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UNIT 4 REPRODUCTIVE AND SEXUAALITY CONDITIONS AFFECTING WOMENA. MENSTRUAL DISORDERS:DysmenorrheaDysmenorrhea is defined as the painful menstruation.MenorrhagiaDefined as a heavy menstrual flow that is abnormal, menorrhagia is the amount of menses that is greater than 80 mL.MetrorrhagiaBleeding be...

UNIT 4 REPRODUCTIVE AND SEXUAALITY CONDITIONS AFFECTING WOMENA. MENSTRUAL DISORDERS:DysmenorrheaDysmenorrhea is defined as the painful menstruation.MenorrhagiaDefined as a heavy menstrual flow that is abnormal, menorrhagia is the amount of menses that is greater than 80 mL.MetrorrhagiaBleeding between menstrual periods is the usual characteristic of metrorrhagia.MittelschmerzThe pain when there is a drop of follicular fluid into the abdominal cavity, leading to the release of prostaglandins, is called mittelschmerz.EndometriosisExtrauterine endometrial cells abnormally grow in the uterine ligaments or ovaries. Postmenopausal bleeding Any bleeding that occurs more than one year after the last normal menstrual period at menopauseThe absence of menstrual flow because of a non-definitive cause can happen in any female who is found to be pregnant or has other related conditions.There are several possible causes, including:1. Menopause2. Stress3. Birth control and medications4. Malnutrition5. Fertility treatments6. Underlying health conditionsHormonal imbalancePelvic inflammatory disease (PID)Uterine fibroidsAbnormal pregnancy; i.e., miscarriage, ectopic (tubal pregnancy)Infection, tumors or polyps in the pelvic cavityCertain birth control devices; i.e., intrauterine devices (IUDs)Bleeding or platelet disordersHigh levels of prostaglandins (chemical substances used to control muscle contractions of the uterus)High levels of endothelins (chemical substances used to dilate blood vessels)Liver, kidney or thyroid diseaseDiagnostic procedures may include:Blood tests - to check for disorders that cause bleeding, nutritional deficiencies, infections, markers of inflammation, and other findings (hemoglobin and hematocrit)Pap test/ smear - to test for cervical cancerUltrasound of abdomen and pelvis, including transvaginal ultrasoundsMagnetic resonance imaging (MRI)Laparoscopy HysteroscopyBiopsy (endometrial)Dilation and curettage (D&C)Urine test - for pregnancy, infection or STDsAssessment: MENSTRUAL DISORDERSSymptoms> typical symptom is when a client has soaked through enough sanitary napkins to require changing every hour, and/or a woman’s menstrual period lasts longer than 7 days in duration, may include clotted blood.> may include spotting or bleeding between menstrual periods- below is an illustration to describe the amount of bleeding in terms of the use of sanitary pads. - other terms used may include: scant, minimal, moderate and fully soaked.> pain - usually described as cramping over the lower part of the abdomen, one sided abdominal pain (mittleschmerz)- dilatation and curettage (D&C) – involving dilation and gentle scraping of the cervix and the lining of the uterus- hysterectomy – the removal of the entire uterus is a drastic last resort, generally only considered for treatment of abnormal uterine bleeding when a serious disease, such as cancer, is also presentB. IMPERFORATE HYMEN> An imperforate hymen is present from birth, but many girls won’t know they have it until puberty.Symptoms often appear when a girl reaches puberty, and may include abdominal pain and swelling that can last days. Other symptoms of an imperforate hymen include: Lack of a menstrual cycle despite having other signs of sexual maturity, such as developing breasts and pubic hair.Abdominal or pelvic pain, often come and going each month.Back pain.Painful urination or no urination at all. This can occur when pooled blood presses against the urethra. The urethra is a tube that carries urine from the bladder to outside the body.Bowel problems, such as constipation.Some women may also have a painful abdominal mass.C. INFERTILITYInfertility/subfertilityInability to conceive after a year or more of regular and unprotected intercourse, or the inability to carry a pregnancy to term.Types; a . Primary infertility – a couple has never been able to conceiveB. Secondary infertility – a couple who has been able to conceive in the past but is currently unable to do so Risk FactorsBehavioral effectsA. cigarette or marijuana smokingB. alcohol use (even in moderation)C. Being 10 % to 15% over or under ideal body weightD. Multiple sexual partnersOccupational and Environmental factors:A. high environmental temperaturesB. Certain chemicalsC. radiationD. heavy electromagnetic or microwave emissions Emotional factors:A. high stress levelsB. Depression D. BREAST DISORDERS: Fibrocystic disease vs Fibroadenoma, Hyperplasia & Hypoplasia Fibroadenomas - tend to be round and have borders that are distinct from the surrounding breast tissue common and are benign tumorsFIBROCYSTIC BREASTSThe lumpiness is due to small breast masses or breast cysts.The condition primarily affects women between the ages of 30 and 50, and tends to become less of a problem after Menopause.SYMPTOMS:breast tenderness or painaccumulated pockets of fluid (cysts), formation of scar like connective tissue (fibrosis), Lump on