REPRODUCTIVE System Benign Prostatic Hyperplasia Glandular units in the prostate that undergo an increase in the number of cells

resulting in enlargement of the prostate gland Hyperirritable bladder, urgency and frequency, hypertrophied bladder wall muscles, cellules and diverticula, hydroureter, hydronephrosis, and overflow urinary incontinence Assessment Urinary pattern, frequency, nocturia, and other symptoms of bladder neck obstruction Lower urinary tract symptoms Hesitancy, intermittency, reduced force and size of urinary stream, a sensation of incomplete bladder emptying, and postvoid dribbling Hematuria Laboratory Assessment Urinalysis Complete blood count Blood urea nitrogen and creatinine levels Prostate-specific antigen Drug Therapy Finasteride Terazosin hydrochloride Doxazosin mesylate Tamsulosin hydrochloride Estrogens and androgens Surgical Procedures Transurethral resection of the prostate Suprapubic prostatectomy Retropubic prostatectomy Perineal prostatectomy Continuous Bladder Irrigation Three-way urinary catheter with a 30to 45-mL retention balloon through the urethra into the bladder Traction via taping to clients abdomen or thigh

Uncomfortable urge to void continuously Antispasmodic medications Postcatheterization Care Client feels burning on urination as well as some urinary frequency, dribbling, and leakage. Symptoms are normal and will subside. Monitor fluid intake. Prostate Cancer Most common invasive cancer among men in the U.S. One of the slowest growing malignancies; metastasizes in a predictable pattern First symptoms related to bladder neck obstruction Diagnostic exam Digital rectal examination Prostate-specific antigen Biopsy necessary to confirm suspected prostatic cancer Postoperative Care of Radical Prostatectomy Hydration with intravenous therapy Caring for wound drains Preventing emboli Preventing pulmonary complications Antibiotics Analgesics Laxative and stool softener Indwelling urinary catheter Antispasmodic Complications Urinary incontinence Erectile dysfunction Nonsurgical Management Radiation therapy Hormonal therapy Chemotherapy Targeted therapy Erectile Dysfunction

Inability to achieve or maintain an erection for sexual intercourse Organic erectile dysfunction Functional erectile dysfunction Assessment Medical, social, sexual history Complete physical examination Duplex Doppler ultrasonography test Interventions Drug therapy includes sildenafil, vardenafil, tadalafil. Avoid alcohol before sexual intercourse. Common side effects include headaches, facial flushing, diarrhea. Men who take nitrates should not take these drugs in addition. Vacuum Devices Cylinder fits over the penis and sits firmly against the body. Vacuum is created to draw blood into the penis to maintain an erection. Rubber ring (tension band) is placed around the base of the penis to maintain the erection; cylinder is removed. Intraurethral Applications Prostglandin E is a self-administered suppository that is placed in the urethra with an applicator. Erection occurs in about 10 minutes and lasts 30 to 60 minutes. Burning of the urethra occurs after application. Prosthesis Penile implants are used when other modalities fail. Implants are semirigid, malleable, or hydraulic inflatable and multicomponent or one-piece instruments. Reservoir is placed in the scrotum. Major disadvantages are device failure and infection. Testicular Cancer

Although uncommon, this cancer is the most common malignancy in men 15 to 35 years of age. With early detection by testicular selfexamination and treatment with combination chemotherapy, testicular cancer can be cured. Germ cell tumors arise from spermproducing cells. Non-germ cell tumors Diagnostics Alpha-fetoprotein Beta subunit of hCG Ultrasound Computed tomography Magnetic resonance imaging Lymphangiograms Surgical Management Radical Retroperitoneal Lymph node Dissection Orchiectomy Nonsurgical Management Chemotherapy Radiation therapy Stem cell transplantation Hydrocele Cystic mass is usually filled with strawcolored fluid that forms around the testis resulting from impaired lymphatic drainage of the scrotum, causing a swelling of the tissue surrounding the testes. Hydrocele may be drained via needle and syringe or it may be removed surgically. Spermatocele A sperm-containing cyst develops on the epididymis alongside the testicle. Normally, spermatoceles are small and asymptomatic, and require no interventions. If they become large enough to cause discomfort, a spermatocelectomy is performed. Varicocele

