OB E1 - Reproductive Issues PDF

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OB E1 – Reproductive Issues ChMenstruation = It is the normal, predictable physiologic process whereby the inner lining of the uterus (endometrium) is expelled by the body. = breaking down of the endometrium.The uterus is preparing to hold a baby. If there is no baby, the lining will shed  menstrua...

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OB E1 – Reproductive Issues Ch4

Menstruation = It is the normal, predictable physiologic process whereby the inner lining of the uterus (endometrium) is expelled by the body. = breaking down of the endometrium. The uterus is preparing to hold a baby. If there is no baby, the lining will shed  menstruation After shedding/menstruation  it will go into growth stage The secretory/secretion stage begins at ovulation to about 3 days before the next menstrual period. Under the influence of the hormone, the endometrium gets thicken and more vascular  These dramatic changes are all in preparation for implantation if it is to occur.

The avg of menstrual cycle is 28 days  If the cycle is irregular, the ovulation date will be different  Ovulation is usually 14 days before your next cycle o ex: if the women’s cycle is 28 days (like in the picture), the ovulation should be day 14 o ex: if a women’s cycle is 30 days, the ovulation should be 16  The sperm can live for 2 – 3 days in the cervix  Intercourse 1 or 2 days before ovulation can lead to pregnancy. o For a woman with a cycle of 30 days, sex on day 14 might get pregnant

Common Menstrual Disorders      

Amenorrhea = Absence of menses Dysmenorrhea = painful menstrual cycle Dysfunctional uterine bleeding (DUB) = bleeding outside of the cycle Premenstrual syndrome (PMS) = symptoms before each cycle Premenstrual dysphoric disorder (PMDD) Endometriosis

Menstrual Disorder Vocabulary

Menarche = the first occurrence of menstruation  Usually by age 12 - 14

Common Women’s Reproductive Disorders    

Menstrual disorders Infertility Contraception Abortion = discontinuation of pregnancy where fetus came out before 20 weeks, same as miscarriage  Menopause o Usually occurs between 50-60, could be as early as 45 for some women

Amenorrhea  = Absence of menses during reproductive years  Two Types: Primary and secondary o Two types of primary amenorrhea  Absence of menses by age 14 with absence of development of secondary sexual characteristics  Absence of menses by age 16 with normal development of secondary sexual characteristics o Secondary amenorrhea:  absence of menses in women who previously menstruated that is related to another condition or disorder  ex: athletes, obesity, stress, anorexia, hormonal issues, pituitary gland tumors Question #1 Is the following statement true or false? Primary amenorrhea occurs in women who have previously menstruated regularly. a. True b. False

Dysmenorrhea  = Painful menstruation  s/s: severe abdominal pain, poor around other people socially, breast tenderness, food craving, dizziness Types  Primary (spasmodic) o Increased prostaglandin production (primary)  Secondary (congestive) o Pelvic or uterine pathology (secondary) o Endometriosis most common cause of secondary dysmenorrhea Question #2 Is the following statement True or False? Endometriosis is the most common cause of secondary dysmenorrhea. a. True b. False

Nursing Management of Dysmenorrhea Nursing assessment  Past medical history, sexual history, menstrual history; bimanual pelvic examination  Manifestations: pain, nausea, vomiting diarrhea, fatigue, fever, headache, dizziness; bloating, water retention, weight gain, muscle aches, food cravings, breast tenderness Client education  Comfort measures: heat pad, lifestyle changes, pain relief with mild pain meds  Teaching Guidelines 4.3

Dysfunctional Uterine Bleeding      

Similar to and may overlap with other uterine bleeding disorders = abnormal uterine bleeding Occurs most often at beginning and end of menstrual cycle Etiology related to hormone disturbance Treatment involves treating the underlying cause Nursing management involves client education