palpationareas of thickeningColor changes on skin Treatment:MammogramExcision BiopsyInterventions:1. Pain management2. Positioning3. Enhance body image4. Breast self examinationE. CERVICAL POLYPSF. UTERINE TUMORS: MYOMA- A uterine myoma (also called fibroid, leiomyoma, leiomyomata, and fibromyoma) is a benign (non-cancerous) tumour that grows within the muscle tissue of the uterusTypes: A. Submucosal - These myoma develop just under the lining of the uterine cavity.B. Pedunculated Myoma - Fibroids that grow on a small stalk that connects them to the inner or outer wall of the uterusC. Sub serosal - These fibroids develop in the outer portion of the uterus and continue to grow outward.D. Intramural - The most common type of myoma. These develop within the uterine wall and expand making the uterus feel larger than normal (which may cause "bulk symptoms").CAUSE: The cause of myomas has not actually been determined, but most uterine myomas develop in women during their reproductive yearsMyomas tend to grow very quickly during pregnancy when the body is producing extra estrogen. Once menopause has begun, myomas generally stop growing and can begin to shrink due to the loss of estrogen.TREATMENT: Hysterectomy Noninvasive Outpatient MR guided Focused Ultrasound myoma treatment.G.PELVIC SUPPORT DISORDERS A. cystocele – occurs when bladder bulges into the front wall of vagina B. Rectocele – occurs when rectum protrudes into the back wall of the vaginaC. Enterocele – occurs when the small intestine and the peritoneum jut downward between the uterus and rectumD. uterine prolapse – occurs when uterus drops down into the vagina CLINICAL MANIFESTATIONSBasically hernias that protrude through the weakend tissues of the support structureCommon symptoms are feeling of heaviness or pressure in the vaginal areaDyspareunia is sometimes present (painful intercourse)A cystocele may lead to urinary incontinenceA rectocele may lead to constipationManagement:Kegel’s exercisePessary –device inserted in various sizes & shape that can be inserted into the vagina to hold pelvic organs in placeH.OVARIAN CYSTSOvarian cysts are fluid-filled sacs or pockets within or on the surface of an ovaryThe most common type is a a)FOLLICULAR CYST, which results from the growth of a follicle. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg.b)POLYCYSTIC OVARIES (PCOS), the follicles in which the eggs normally mature fail to open and cysts form.Treatment:Oral contraceptives Metformin Ovulation induction agents (eg. Clomid) c)ENDOMETRIOMAS. In women with endometriosis, tissue from the lining of the uterus grows in other areas of the body. This includes the ovaries. It can be very painful and can affect fertility.d)CYSTADENOMAS. These cysts form out of cells on the surface of the ovary. They are often fluid-filled.SYMPTOMS OF OVARIAN CYST: Abdominal bloating or swelling painful bowel movements pelvic pain before or during the menstrual cycle painful intercourseCOMPLICATIONS:Ovarian torsion is a rare complication of ovarian cysts. This is when a large cyst causes an ovary to twist or move from its original positionRuptured cysts, which are also rare, can cause intense pain and internal bleeding. TREATMENT:Birth Control Pills. oral contraceptives stop ovulation and prevent the development of new cysts. Oral contraceptives can also reduce your risk of ovarian cancer. Laparoscopy -tiny incision is done near the navel and then a small instrument is inserted into the abdomen to remove the cyst.LaparotomyHysterectomyG. VAGINAL FISTULAA fistula is a passage or hole that has formed between: Two organs in the body.An organ in the body and skin. A fistula that has formed in the wall of the vagina – vaginal fistulaTypes: A vaginal fistula that opens into the urinary tract is called a vesicovaginal fistula. A vaginal fistula that opens into the rectum is called a rectovaginal fistula.A vaginal fistula that opens into the colon is called a colovaginal fistula.A vaginal fistula that opens into the small bowel is called a enterovaginal fistula. Cause and symptoms:Anal and rectal fistulas are usually caused by an abscess. Symptoms include constant throbbing pain and swelling in the rectal area. Pus is sometimes visible draining from the fistula opening on the skin. Many individuals have a fever resulting from the infection causing the abscess.Vaginal fistulas are caused by infection and trauma to the tissue during childbirthwoman smells unpleasant and leaks urine or feces through her vaginaTreatmentVaginal fistulas are usually treated with surgery through the abdomen or vagina.ADULT MEN: BENIGN PROSTATIC HYPERTROPHYH. BENIGN PROSTATIC HYPERLASIA (BPH) — also called prostate gland enlargement - is a common condition as men get older - An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. - It can also cause bladder, urinary tract or kidney problems.Symptoms: incomplete bladder emptyingnocturia, which is the need to urinate two or more times per nightdribbling at the end of your urinary streamincontinence, or leakage of urinethe need to strain when urinatinga weak urinary streama sudden urge to urinatea slowed or delayed urinary streampainful urination blood in the urineUrinary retentionInterventions:urinating as soon as you feel the urgegoing to the