Care of Clients with

Reproductive Issues
ANALIZA M GONZALES MAN, MAEd
Lecturer
 Learning Outcomes
Discuss nursing care of pediatric clients with defects of the genitourinary tract
Analyze clinical manifestations, pathophysiology, clinical treatment and nursing
management of common women’s gynecologic issues.
Compare common gynecologic surgeries.
Differentiate problems related to menstruation
Examine nursing care of clients with Pelvic Inflammatory Disease, endometriosis,
cervical cancer, and ovarian cancer
Describe the collaborative and nursing care of clients with various gynecologic
surgeries.
Discuss nursing care of clients affected by sexual assault.
Analyze clinical manifestations, pathophysiology, clinical treatment and nursing
management of male reproductive tract and urology issues including: Erectile
Dysfunction, BPH, and TURP.
Identify pharmacologic interventions for clients with GU problems
Defects of Genitourinary Tract
Obvious at birth
Early correction of visible genital
defects
– preferably w/o multiple-stage
repairs
Surgery involving sexual organs
particularly disruptive to preschoolers
Cryptorchidism
Undescended testes
Most common congenital testicular condition
May occur bilaterally or unilaterally
May be cause of infertility
if corrective surgery not done by 2 years of age
Incidence of testicular cancer higher
if condition not corrected before puberty
Clinical Manifestations
Therapeutic Management
surgery performed to locate & suture testis or testes to
scrotum
 Hypospadias
Urethral opening located below glans penis or anywhere
along ventral surface of penile shaft
Causes:
– hormonal influences in utero
– Environmental factors
– Genetic factors
Surgical correction
Preferred time for surgical
repair: 6-12mos of age
Nursing care management
 Ambiguous Genitalia
Potential lifetime social strategy for child &
family
Disturbances in normal order of event in gender
determination
produce abnl genitalia & reproductive organ
development w/presence of ambiguous or
indeterminate external genitalia at birth
Can be variable & may often closely conform to
one gender or the other
 Ambiguous Genitalia

Four conditions
– masculinized female
– incompletely masculinized male
– presence of both male & female sexual
organs
– mixed gonadal dysgenesis
Nursing care management
– Best approach is honesty
Circumcision
• Surgical removal of
foreskin on glans penis
• Risks & benefits
Problems Related to
Menstruation
• Premenstrual syndrome (PMS)
Common disorder in women
A group of physical & psychological sx occur during last
few days of menstural cycle & before onset of
menstruation
• Etiology & Pathophysiology
• Clinical Manifestations
• Diagnostic Studies & Collaborative Care
Problems Related to Menstruation

• Dysmenorrhea
– Abd cramping pain or discomfort associated with menstrual flow
– One of most commom gynecologic problems,
– Affect approx. 50% of all women
• Etiology & Pathophysiology
Primary dysmenorrhea
Secondary dysmenorrhea

● Collaborative Care
Problems Related To Menstruation

• Premenopause: may last >5 yrs before true

menopause occurs
• Menstrual variations
• Sudden episodes of vasodilation
• Vaginal dryness
• Changes probably caused by alterations in
hypothalamic-pituitary-ovarian feedback
system
Menopause

• Permanent end of menstruation caused by

decreased ovarian function
• After 1 yr of amenorrhea (absence of
menstruation)
• Average age 51 yrs
• Clinical Manifestations
Therapy for Menopause

• Hormone replacement therapy (HRT)

• Most prevalent treatment
• Oral estrogen taken together with synthetic
hormone progestin
• Progestin added
– To minimize risk of endometrial
hyperplasia & endometrial cancer from
use of estrogen alone
– Potential negative effects of progestins
Therapy for Menopause
• Women’s Health Initiative trial
– HRT should not be prescribed for long-term
prevention of chronic dz
– HRT associated w/inc. risk of breast CA,
thromboembolism, coronary artery dz & stroke
– should only be used for treatment of menopausal
symptoms at lowest dose & shortest duration
possible
Pelvic Inflammatory Disease
• Infectious condition of pelvic cavity
• Infection of fallopian tubes, ovaries, and
pelvic peritonium
• “silent” – women do not
perceive any symptoms
Etiology & Pathophysiology