Premenstrual Syndrome (PMS)  Wide range of recurrent symptoms  More severe variant: Premenstrual dysphoric disorder (PMDD) o Etiology: unknown o Therapeutic management  Multidimensional approach  Vitamin supplements, diet changes, exercise, lifestyle, medications Categorizing Premenstrual Syndrome (PMS) Symptoms  Nursing assessment: irritability, tension, dysphoria (most prominent and consistent symptoms) o A: anxiety o C: craving o D: depression o H: hydration o O: other  ACOG criteria  Mood disorders: main symptoms of PMDD

Treatment Options for PMS and PMDD

Depending on how badly it is affecting the patient, some physicians will put them on some antidepressant medication because some persons really show signs of depression. Question #3 When assessing a woman for premenstrual syndrome, which of the following would the nurse be least likely to find? a. Irritability b. Tension c. Dysphoria (a state of unease or generalized dissatisfaction with life) d. Weight loss

Endometriosis It is caused when tissue similar to that of the endometrium implants outside of the uterus (painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus.)  when the lady has her menstrual cycle, it's very painful because those areas also shed.  patient could be anemic but cannot find the reason because the blood is not going outside, so they don't realize she's bleeding except for her having severe abdominal pain.  Etiology: risk factors; exact cause unknown  Therapeutic management o Surgery - usually surgically corrected if the hormone therapy is not working o Medication therapy  Nursing assessment: o infertility and pain o nonspecific pelvic tenderness o tender nodular masses on uterosacral ligaments, posterior uterus, or posterior cul-de-sac  Management o Education o Healthy lifestyle habits o Support groups

Infertility  = inability to conceive a child after 1 year of regular sexual intercourse unprotected by contraception  Primary or secondary o Primary infertility = this woman has never been pregnant o Secondary infertility = the inability to conceive after a previous pregnancy  Cultural expectations for reproduction  Impact of culture, ethnicity, and religion on perceptions and management of infertility  Multiple known and unknown factors affecting fertility  Male and female risk factors o Need to do a semen analysis in the male o Checking female’s hormone and if she is actually ovulating o If both man and woman are okay  can try artificial insemination, in vitro fertilization, surrogate, adopt  Therapeutic management: drugs or surgery Nursing Management of Infertility  Respect for couple  Education, anticipatory guidance, stress management, counseling  Assistance in decision making; advocacy  Assistance with financial strategies Fertility Assessment  Male factor assessment: o semen analysis, sexual characteristics, external and internal reproductive organ examination, digital prostate examination o reasons for man to be infertile: undescended testes, history of mumps  Female factor assessment: o ovarian function, pelvic organs  Laboratory and diagnostic testing:

o home ovulation predictor kits, clomiphene citrate challenge test, hysterosalpingogram, laparoscopy Selected Treatment Options for Infertility

*Not tested

Contraception  Dental damn o latex or polyurethane sheets used between the mouth and vagina or anus during oral sex. Behavioral Methods  Abstinence  Fertility awareness o Cervical mucus ovulation method o Basal body temperature o Symptothermal method o Standard days method o woman checking her temperature because her temperature goes up a little bit when she is ovulating. She's also checking her mucus because the mucus plug comes down, and it is a little thicker than egg white when it's time for ovulation.  Withdrawal (coitus interruptus) o A man controls his ejaculation during sexual intercourse and ejaculates outside the vagina. o Known as “pulling out” o The problem with this method is that the first few drops of the true ejaculate contain the greatest concentration of sperm, and if some preejaculatory fluid escapes from the urethra before orgasm, conception may result. o The typical failure rate is estimated at 18% to 22% o This method requires that the woman rely solely on the cooperation and judgment of the man. o Nurses might discuss the use of emergency contraceptives with this couple or use of a more effective method of contraception.  Lactational amenorrhea method