bathroom to urinate, even when you don’t feel the urgeavoiding over-the-counter decongestants or antihistamine medications, which can make it harder for the bladder to emptyavoiding alcohol and caffeine, especially in the hours after dinnerreducing your stress level, as nervousness can increase the frequency of urinationexercising regularly, as a lack of exercise can aggravate your symptomslearning and practicing Kegel exercises to strengthen your pelvic muscleskeeping warm, since being cold can make symptoms worseAdministration of medicationsPreparation of clients for proceduresONCOGENESIS/ CARCINOGENESIS: - is the process through which healthy cells become transformed into cancer cells. - it is characterized by a series of genetic and cellular changes, including oncogene activation, that lead the cell to divide in an uncontrolled manner.- proto-oncogene - normal (pre-mutation) genes, present in normal cells, code for proteins which regulate cell growth and differentiation. - oncogene - mutated versions of proto-oncogenes, contributes to cancer development by disrupting a cell’s ability to control its own growth. Most normal cells will undergo programmed form of rapid cell death (apoptosis) when critical functions are altered and malfunctioning.Stages:1. Initiation - involves the alteration, change, or mutation of genes arising spontaneously or induced by exposure to carcinogenic agents such as:2. Promotion - this stage is considered to be a relatively lengthy and reversible process in which actively proliferating preneoplastic cells accumulate. 3.Progression - is depicted as the time during which the transformed cell develops into a tumor. - large cluster of cells represents a tumor, and smaller cluster of cells represents cells that have detached and metastasized.Metastasis involves the spread of cancer cells from the primary site to other parts of the body through the bloodstream or the lymph system. The five main types of gynecologic cancer are: cervical, ovarian, uterine, vaginal, and vulvar. (A sixth type of gynecologic cancer is the very rare fallopian tube cancer.)Eight gynecological cancer symptoms include:1. Fatigue - cancer cells use up the body’s energy supply 2. Abnormal vaginal bleeding or discharge.3. Bloating or feeling of fullness for multiple weeks or paired with another cancer symptom4. Eating difficulty or feeling full too quick5. Changes in bathroom habits (increased urination, constipation, or diarrhea)6. Unexplained weight loss7. Pelvic pain or pressure - for more than four (4) weeks8. Changes in vulva color or skin (rash, sores, warts, or ulcers), itchingManagement of Gynecological Cancers:Chem oth era p y: Im munoth era p y: H orm one t h era p y: S urg ery- D eb ulk in g s u rg ery : R em ove s a s m uch o f th e tu m or a s p ossib le , ty p ic a lly in pre para tio n fo r c h em oth era py s o th ere w ill b e le ss tu m or to tr e at- T ota l h yste re cto m y: R em ove s th e u te ru s a nd th e c e rv ix- R ad ic al h yste re cto m y: R em ove s th e u te ru s, c e rv ix , a nd p art o f th e v a gin a; m ig ht a ls o r e m ove th e o va rie s, fa llo pia n tu bes, o r n earb y ly m ph n odes- U nila te ra l s alp in go-o ophore cto m y: R em ove s o ne o va ry a nd o ne fa llo pia n tu be- B ila te ra l s alp in go-o ophore cto m y: R em ove s b oth o va rie s a nd b oth fa llo pia n tu bes- O m en te cto m y: R em ove s th e o m entu m ( a fa t p ad w it h in th e a bdom in al c a vit y )- L ym ph n ode r e m oval: R em ove s s o m e o r a ll ly m ph n odes a ffe cte d b y c a nce rR ad ia tio n t h era p y is a n e sse ntia l tr e atm ent fo r m ost g yn eco lo gic c a nce rs , w heth er it ’s u se d a s a p rim ary /c u ra tiv e tr e atm ent o r p ost- o pera tiv e ly , a s a n a dju va nt th era py.Side effects of therapy for gynecological cancersNausea and vomiting.Loss of appetite.Hair loss.Mouth sores.Fatigue (tiredness)Skin irritationsReduced blood countsInterventions:1. Administration of medications such as (analgesics and anti-emetics)2. Discuss treatment alternatives, including the prognosis with each option. 3. Administer pain medications as prescribed. 4. Inspect skin surfaces daily before and after radiation therapy. 5. Provide information on biofeedback training and relaxation techniques for control of moderate pain. Educate client about: Ten things a Cancer Client can do:A. Keep you weight normalB. Eat healthyC. Stand, walk and moveD. Exercise regularly E. Drink minimal or no alcoholF. Find a good balance between sleep and thoughtsG. Avoid tobacco smokeH. Quit smokingI. Join othersJ. Participate in follow up and screeningreferencesE-book Pillitteri, A. (2010). Maternal & child health nursing: care of the childbearing and child rearing family (8th ed). Philadelphia: Lippincott Williams & Wilkins.Pillitteri, A. (2018). Maternal & child health nursing: care of the childbearing and child rearing family (8th ed). Philadelphia: Lippincott Williams & Wilkins.Doenges, M., Moorhouse, M., & Murr, A. (2009). Nursing care plans: Guidelines for individualizing client care across the life span (8thed.). Philadelphia, PA: FA Davis Company. NANDA-I (2011). Nursing diagnoses: Definitions and classification 2012-14 (9th ed.). New York, NY: Wiley-Blackwell.