A cluster of dilated veins occur behind and above the testis. Varicoceles can also cause infertility. Varicocelectomy is performed through an inguinal incision in which the spermatic veins are ligated in the cord. Scrotal Trauma Torsion of the testes involves twisting of the spermatic cord and occurs most often during puberty. Because the testes are sensitive to any decrease in blood flow, torsion of the testis is a surgical emergency. Surgical intervention may be required. Cryptorchidism Results when the testicles fail to descend; mainly a pediatric problem Injections of B-HCG luteinizing hormone-releasing hormone or testosterone optional to promote descent of the testicles Orchidopexy surgical procedure optional Cancer of the Penis Epidermoid (squamous) carcinomas developing from squamous cells Circumcision in infancyalmost always eliminates the possibility of penile cancer Painless wartlike growth or ulcer Excisional biopsy Radiation therapy Penectomy Phimosis and Paraphimosis Constricted prepuce that cannot be retracted over the glans; prepuce remains down around the tip of the penis Emergency requiring immediate treatment Circumcision Warm bath to allow dressing to loosen Barbiturate sleeping medications Priapism

Uncontrolled and long-maintained erection without sexual desire; causes the penis to become large and painful Can occur from: Thrombosis of veins of corpora cavernosa Sickle cell disease Abnormal reflex Some drug effects Recreational drugs Prolonged sexual activity Collaborative Management Urologic emergency Goal of intervention: to improve the venous drainage of the corpora cavernosa Meperidine Warm enemas Urinary or suprapubic catheterization Large-bore needle or surgical intervention Bacterial Prostatitis Often occurs with urethritis or an infection of the lower urinary tract Fever, chills, dysuria, urethral discharge, and boggy, tender prostate Urethral discharge with white blood cells in the prostatic secretions. Epididymitis Inflammation of the epididymis resulting from an infection or noninfectious source such as trauma Treatment: bedrest with scrotum elevated on a towel, scrotal support when ambulating Comfort measures Epididymectomy Orchitis (Mumps) Acute testicular inflammation resulting from trauma or infection Treatment: bedrest with scrotal elevation, application of ice, and administration of analgesics and antibiotics Female reproductive system

Interventions for Clients with Breast Disorders Benign Breast Disorders Fibroadenoma,most common cause of breast masses during adolescence; may occur in clients in their 30s Solid, slowly enlarging, benign mass; round, firm, easily movable, nontender, and clearly delineated from the surrounding tissue Usually located in the upper outer quadrant of the breast Fibrocystic Breast Disease Physiologic nodularity of the breast, most common breast problem of women between 20 and 30 years of age Stage 1: premenstrual fullness and tenderness, symptoms occur on menstrual cycle Stage 2: multiple nodular areas in both breasts (Continued) Fibrocystic Breast Disease Stage 3: microscopic or macroscopic cysts associated with pain, tenderness, or burning occurring in women between 35 and 55 years of age Collaborative Management Symptomatic management Hormonal manipulation Drug therapy: vitamins C, E, and B complex Diuretics Avoidance of caffeine Mild analgesics Limited salt intake before menses Well-padded supportive bra Local application of heat or ice for pain relief Ductal Ectasia Benign breast problem of women approaching menopause caused by dilation and thickening of the collecting ducts in the subareolar area

Mass that is hard with irregular borders, tender Greenish brown nipple discharge, enlarged axillary nodes and edema over the site of the mass Intraductal Papilloma Occurs most often in women 40 to 55 years of age Benign process in the epithelial lining of the duct, forming an outgrowth of tissue Trauma and erosion within the duct, resulting in bloody or serous nipple discharge Diagnosis aimed first at ruling out breast cancer Gynecomastia Benign condition of breast enlargement in men Can be a result of primary cancer such as lung cancer Causes include: Drugs Aging Obesity Underlying disease causing estrogen excess Androgen deficiency Breast cancer Complications include: Invasion of lymph channels causing skin edema Metastasis to lymph nodes Bone, lungs, brain, and liversites of metastatic disease from breast cancer Ulceration of overlying skin Types of Breast Cancer Ductal carcinoma in - situ Invasive or infiltrating ductal carcinoma Invasive or infiltrating lobular carcinoma Medullary carcinoma Tubular carcinoma Mucinous carcinoma Pagets disease