Barrier Methods  Condoms (male and female) o MALE condom  put on over an erect penis before it enters the vagina and is worn throughout sexual intercourse  it offers protection against STIs  breakage and slippage can occur o FEMALE condom  It is a polyurethane or nitrile pouch inserted into the vagina to catch the male ejaculate  Diaphragm o a soft latex or silicone dome surrounded by a metal spring o it is inserted into the vagina to cover the cervix o The diaphragm may be inserted up to 2 hours before intercourse and must be left in place for at least 6 hours afterward. o available only by prescription and must be professionally fitted by a health care provider  Cervical cap o smaller than the diaphragm and covers only the cervix o The cap may be inserted up to 36 hours before intercourse and provides protection for 48 hours.  Contraceptive sponge o nonhormonal, nonprescription device that includes both a barrier and a spermicide. o soft concave device that prevents pregnancy by covering the cervix and releasing spermicide. o does not offer protection against STIs o It can be inserted up to 24 hours before intercourse and should be left in place for at least 6 hours following intercourse.

Hormonal Methods  Oral contraceptives o OCs work primarily by suppressing ovulation by adding estrogen and progesterone to a woman’s body, thus mimicking pregnancy. o when you forget or as soon as you forget, you should just take as soon as possible.  Injectable contraceptives o Injectable contraception includes progestin-only and combination estrogen and progestin agents that provide safe and highly effective birth control for up to 3 months. o Given IM or SQ o NOTE - if you take this, it can take up to one year for your fertility, to return to normal.  Transdermal patches o 91% effective o what you do is you wear a patch on certain parts of your body your belly upper arm butt or back  And it releases hormones, through your skin that prevent pregnancy o When applying the patch, you want to make sure you don't have any lotion oils or powder makeup where you put the patch. o you want to change your patch every week on the same day, so if you put it on this Wednesday have to change it again the next Wednesday. o as soon as you take the patch off, you can get pregnant  Vaginal rings o Insert the ring into your vagina once a month o 99% effective o if the ring does come out, you can always just rinse it with warm water and put it back as soon as possible  Implantable contraceptives o Over 99% effective o The implant is a very small rod inserted under the skin of a woman's upper arm to provide birth control. o Remove it whenever you want

o Limited side effects  Intrauterine contraceptives o small T-shaped object that is placed inside the uterus to provide contraception o inserted by a nurse or doctor o 99% o Limited side effects o Copper IUD and hormonal IUD  Emergency contraception o known as the morning after pill. o used after sex unprotected sex or following an error to stop pregnancy o It should be taken orally within 72 hours after unprotected sex and the longer you take to use it, the less the effectiveness becomes. So it's 85 to 90% effective when you take it within 72 hours. o Side effect: N/V; if you do vomit within two hours, you should take it again. o It can cause lasting menstrual irregularities, if you take it as your primary method, so you don't want to make this like your regular method of birth control, it's just for emergency. Sterilization These are permanent methods  Tubal ligation o Sterilization for women o A laparoscope is inserted; fallopian tubes are grasped and sealed o Can be reversed  Vasectomy o Sterilization for men o Usually performed under local anesthesia o Involves cutting the vas deferens, which carries the sperm

Menopause Menopause usually start between people who are 45-60; People who have early menarche will tend to have an early menopause. (considering 35 years of fertility) Menopause being the end of fertile years does NOT mean the end of her femininity or sexuality  Brain: hot flushes; sleep, mood, and memory problems  Heart: lower levels of HDL; increased risk of CVD  Bones: bone density loss; increased risk of osteoporosis  Breasts: duct and gland tissue replaced by fat  Genitourinary: vaginal dryness, stress incontinence, cystitis o For vaginal dryness  use water-based lubricant  GI: less Ca+ absorbed; increased fractures  Skin: skin dry (more prone to wrinkles), thin; collagen decreases o Encourage to increase fluid consumption o Use moisturizer to keep skin moist

Menopause Transition Nursing assessment  Screening for osteoporosis, cardiovascular disease, and cancer risk  Lifestyle to plan strategies to prevent chronic conditions Nursing management  Health maintenance education; risk reduction  Lifestyle modifications  Stress management...