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What are the organs of the female reproductive system?
Ovaries, uterus, Fallopian tubes and the vagina
Ovaries / gonads
A pair of almond size/ shape. At puberty they release progesterone and the female sex hormone estrogen, and they release a mature egg during the menstrual cycle.
Fallopian tubes
A pair of ducts approximately 4 inches long. One opening is to the fun us and the other end into the peritoneal cavity over the ovary.
Where does fertilization take place?
Fertilization takes place in the outer third of this tube. The fertilized ovum (zygote) is moved through the tube by a combination of muscular paristaltic movements and the sweeping action of the cilia.
Uterus
Shaped as an invertedpear 3x2x1 inches. Located between the urinary bladder and rectum.
What are the 3 layers of tissue in the uterus?
Endometrium (inner layer), Myometrium (middle layer) , Perimetrium (outer layer)
What are the major portions of the uterus?
Fundus (upper rounded portion), Corpus (body), Cervix (goes oartway into the vaginal vault)
How big can the uterus get during pregnancy?
It is capable of enlarging up to 800 times
Vagina
A thin walled, muscular, tube like structure of the female genitalia, approximately 3 inches long.
External Genitalia / vulva structures?
Mons pubis, Labia Majora, Labia Minora, Clitoris and Vestibule.
Paraurethral / Skenes, glands
Largest glands opening into the urethra.
Bartholins gland (vestibular)
Bilateral to thevaginal opening are 2 small, mucus-secreting glands which lubricate the vagina for sexual intercourse.
Perineum
The area enclosing the region containing the reproductive structures, starts at the symphysis pubis and extends to the anus it is diamond shaped.
Mammary glands (breast)
Attached to the prctoral muscle. Each breast contains 15-20 lobes that are separated by adipose tissue. Within each lobe are many lobules that contain milk-producing cells that lead to the Lactiferous ducts that empty into the nipple.
Nipple
Composed of smooth muscle that erects the nipple, the areola surrounds the nipple. Milk production doesn\'t start until after birth. Prolactin forms the milk and oxytocin releases it.
Menarche / Menstrual cycle
Begins at approximately 12 yrs of age. 3 phases : menstraul, preovulatory and postovulatory.
Colposcopy
Visualization of vagina and cervix under low-power magnification
Culdoscopy
Insertion of a culdoscope through posterior vaginal vault into Douglas\'s cul-de-sac for visualization of Fallopian tubes and ovaries.
What can be done during a Culdoscopy procedure?
Conization to remove eroded or infected tissue. N/I post -assess for bleeding, vs, and monitor voiding.
Laparoscopy
Examination of the abdominal cavity with a laparoscope through a small incision made beneath the ambilicus, then insufflation of abdomen with carbon dioxide, provides direct visualization of the uterus and the adnexa.
What side effect does the introduction of carbon dioxide have afterward?
Shoulder pain
Papanicolaou test ( Pap Smear)
A simple smear method of examining stained exfoliative peeling and sloughed-off tissue or cells used to detect cervical cancer.
When does the American cancer society recommend a pap smear be done?
It should be done within 3 yrs after becoming sexually active or no later than 21 years of age.
Dilation and Curettage (D&C)
Scraping of the material from the wall of a cavity or other surface; performed to remove tumors or other abnormal tissue for microscopic study a procedure used to obtain tissue for biopsy, to correct cervical structures and to treat dysmennorrhea.
Why is a second incision in a laparoscopy done?
Its done to allow a instrument insertion for biopsy or organ manipulation. Ovaries and Fallopian tubes are observed for masses and ectopic pregnancy, adhesion, PID pelvic inflammatory disease and tubal libation.
What is an expected complaint after laparoscopy?
Shoulder pain because of the carbon diaxide being introduced into the abdomen.
Paponicolaou Test (Pap Smear)
A simple smear method of examination stained exfoliative peeling and sloughed off tissue or cell ; used for the early detection of cervical cancer.
When does the American Cancer Society recommend a Pap Smearbe done?
Pap Smear should be done within 3 yrs of becoming sexually active or by the age of 21.
Conization of the cervix
Used to remove eroded or infected tissue or confirm cervical cancer. Observe pt for bleeding/ done same day
Dilation and Curettage (D & C)
Scraping of material from the wall of a cavity or other surface ; performed to remove tumors or other abnormal tissue for microscopic study. This procedure is used to obtain tissue for biopsy, to correct cervical stricture, and to treat dysmenorrhea.