• Often result of untreated cervicitis

• Most common organisms: _________
• _______ infections can be asymptomatic &
unknowingly transmitted during intercourse
• Silent PID can cause irreversible damage
• Major cause of female infertility
Clinical Manifestations: PID

• Lower abd pain

– Pain usually starts gradually & is constant
– Pain with intercourse
• Spotting after intercourse
• Purulent cervical or vaginal discharge
• Fever & chills
Complications of PID

• Septic shock
• Fitz-Hugh-Curtis Syndrome
• Tubo-ovarian abscesses
• Thrombophlebitis of pelvic veins
• Long-term complications
– Ectopic pregnancy
– Infertility
– Chronic pelvic pain
• Adhesions & strictures in fallopian tubes
Collaborative Care: PID

• Usually treated on outpatient basis

• Abx – Cefoxitin & doxycycline
• No intercourse for ____ weeks
• Examine & treat her partner(s)
• Physical rest & oral fluids
• Hospitalization if tubal-ovarian abscess
present
Nursing Management: PID

• Prevention, early recognition & prompt

treatment of vaginal & cervical infections
• Seek prompt medical attention
• Unusual vaginal discharge
• Possible infection of reproductive organs
Endometriosis

• Presence of normal endometrial tissue in

sites outside endometrial cavity
• Most frequent sites: in or near ovaries,
uterosacral ligaments & uterovesical
peritoneum
• Typical pt:
• late 20s or early 30s, white,
• never had full-term pregnancy
• Etiology
Clinical Manifestations of
Endometriosis
• Dysmenorrhea
• Secondary dysmenorrhea
Collaborative Care:
Endometriosis
• Laparoscopy

• Drug therapy:
– used to reduce symptoms
– inhibit estrogen production by ovary → shrink
endometrial tissue
– controlled but not cured by hormonal therapy
• Surgical removal is only cure
Pharmacologic Therapy for
Endometriosis
• Danazol (Danocrine)
– med of choice for endometriosis
• Commonly used for women w/infertility
associated with endometriosis
• May be used for PMS
Cervical Cancer

• 10,370 women in U.S. have invasive

cervical cancer & 3,700 women die
annually
• African American: 2x Mortality rate
Etiology and Pathophysiology:
Cervical Ca
• Strong relationship between sexual
exposure of ________ virus and dysplasia
• Increased risk associated with
– Low socioeconomic status
– Early sexual activity
– Smoking
Clinical Manifestations: Cervical
Cancer
• Precancerous changes: asymptomatic
• Routine screening very important
Diagnostic Studies: Cervical Ca

• Pap test at least once every 3 yrs,

beginning 3 yrs after 1st sexual
intercourse, but no later than age 21.
Diagnostic Studies: Cervical Ca

• Colposcopy
– Direct visualization of cervix with
binocular microscope
– Allows magnification & study of cellular
dysplasia & vascular & tissue abnl of
cervix
Collaborative Care: Cervical Ca

• Vaccine
– 3 shots over 6 months
• Surgery, radiation & chemo as single
treatments or in combination
Ovarian Cancer

• Malignant neoplasm of ovaries

• 4th leading cause of cancer deaths in
women in U.S.
• Cause unknown
• Greatest risk factor
• Other risk factors
• Use of _____________ assoc. w/lower
ovarian cancer risk
Clinical Manifestations: Ovarian
Ca
• Early stages • As malignancy
– Vague sx grows
– General abd – Inc. in abd girth
discomfort – Bowel & bladder
– Sense of pelvic dysfunction
heaviness – Persistent pelvic or
– Loss of appetite abd pain
– Change in bowel – Menstrual
habits irregularity
– Ascites
– Abnl vag bleeding
Diagnostic Studies for Ovarian
Cancer
• No screening test exists
• Yearly bimanual pelvic exam
• Abd or transvaginal US
Surgical Procedures: Female
Reproductive System
• HYSTERECTOMY

– Total Hysterectomy

– Total abdominal hysterectomy & bilateral

salpingo-oophorectomy (TAH-BSO)
Collaborative care of clients with
gynecologic surgeries
• Preop
– Prepare pt physically for surgery
• Provide psychologic support
Gynecologic Surgeries