Inflammatory breast cancer Breast Cancer in Men Of all breast cancers, only 1% occurs in men. Breast cancer in men usually presents as a hard, nonpainful subareolar mass. Breast cancer in men is often a widely spread disease because it is usually detected at a later stage than in women. Mammography Baseline screening mammography yearly at age 40 is recommended. Barriers to mammography compliance can involve factors such as fear. Increase compliance through education. Breast Self-Examination The goal of screening for breast cancer is early detection because breast self-examination cannot prevent breast cancer. Early detection reduces mortality rate. Teach breast self-examination. Breast Care Clinical breast examination Cancer surveillance Prophylactic mastectomy Chemoprevention Pathologic Examination Key to diagnosis of breast cancer Presence or absence of estrogen receptors or progesterone receptors S-phase index, or growth rate DNA ploidy Histologic or nuclear grade HER2/neu gene expression Surgical Management Lumpectomy Mastectomy Axillary lymph nodes (dissection or removal) Sentinel lymph node biopsy Reconstructive breast surgery

Postoperative Care Avoidance of using the affected arm for blood pressure measurement, giving injections, or drawing blood Monitoring of vital signs Care of drainage tubes Comfort measures Mobility and diet Breast reconstruction Adjuvant Therapy To decrease the risk of recurrence, adjuvant therapy consists of: Radiation therapy Chemotherapy Hormonal therapy Female reproductive system Interventions for Clients with Gynecologic Problems Primary Dysmenorrhea One of the most common gynecologic problems, occurring most often in women in their teens and early 20s. Treatment Postaglandin synthetase inhibitors, oral contraceptives Complementary and alternative therapy Endometriosis Endometriosis is usually a benign problem of endometrial tissue implantation outside the uterine cavity. Manifestations include pain, dyspareunia, painful defecation, sacral backache, hypermenorrhea, and infertility. Diagnostic exam Erythrocyte sedimentation rate and white blood cell count rule out pelvic inflammatory disease. Laparoscopy is the key diagnostic procedure. Interventions Drug therapy

Mild analgesics, nonsteroidal antiinflammatory drugs, hormonal therapies, pseudopregnancy, pseudomenopause, or medical oophorectomy Complementary and alternative therapy Surgical management Laparoscopic excision Hysterectomy Leiomyomas Benign smooth muscle neoplasm that is not premalignant. They can occur in any organ, but the most common forms occur in the uterus, small bowel and the esophagus. Simple Vaginitis Inflammation of the lower genital tract Result of one or more of the following: Menopause Trichomonas vaginalis Candida albicans Changes in normal flora Alkaline pH Foreign bodies Chemical irritants Diabetes Management Perineal cleaning after urination or defecation Wearing cotton underwear Avoiding strong douches and feminine hygiene sprays Avoiding tight-fitting pants Using estrogen creams Eating yogurt with antibiotics Vulvitis Inflammatory condition of the vulva (itching) associated with symptoms of pruritus and a burning sensation Other causes include the following: Atrophic vaginitis Vulvar kraurosis Vulvar leukoplakia Cancer

Urinary incontinence Management Measures to relieve itching, including sitz baths Prescribed antibiotics Treatment of pediculosis and scabies, if needed Laser therapy Toxic Shock Syndrome (TSS) First recognized in 1980 when it was found to be related to menstruation and tampon use Staphylococcus aureus Abrupt onset of high temperature, headache, sore throat, vomiting, diarrhea, generalized rash, hypotension Penicillin or vancomycin Uterine Prolapse Stages of uterine prolapse are described by the degree of descent of the uterus. Dyspareunia, backache, pressure in the pelvis, bowel or bladder problems Pessaries Surgery Cystocele Protrusion of the bladder through the vaginal wall due to weakened pelvic structures Difficulty in emptying bladder, urinary frequency and urgency, urinary tract infection, stress urinary incontinence Kegel exercises Surgery Rectocele Protrusion of the rectum through a weakened vaginal wall Constipation, hemorrhoids, fecal impaction, feelings of rectal or vaginal fullness High-fiber diet, stool softeners, laxatives Surgery