Why is a breast biopsy performed and why?
It is performed to differentiate benign or malignant tumors. The biopsy is performed by fine needle aspiration (FNA) ; stereotactic or ultradound core biopsy, under local anesthetic ; or surgical biopsy, with general or local anesthetic.
What is cervical biopsy and how is it performed?
It is done to evaluate cervical lesions and to diagnose cervical cancer. It is done without anesthesia with a colposcope that is inserted through the vaginal speculum for direct visualization, the cervical site is selected and cleansed and tissue is removed.
What is endometrial biopsy and how is it performed?
It is performed to collect tissue for diagnosis of endometrial cancer and analysis for fertility studies. Performed at the time of menstration when the cervix is dilated. Cervix is locally anesthetized, a curette is inserted, and tissue is obtained from selected sites of the endometrium.
Cultures and smears
They are collected to examine and identify infectious process, abnormal cells, and hormonal changes of the reproductive tissue. Cultures are taken from exudates of the breast, the vagina, the rectum and the urethra.
What is the Schillers Iodine Test for and how? What\'s normal / abnormal
It is done for early detection of cancer cell and to guide the physician in doing a biopsy. An iodine preparation is applied to the cervix, and glycogen which is present in normal cells, stains brown. Abnormal or immature cells do not absorb the stain. After procedure the pt should wear a perineal pad to avoid staining of clothes.
Hysterograms and Hysterosalpingograms are studies for visualizing the uterine cavity to confirm what?
1. Tubal abnormalities (adhesion and occlusions), 2. The presence of foreign bodies, 3. Congenital malformations and leiomyomas (fibroids), 4. Traumatic injuries
What is a Mammography and when should it be done?
A radiography of the soft tissue of the breast to allow identification of various benign and neoplastic processes, especially those not palpable on physical examination, can detect a mass as small as 0.5 mm. The recommended baseline mammograms for women should be between 35-39 years of age and annually after 40 yrs old.
What is a Tubal insufflation (Rubins Test), how is it performed, what\'s an expected side effect?
It involves transuterine insufflation of the Fallopian tubes with carbon dioxide to enable evaluation of the patency of the Fallopian tubes and may be part of a fertility study. If tubes are open, the gas enters the abdominal cavity. A high-pitched bubbling is heard through the abdominal wall with a stethoscope as the gas escapes from the tubes. The pt may complain of shoulder pain from diaphragmatic irritation.
What hormone is secreted in the urine after the fertilization of the ovum?
hCG - human Chorionic Gonadotropin
Serum CA-125
Is a tumor antigen associated with ovarian cancer, to signal a recurrence of ovarian cancer.
Menarche
The beginning of menses designates the first menstrual cycle, body is capable of supporting pregnancy. Menarche occurs 2-21/2 years after breast development usually about 9-17 yrs of age, on average 12 1/2 yrs old. The amount is 10-75 ml, on average 35 ml per cycle.
Amenorrhea
Absence of menstrual flow, primarily when menarche has not occurred by the age of 17-18 yrs ; secondary vigorous exercise, depression, anorexia, or bulimia. Diagnostic tests include pelvic exam, blood, urine, hormone analysis, determination of existing tumors and a pap smear. Hormone therapy may be needed.
Dysmenorrhea
Uterine pain with menstruation (menstrual cramps), causes can be related to endocrine imbalance; an increase in prosteglandin (causes pain awareness) secretions; or chronic illnesses, fatigue, and anemia. S/S : breast tenderness, abdominal distention, nausea, vomiting, headache, vertigo, palpations and excessive perspiration, colicky and cyclic pain, dull pain in the lower pelvis and 24-48 hrs before menses. Diagnostic test- pelvic exam, laparoscopy, D&C, and hysterosalpingography. Medical Management : If no organic cause is found women should exercise, eat nutritious foods high in fiber, apply heat, and mild analgesics. Prostaglandin Inhibitors - Ibuprofen ( motrin, Advil), Naproxen sodium (anaprox) Oral Contraceptives may be used to suppress ovulation by inhibiting prosteglandin levels - or tho novum, norlestrin, oral triphasil
Menorrhagia
Excessive bleeding at the time of the regular manstrual flow, increased duration (more than 7 days). Attributed to endocrine disturbances, in older women inflammatory disturbances or uterine tumors fibroids/ leiomyomas or endometrial polyps.
Metrorrhagia
The appearance or uterine bleeding between regular menstrual periods or after menopause, it may indicate cancer or benign tumors of the uterus. Endometrial cancer must be considered for postmenopausal women.
