CONCEPT OF REPRODUCTIVE SYSTEM

 ROLE OF NURSES IN WOMEN’S HEALTH

1. Encourage to determine health goals and behaviors.
a. Providing information about scheduling regular examination.
b. Providing open, non judgmental environment
c. Recognizing signs and symptoms of abuse and screening all patients
in private and safe environment.
d. Recognizing cultural differences and beliefs and respecting sexual
orientation and concerns.

2. Teaches concepts of health and illness

3. Offers interventional strategies.
4. Provide support, counseling and monitoring of health promotional
activities.
 ASSESSMENT FOR FEMALE
REPRODUCTIVE SYSTEM

1. Health History
a Menstrual History
b. History of Pregnancies
c. History of Exposure to Medications
d. Pain History
e. History of Vaginal Discharge and Odor or Itching
f. History of problems with urinary functions
g. History of problems with bowel or bladder control
h. Sexual History
I. History of sexual abuse or physical abuse
j. History of surgery or other procedures on reproductive tract structures
k. History of chronic illness or disability that may affect health status,
reproductive health , need for health screening or access to health care.
l. History of genetic disorder
 PHYSICAL ASSESSMENT FOR FEMALE
REPRODUCTIVE SYSTEM
1.Periodic examinations and routine cancer screening are important for women.
2. Annual breast and pelvic examination.
3. Proper explanation and teaching regarding pelvic examinations.
4. Before examination, the patient is asked to void and provide a urine specimen ( if
urinalysis is ordered).
5.Supine Lithotomy Position for Pelvic Examinations
a. Most comfortable position for women.
b. Allows better eye contact between patient and examiner.
c. Provide an easier means for examiner to carry out bimanual examination.
d. Enables the patient to use mirror to see her anatomy.
6. Pelvic Examination ( assessment of the appearance, size and shape of the vulva,
vagina, uterus and ovaries to ensure reproductive health and absence of illness ).
7. Speculum is done to inspect cervix and a pap smear is obtain.
8. Bimanual palpation is done using forefinger and middle finger of a gloved and
lubricated hand.
 ASSESSMENT FOR MALE REPRODUCTIVE
SYSTEM

1.Health History ( PLISSIT model of sexual assessment and

intervention )
a. Urinary functions and symptoms
b. Sexual function and dysfunction
c. Use of medications affecting sexual function
d. Stress
e. Alcohol Use
2. Physical Assessment
a. Digital Rectal Examination ( DRE )
b. Testicular Examination
 NURSING CARE MANAGEMENT OF NORMAL AND
ALTERED FEMALE PHYSIOLOGIC PROCESS

A.Menstruation
a. Cyclic vaginal flow of tissue that lines the uterus every 28 days interval.
b. Duration : 4-5 days with actual blood loss of 50-60 ml.
c. Psychosocial Considerations
1. Proper Instruction of the normal process of the menstrual cycle
prior to menarche.
2. Inform what are the normal symptoms felt during this cycle.
3. Discomfort can be minimized through adequate rest, nutrition and
exercise
d. Cultural Considerations
B. Perimenopausal
a. Period extending from the first sign of menopause to beyond the complete
cessation of menses.
b. Discussion of health related concerns ( Midlife Crisis )
c. Importance of Diet and Exercise
 NURSING CARE MANAGEMENT OF NORMAL AND
ALTERED FEMALE PHYSIOLOGIC PROCESS
C. Menopause
a. Permanent physiologic cessation of menses associated with declining ovarian
function.
b. Associated with atrophy of the breast tissue and genital organs, loss of bone
density and vascular changes.
c. Starts gradually and signals by changes in the pattern of menstruation.
1. Ovulation less frequent
2. Fluctuation of estrogen levels
3. Rise of FSH to stimulate estrogen production.
d. Menopause may result to role confusion or feelings of sexual and personal
freedom.
e. HRT reduces and eliminates symptoms related to menopause.
f. Contraindication for HRT ( history of breast cancer, vascular thrombosis, active
liver disease or impaired liver function, uterine cancer and abnormal vaginal
bleeding.
g. Menopause is not a complete change of life, it is a physiologic function that rarely
accompanies nervous symptoms or illness.
 PREMENSTRUAL SYNDROME
a. Combination of symptoms that occur before menses and subside with the
onset of the menstrual flow.
b. Unknown cause but serotonin regulation is a most plausible theory.
c. Premenstrual dysphoric disorder is a severe form of PMS which interferes
with the woman’s school, work, job, social or family life.
d. Physical Symptoms ( Fluid Retention, Headache, Swelling )
e. Affective Symptoms ( Depression, Anger, Irritability, Anxiety, Confusion
and Withdrawal )
f. Nursing Care Management
1. Health History
2 Nutritional History
3. Use of Family and Social Support and Resources
4. Stress Reduction Techniques
5. Compliance to Prescribed Medication Regimen
 MENSTRUAL DISORDERS
1. Dysmenorrhea
a. Characterized by crampy pain that begins before or shortly after onset of
menstrual flow and continues 48-72 hours.
b. Results from excessive production of prostaglandins which causes painful
contraction of the uterus and arteriolar vasospasm.
c. Psychological Factors ( anxiety and tension ) contribute to dysmenorrhea.
d. Resolves after childbirth.
d. Types of Dysmenorrhea
1. Primary: painful menstruation without identifiable pelvic pathology
2. Secondary : with pelvic pathology
e. Treatment
1. Application of heat, rest, distraction, exercise, analgesia for primary
dysmenorrhea
2. Secondary : depends on the underlying cause
 MENSTRUAL DISORDERS