Fistulas Abnormal openings between two adjacent organs or structures Leakage of urine, flatus, or feces into the vagina, irritation or excoriation of the vulva and vaginal tissues, fecal or urine odor in the vagina, feelings of wetness or dribbling in the vagina Nonsurgical treatment Surgical treatment Follicular Cysts Cystusually small and may be asymptomatic unless it ruptures Rupture of a follicular cyst or torsion may cause acute, severe pelvic pain Medical management Surgical management includes: Cystectomy Oophorectomy Polycystic Ovary High levels of luteinizing hormone overstimulate the ovaries, producing multiple cysts on one or both ovaries. Endometrial hyperplasia or even carcinoma may result. Typical client is obese, hirsute, has irregular menses, and may be infertile. Treatment is with oral contraceptives, surgery, or clomiphene. Bartholin Cyst Obstruction of the duct of the Bartholins gland caused by infection, thickened mucus near the ductal opening, or trauma such as lacerations or episiotomy Simple incision and drainage Marsupialization (formation of a pouch) Postoperative care Cervical Polyps Pedunculated tumors (on stalks) arising from the mucosa and extending to the opening of the cervical os Polyp removala simple office procedure

Endometrial Cancer Endometrial cancer is a reproductive cancer, of which adenocarcinoma is the most common type. The main symptom is postmenopausal bleeding. Diagnostic assessment includes the following tests: CA-125 tumor marker Chest x-ray Intravenous pyelography Barium enema CT of the pelvis Liver and bone scans Functional dilation and curettage Management Radiation Therapy External and internal Teletherapy Brachytherapy Intracavitary radiation Surgical Management Total abdominal hysterectomy and bilateral salpingo-oophorectomy Radical hysterectomy with bilateral pelvic lymph node dissection for stage II cancer Cervical Cancer Common reproductive cancer among women in the U.S. Disorder is a progression: from totally normal cervical cells to premalignant changes in appearance of cervical cells (dysplasia), to changes in function, ultimately to transformation to cancer Carcinoma in situ Preinvasive or invasive Clinical Manifestations Client often asymptomatic Classic symptom: painless vaginal bleeding Watery, blood-tinged vaginal discharge that may become dark and

foul-smelling as the disease progresses Clinical Manifestations Leg pain Flank pain Unexplained weight loss, pelvic pain, dysuria, hematuria, rectal bleeding, chest pain and cough Diagnostic Assessment Pap smear Squamous atypia, inflammatory atypia, or minor atypia abnormalities Bethesda system Colposcopic examination Endocervical curettage Nonsurgical Management Local ablation of electrosurgical excision using the loop electrosurgical excision procedure Laser therapy Cryotherapy Radiation therapy Chemotherapy Conization Surgical Management Clinical staging performed before surgery to establish extent of the disease Simple hysterectomy Radical hysterectomy Pelvic exenteration Postoperative Care Early stages of recovery, assess for: Hemorrhage and shock Pulmonary complications Fluid and electrolyte imbalances Renal or urinary complications Pain Later stages of recovery, assess for: Deep vein thrombosis Pulmonary emboli Paralytic ileus Wound infections Wound dehiscence Wound evisceration

Pain Ovarian Cancer Most common typeserous adenocarcinoma Vague abdominal discomfort, dyspepsia, indigestion, gas, and distention Ovarian antibody CA-125, ultrasound, intravenous pyelography, barium enema, upper gastrointestinal radiographic series to rule out tumors Nonsurgical Management Chemotherapy with agents such as cisplatin, carboplatin, and paclitaxel Radiation therapy Surgical Management Total abdominal hysterectomy and bilateral salpingo-oophorectomy Staging Second-look procedure usually after 1 year of chemotherapy Vulvar Cancer Most are squamous cell carcinomas. Women often report irritation or itching in their perineal area or a sore that will not heal. Toluidine blue test identifies abnormal cells. Keyes dermal punch is used for tissue biopsy. Management Laser therapy Radiation therapy Surgical management: vulvectomy or skinning vulvectomy, or radical vulvectomy Postoperative Care Providing wound care Promoting urinary and bowel elimination Managing pain Addressing sexuality Vaginal Cancer

Rare, accounting for less than 2% of all gynecologic cancers Associated with intrauterine exposure to diethylstilbestrol Treatment with any of the following: Laser therapy Topical chemotherapy Vaginal Cancer Radiation therapy Surgical managementvaginectomy for invasive disease