How is Menorrhagia / Metrorrhagia diagnosed and what are the nursing interventions?
Diagnosis is made through routine speculum and pelvic exam. Endometrial biopsy and ultrasonography can diagnose the cause and endometrial ablation. Nursing Intervention : 1. Assess for bleeding, pain, vaginal secretuons, and psychosocial concerns. 2. Encourage women to express her feelings. 3. Explain the importance of recording dates, type of flow, and number of sanitary pads or tampons. 4. Teach the pt pain relieving techniques. 5. Explain to the pt the importance or sharing her concerns with her partner.
PMS / Premenstrual Syndrome
Related to the neuroendocrine events occurring within the anterior pituitary gland. Loss of intravascular fluid into the body tissue causes water retention, bloating, and weight gain. Other causes of PMS include estrogen and progesterone imbalances and nutritional deficiencies of pyridoxine (B6) or magnesium. PMD-D (Premenstrual Dysphoric Disorder is PMS with severe mood disorder. PMS occurs 7-10 days before menstrual period and subsides within the first 3 days after onset of me strual flow. S/S : Behavioral : anxiety, mood swings, irritability, lethargy, fatigue,sleep disturbances, and depression / Physical : Headache, virtogo, backache, breast tenderness, abdominal distention, acne, paresthesia (burning or tingling) of hands and feet and allergies Medical Management : Analgesics, diuretics, and progesterone, Diet : high in complex carbs, moderate protein, low in refined sugar and sodium, especially during premenstrual intervals. Supplements of vitamin B6, calcium, and magnesium. Reduce or eliminate caffeine, alcohol, and smoking. Encourage 30 mins of exercise 3-4 times a week, stress reduction techniques (yoga, biofeedback), adequate rest and relaxation. Pristiglandin inhibitors (ibuprofen) for pain ; for anxiety burspirone (BuSpar) taken during the luteal phase of the menstrual cycle. PMD-D Antidepressants - fluoxetine (Prozac, Sarafem) ; Tricyclic antidepressants : Amitriptyline (Elavil) ; SSRIs (Serotonin Reuptake Inhibitors - Sertaline (Zoloft)
Menopause
A transition from a reproductive phase to a no reproductive stage of life. Cessation of menses, infrequent cycle that is less than 2 years. Menopause begins in most women between 42-58 (average age 51 ) and is characterized by infrequent ovulation, decreased menstrual function, and eventual cessation of menstrual flow. Menopause may be artificially induced by such procedures as irradiatiin of the ovaries or surgical removal of both ovaries, illness, side effects of cheo or drugs. Decline in ovarian function produces a variety of symptoms, including a decrease in the frequency, amount, and duration of the menstraul flow, spotting, amenorrhea, and polymenorrhea. Symptoms can last from a few months to several years before menstruation ceases permanently. Menopause is not considered complete until 1 year after the last menstrual period. clinical manifestations : Changes of the reproductive system include shrinkage of vulval stucture s, atrophic vulvitis, shortening of the vagina, and dryness of the vaginal wall. Relaxation of supporting pelvic structures result from the decrease in estrogen, urinary frequency and urgency. There is loss of skin tugor and elasticity ; increased subcutaneous fat, decreased breast tissue and thinning hair of the axilla, head amd pubis ; osteoporosis Hot flashes, fatigue, vertigo, dyspareunia (painful intercourse), palpations, weight gain, tachycardia. Diagnostic test :Analysis of Hormone levels Medical Management : HRT Hormone Replacement Therapy - long term use of HRT estrogen-progestin combination heightened the risk of ischemic stroke, coronary heart disease, breast cancer that is at a more advanced stage at the time of diagnosis, ovarian cancer and thromboembolism
Simple Vaginits
A common vaginal infection caused by E. Coli, possibly staphylococcal, streptococcal organism, T. vaginitis (flagellated protazoan), C. albicans (yeastlike fungus) . S/S : exudatein vaginitis is yellow, whitish, or grayish white, curdlike and accompanied by pruritis, burning, and edema of the surrounding tissue. Med. management : Douching, vaginal suppositories ( to be administered at bedtime and to remain recumbent for 30 minutes for optimal absorption) ointments, and creams.
Senile Vaginitis or Atrophic Vaginitis
occurs postmenopause due to low estrogen level that cause the vulva/ vagina to atrophy and become susceptible to invation of bacteria.
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