• Salpingectomy:
removal of a ___________
• Oophorectomy:
removal of ____________
Surgical menopause results when both
ovaries are removed (bilateral
oophorectomy)
Nursing care of clients after
hysterectomy
• Nursing diagnosis

• Interventions
– Observe dressing freq for sx of bleeding
– Monitor for urine retention & abd distention
– Prevent development of DVT
– Discharge teaching
 Uterine Prolapse

• Downward displacement of uterus into vaginal

canal
• Therapy depends on degree of prolapse & how
much client’s daily activities have been affected
• Pelvic muscle strengthing exercises (Kegel
exercises)
• Pessary
• Surgery
Sexual Assault

• Forcible perpetration of a sexual act on a

person without his or her consent
• Physical manifestations

• Psychologic manifestations
Collaborative & Nursing Care

• Ensure client emotional & physical safety

• Do not clean client until all evidence
collected
– Do not wash, douche, urinate, brush teeth, or
gargle
• Obtain forensic evidence per local protocol
• Obtain baseline HIV, syphillis & other STD
screening
Problems of the Prostate Gland

• Benign prostatic hyperplasia (BPH)

– Enlargement of prostate gland
– from increase in number of
epithelial cells & stromal tissue
– Most common urologic problem
in male adults
– Does not predispose individual
to develop prostate cancer
Etiology & Pathophysiology:
BPH
• Cause not completely understood
• Endocrine changes associated with aging
process
• No direct relationship between size of
prostate & degree of obstruction
• Location of enlargement most significant in
development of obstructive symptoms
Risk factors for BPH

• Family history
• Obesity
• Diet
Clinical Manifestations: BPH

• Symptoms usually gradual in onset

• What are the symptoms???
Complications: BPH

• Acute urinary retention

• UTI & potentially sepsis secondary to UTI
• Incomplete bladder emptying
• Calculi
• Renal failure caused by hydronephrosis
• Bladder damage if treatment for acute
urinary retention delayed
Diagnostic Studies: BPH

• Digital rectal exam (DRE)

• Prostate-specific antigen (PSA)
• Transrectal ultrasound scan in patients
with an abnormal DRE & elevated PSA
Collaborative Care: BPH

• “watchful waiting” with no symptoms or mild

symptoms
• Early detection & treatment
• Diet changes
• Limit ETOH & caffeine
• Avoid meds such as decongestants &
anticholinergics
• Urinate when first feel urge
• Restrict evening fluid intake
Drug Therapy for treatment of
BPH
• 5 Alpha-Reductase Inhibitors – Finasteride (Proscar),
Durastride (Avodart, Duragon)

– Reduce size of prostate gland

– Regression of hyperplastic tissue through suppression of

androgens

– Takes 3 to 6 months to be effective

– Take on continuous basis

– Side effects
Drug Therapy for BPH

• Alpha-Adrenergic Blocking Agents

• Tamsulosin (Flomax); Doxazosin (Cardura); Terazosin (Hytrin)

• Alfuzosin (Uroxatral)

– Side Effects

• Promote smooth muscle relaxation in prostate →

facilitates urinary flow through urethra
• 50% to 60% efficiency in improvement of symptoms
• Improvement of symptoms within 2 to 3 weeks
Herbal Therapy for BPH

• Plant extracts: Saw Palmetto

• Improve urinary symptoms & urinary flow
measures
• Nursing implications:
• Caution in clients with GI disease
– May increase risk of bleeding
• Contraindicated before surgical or dental
procedures
• May increase BP
Invasive Therapy: BPH

• Indication:
• Decrease in urine flow sufficient to cause
discomfort
• Persistent residual urine
• Acute urinary retention with no reversible
precipitating cause
• Hydronephrosis
Invasive Therapy: BPH

• Transurethral
Resection of Prostate
(TURP): surgical
procedure involving
removal of prostate
tissue using a
resectoscope inserted
through urethra
• “gold standard”
surgical treatment for
obstructing BPH
Preoperative Care: BPH

