weeks and produce a healthy child. - Physical and psychological sexual characteristics and function, including libido are expected to be adequately maintained by hormones. - Much of what happens in the female reproductive system disorders occur within the body and may not show external signs. - Use WHATS UP? Format to discover signs and symptoms related to pain. Health History: General personal information, as well as menstrual, obstetrical, gynecological, sexual, family, and psychosocial histories. - Obstetrical history includes number of pregnancies, pregnancy outcomes, and complications - GTPAL system Objective Data Collection for Female Reproductive System: - Clinical Breast Examination (CBE): Observe and palpate for swelling, lumps, skin changes, and nipple exudate - Abnormalities may indicate breast cancer or fibrocystic breast disease - External genitalia: Observe for color, symmetry, hair distribution, lesions, swelling, and exudate - Abnormalities may indicate vulvar cancer, developmental abnormalities, infection or injury. - Vagina: Observe for shape, bulges, color changes, lesions, and exudate. - Changes may indicate infection, structural abnormalities, or injury. - Internal Genitalia: Palpate for tenderness, size, shape, and mobility. Observe for color, lesions, exudate, and bleeding. - Changes may indicate infection, structural abnormalities, cervical cancer, polyps, endometriosis, fibroid/malignant tumors, pregnancy, or injury. - Perineum: Observe for lesions and shape - Abnormalities may indicate infection, structural abnormalities,or injury. - Anus: Observe for shape, color changes, and lesions - Abnormalities can indicate hemorrhoids or injury. - Inguinal Nodes: Palpate for swelling and tenderness - May indicate infectious process or regional malignancy. BREAST EXAMINATION Palpation: Palpation is the best technique for breast examination to identify alterations from normal consistency, confirm the presence of lumps, and locate areas of tenderness. Breast Self Examination (BSE): Self palpating if done regularly and throughly may be even more sensitive than HCP or nurse palpation Patient Education: - BSE should be done 1 week after menses when selling of normal breast tissue is at a minimum. - Puckering or dimpling of skin, asymmetrical movement, and different pointing position of the nipples should be reported. - Examination should be methodical and cover all areas of the breast including the tail of Spence, which extends into the axilla. DIAGNOSTIC TESTS OF THE BREASTS Ultrasound and Mammography: Ultrasound can determine the density of the tissues and map breast structures and is useful for distinguishing fluid filled (cystic) lumps from solid tumors. Mammography is a radiographic (X-ray) examination of the breasts. - Women aged 40-44 have the option to start screening mammograms yearly - Women aged 45-54 should get mammograms yearly - Women aged 55+ can switch to every other year or continue yearly - All women should know how their breasts look and feel and should report any changes. MRI and mammograms every year are recommended for women at high risk for breast cancer - Those with BRCA1 or BRCA2 genetic mutations or strong family history. Patients should bathe and not apply deodorant, powder, or any other substance to upper body because they can cause false shadows on the test. Thermography, Computed tomography Scan, and MRI: - Thermography maps the breast using photographic paper that records temperature variations throughout tissue in different colors. - CT or MRI offers precise location of tumors without displacement Biopsy: Further assessment of suspicious lesions found. - Done by surgical removing a portion of tissue or by aspirating fluid or cells through a needle placed into the lesion. - Remain calm and explain procedure to patient, reducing anxiety and making it less traumatic. Laboratory Tests: Blood test can be done to identify mutations in BRCA1 and BRCA2 genes that are associated with breast and ovarian cancer. - Testing can be offered to those with family history or high risk BONE HEALTH DATA COLLECTION - Women of child rearing age produce estrogen, which helps prevent bone loss and works with calcium and other minerals to build bone. - As women age and approach menopause, estrogen production slows and slows the building and remodeling of bone. - Supplements should not be used. Women should get recommended calcium and vitamin D amounts through diet. DIAGNOSTIC TESTS OF THE BONES: Menopausal women older than age 50 who are not on hormone replacement therapy should be assessed for bone loss.  - Best test for bone density is a dual-energy x-ray absorption entry (DEXA) scan which measures bone density at hip or spine. - CT scan can also determine bone density. ADDITIONAL DIAGNOSTIC TESTS OF THE FEMALE REPRODUCTIVE SYSTEM Hormone Tests: Used to assess endocrine system function as it relates to reproduction. Tests can measure potential fertility, find reasons for abnormal menses, assess hormone-producing tumors, and determine efficacy of treatments to adjust hormone levels. Pelvic Examination: Allows visual inspection of the vagina and cervix as week as sampling of mucus, discharge, cells, and exudates. Bimanual Palpation: Often done during a pelvic exam. They can allow one to feel the size, shape, and consistency of the uterus and adnexa and to check for any abnormal growths. Cytology: Study of cells taken as tissue samples. - Pap smear: One or more small samples are gently scraped away from the surface of the cervical canal. - Cells may be collected by conization: removing a small cone-shaped sample from the cervical canal, or punch biopsy, which removes a small core of cells. - Endometrial biopsy specimens are samples of cells taken from the lining of the uterus by scraping with a small spoon-shaped tool called a curet. - Nursing Care: - Cells die and degrade rapidly once removed so they must be packaged securely for transport to lab facilities. - Removal of sample may cause bleeding, swelling, or later, inflammation so monitor the patient after the procedure and educate the patient of complications to report if they occur. Swabs and Smears: Done to determine which microorganisms are causing infection and which antibiotics should be used to treat them. - Chlamydia samples are especially difficult to transport and special kits are available for this pathogen. - Some microorganisms such as yeasts and Trichomonas can be identified from smears on slides. - Wet mounts: Smears of discharge spread onto a slide and must be taken to the microscope immediately. Sonography: May be used to determine size, shape, development, and density of structures associated with the female reproductive system as well as fetal measurements and some types of prenatal diagnosis. - Useful for differentiating cysts from solid tumors and locating ectopic pregnancies and intrauterine devices. - Full bladder may be required for some tests Radiographic procedures: CT and MRI are used to locate tumors of the reproductive system. - Hysterosalpingogram: Dye is injected into uterus until it comes out the ends of the fallopian tubes to identify congenital abnormalities in the shape or structure of the uterus and blockage of fallopian tubes. - Nursing Care: Preparation may include a laxative, enema, or suppository. - Ask about allergies to dye or iodine.  - After procedure monitor for symptoms of nausea, lightheadedness, and signs of allergic reaction. - Promote comfort: Cramping may occur. - Advise patient to wear peri-pad until vaginal discharge stops. Endoscopic Examinations: Visually inspect internal areas to diagnose (and sometimes treat) reproductive disorders. - Laparoscopy: Views abdominal cavity and is useful in identifying problems such as endometriosis. - Salpinogoscopy: See the inside of the fallopian tubes. - Hysteroscopy: See the inside of the uterus. - Colposcopy: Binocular microscope is used with an endoscope introduced into the vagina to closely study lesions of the cervix. - Culdoscopy: Endoscope introduced into the vagina and through a small incision in the vagina into the cul-de-sac of Douglas (cavity behind uterus) to observe for abnormalities in this region. - Nursing Care: Make sure patient has fasted as instructed, assess vital signs, record time of last voiding, helping patient into gown, and ensure informed consent has been signed. - Post-op provide comfort. Pain may be experienced in the neck, shoulders, and upper back if CO2 was pumped into the body compartment being examined. This is called Insufflation and increases the distance between structures for easy visualization - Patient Education: Advise patient to observe incision site for redness, bleeding, or drainage and notify HCP if these occur. - Advise patient to wear peripad until drainage stops - Report any bright red bleeding after operative day and any fever or foul-smelling discharge. MALE REPRODUCTIVE SYSTEM DATA COLLECTION Health History: Use a professional attitude and explain why the information is important. Ask questions about ejaculation history so men can talk about difficulties they are experiencing. Physical Exam: - Normal male pubic hair grows in a triangular shape up toward the umbilicus. - Excess breast tissue may indicate gynecomastia from an excess of femal hormones. Hair or breast abnormalities may indicate a hormone imbalance. - Penis, scrotum and testes are examined by observation and palpation by an examiner. - Size can vary greatly and should not be a concern unless it is abnormally small (microphallus) or edematous. - Left testis typically hangs slightly lower in the scrotum than the right - Make sure the urethral opening is at the tip of the penis. - Hypospadias: Urethral opening on underside of the shaft. - Epispadius: Urethral opening on the dorsum of the shaft. - Check uncircumcised penises for signs of inflammation or foul-smelling discharge.  - Testes are egg shaped and should feel smooth and rubbery when lightly palpated between thumb and fingers. - If a fluid filled mass (hydrocele) is found, further evaluation should be done. - Transilllumination test: Noninvasive test to determine whether a mass is fluid-filled or solid. - Use a flashlight behind the scrotum. - Fluids appear with a red glow, solids appear opaque. - Varicocele: Swelling of the veins of the spermatic cord - Feels like a bag of worms. - Evaulated for inguinal hernias by pressing up through the scrotum into each of the inguinal rings while asking to cough or bear down. - Digital Rectal Evaluation (DRE) palpates the prostate by inserting a gloved, lubricated finger into rectum while the man is in left sims or standing and bending at right angle. - Entire posterior lobe of the gland can be felt this way. - If it is very hard, soft, feels enlarged, or contains any lumps, a rectal ultrasound with needle biopsy may be ordered. - A swollen, painful prostate generally indicates that an infection is present. - Even with surgery, prostate tissue can regrow over time and cause issues again. - Remind all men aged 50 and older about prostate cancer screening TESTICULAR SELF EXAMINATION - Should be done monthly to detect tumors or changes in scrotum. BREAST SELF EXAMINATION Men should be familiar with their breasts and report changes. Although rare, men can have breast cancer. DIAGNOSTIC TESTS Of THE MALE REPRODUCTIVE SYSTEM Ultrasound: Done to diagnose or evaluate various male reproductive or genitourinary problems. - Transrectal ultrasound can help diagnose prostate cancer - Rectal probe is inserted into the rectum and sound waves are used to evaluate the prostate gland. - Pelvic or scrotal ultrasound helps evaluate and locate masses. - An enema may be ordered before the procedure. No specific after care is necessary. Cystourethrography: Evaluate the degree of obstruction by an enlarged prostate gland. Foley catheter is inserted and dye is injected into the bladder; Radiographs are taken with the dye in the bladder and while voiding after the catheter is removed. - Void before procedure. - Intake and output measured for 24 hours after procedure - Fluids encouraged to promote excretion of dye - Warm, moist cloth held over urethra can assist with mild pain Laboratory Tests: - Prostate Specific Antigen (PSA): Glycoprotein produced by prostate cells. Elevated level indicates prostatic hypertrophy or cancer (normal range is 4 ng/mL) - Prostatic Acid Phosphatase (PAP): An enzyme affecting metabolism of prostate cancer cells. Normal value is less than 3 ng/mL. Elevated level may indicate prostate cancer.  - Other Tests: Other tests may be performed if prostate cancer is suspected or diagnosed. Acid phosphate may be elevated in metastatic prostate cancer and alkaline phosphate and serum calcium levels may be elevated if metastasis to the bone has occurred. Tests for Infertility: Various hormone levels may be measured, includingFSH, LH, testosterone, adrenocorticotropic hormone (ACTH) to help determine cause of infertility in male patients. - Semen may be evaluated for sperm count, mobility, and shape. - Other tests determine if sperm contains adequate nutrition to support sperm, whether antibodies to the sperm are present, and whether sperm can penetrate an ovum. - Nursing Care: - Refrain from evacuation for 3 days before collection of the semen sample - Sample must be taken to laboratory within one hour of collection. TRANSGENDER POPULATION DATA COLLECTION Transgender is a term used to describe individuals who identify with a gender that does not match their gender at birth. - Patients transitioning from male to femal may be prescribed a combination of estrogen and medications that decrease androgen levels. - Patients transitioning from female to male may be taking testosterone. - The transgender patient should receive appropriate tests related to the gender assigned at birth. - A psychosocial assessment and depression screening should be completed.