• Restore urinary drainage before surg

• Encourage hi fluid intake
• Coude (curved-tip) catheter
• Treat any UTIs
• Provide opportunity for pt & partner to
express concerns on sexual functioning
after surg
Postoperative Care: BPH

• Major complications
– Hemorrhage, bladder spasms, urinary
incontinence & infection
– Use careful aseptic technique
– Blood clots expected 24 to 36 hrs after surg
– Bladder may take up to 2 months to return to
nl capacity
Erectile Dysfunction

• Inability to attain or maintain an erect

penis
• 20 to 30 million men in U.S. experience
ED
• Can occur at any age, incidence increases
with age
• Can be affected by substance abuse in
younger men
Etiology & Pathophysiology: ED

• Physiologic ED
• Diabetes mellitus
• Vascular disease
• Side effects from medications
• Result of surgery (prostatectomy)
• Trauma
• Chronic illness
• Decreased gonadal hormone secretion
Etiology & Pathophysiology of
ED
• Psychologic ED
• Stress
• Difficulty in a relationship
• Depression
• Low self-esteem
Meds Causing Sexual
Dysfunction in Males

• Anticholinergics
• Antidepressants
• Antihistamines
• Antihypertensives
• Antipsychotics
• Sedatives & social drugs
• Others
Collaborative Care of ED

• Drug therapy:
• Levodopa:
– Effective in stimulating libido & treating erectile
dysfunctions in non-Parkinson’s pts.
• Viagra, Cialis, Levitra
– contraindicated for patients taking nitrates
• Vacuum Constrictive Devices
• Intraurethral Devices
• Penile Implants
• Sexual Counseling
Read/Review: Genital herpes &
Syphilis (ATI)
• Lewis: pp. 1264-1266; pp. 1267-1269
– this content will NOT be on N003 exams
References
Adams, M.P., & Urban, C.Q. (2013), Pharmacology :
Connections to nursing practice (2nd ed.) Boston: Pearson
Education, Inc.
Hockenberry, M.J. & Wilson, D. (2015). Nursing care of
infants and children (10th ed.). St. Louis, MO: Mosby.
Lewis, S., Heitkemper, M. & Dirksen, S. (2014). Medical
Surgical Nursing: Assessment and Management of Clinical
Problems (9th ed.). St. Louis, MO: Mosby
Touhy, T. & Jett, K. (2014). Ebersole & Hess’ Gerontological
Nursing Healthy Aging (4th Ed.). St. Louis: Mosby/Elsevier
STD & AIDS Prevention
The prevention and control of STDs is based on the following
five major concepts:
1. Education and counseling of persons at risk on ways to
adopt safer sexual behavior;
2. Identification of asymptomatically infected persons and of
symptomatic persons unlikely to seek diagnostic and
treatment services;
3. Effective diagnosis and treatment of infected persons;
4. Evaluation, treatment, and counseling of sex partners of
persons who are infected with an STD; and
5. Pre- exposure vaccination of persons at risk for vaccine-
preventable STDs (Hep A and B)
Sexually Transmitted Disease
 90 % of STD’s occur among persons
from 15 – 29.
 There are over 25 known STDs, some of
which are incurable.
 Risks increase:
 More sexual partners
 Alcohol and drug use
Curable and Incurable STDs
Bacterial (curable)
 Chlamydia
 Gonorrhea
 Syphilis

Viral (incurable)
 AIDS
 Genital herpes
 Genital warts
 Hepatitis B
What is HIV and AIDS?
AIDS Aquired Immune Deficiency Syndrome is
caused by HIV Human Immunodeficiency Virus
 HIV attacks lymphocytes (white blood cells)
called T-cells.
 The reduction of T-cells results in a weakened
immune system
 The AIDS diagnosis is made once opportunistic
diseases occur.
 Many AIDS victims can survive for many years
with the use of antiretroviral therapy, which delays
AIDS progression
HIV Symptoms
 There may be no symptoms for up to 10 to
12 years until the immune system is
suppressed enough to cause problems
 Symptoms:
 Chronic fatigue
 Swollen lymph gland
 Unexplained weight loss
Fevers, and night sweats.