2.Amenorrhea
a. Absence of menstrual flow.
b. Types of Amenorrhea
1. Primary ( delayed menarche ) : variations in body build, heredity, environment
physical, mental and emotional development
2. Secondary : absences of menses for 3 cycles or 6 months after a normal
menarche caused by pregnancy, tension, emotional upset, stress
and nutritional factors
c. Management
1. Verbalization of concerns and anxiety about the problem.
2. Complete physical examination, health history and simple laboratory test
 MENSTRUAL DISORDERS

3. Menorrhagia
a. Prolonged or excessive bleeding at the time of regular menstrual flow.
b. Early Life : endocrine Problem
c. Later Life : inflammatory disturbance, uterine tumors, hormonal imbalances
d. Consultation with ob-gyne is required.

4. Metorrhagia
a. Vaginal bleeding between regular menstrual periods associated with cancer,
benign tumors of the uterus or other gynecologic problems.
b. Warrants early diagnosis and treatment
 ABORTION
a. Interruption of pregnancy or expulsion of the product of
contraception before the fetus is viable (anytime after the fifth to sixth month
of gestation)
b. Types
1. Spontaneous Abortion
Causes:
- Abnormality in the fetus that makes survival impossible
- Systemic diseases
- Hormonal imbalance
- Anatomic abnormalities
Kinds:
- Threatened Abortion
- Inevitable/Imminent Abortion
- Incomplete Abortion
- Complete
* If spontaneous abortion becomes successive, repeated and of
unknown cause it is defined as habitual or recurrent abortion.
 ABORTION
c. Medical Management
1. Examination of all tissue and all discharged material passed
2. Estimation of the bleeding volume by recording the number of perineal
pads and the degree of saturation over 24 hours
3. Dilation and evacuation or dilation and curettage

d. Nursing Management
- Provision of emotional support and understanding
 ECTOPIC PREGNANCY
a. Pregnancy occurring when a fertilized ovum becomes implanted on any tissue
other than the uterine lining (fallopian tubes, ovary, abdomen, or cervix)
b. Causes:
1. Salphingitis
2. Peritubal adhesions
3. Structural abnormalities of the fallopian tubes
4. Previous tubal surgery
5. Multiple previous induced abortion
c. Manifestations
1. Delay in menstruation from 1 – 2 weeks followed by slight bleeding or
a report of a slightly abnormal period, ( possible ectopic pregnancy)
2. May begin late, with vague soreness on the affected side
3. Sharp, colicky pain
 ECTOPIC PREGNANCY
c. Manifestations (Ruptured)
1. Agonizing pain, dizziness, faintness, nausea and vomiting
2. Air hunger and signs of shock may occur
d. Diagnostic Findings
1. Vaginal examination
2. hCG level testing
3. Serum progesterone level testing
e. Possible Nursing Diagnoses
1. Anticipatory grieving
2. Acute pain
3. Deficient knowledge about the treatment and effect on future
pregnancies
 Hydatidiform Mole
a. A gestational trophoblastic neoplasm
b. Manifestations
1. Delayed menses
2. Hyperemesis and uterine enlargement beyond expected for
gestational age
3. Pregnancy-induced hypertension (edema, hypertension,
proteinuria)
c. Treatment
1. Suction curettage
2. Monitoring serial beta-human chorionic gonadotropin levels
 VULVOVAGINAL INFECTIONS
1.Gonorrhea (N. gonorrheae)
a. Heavy purulent vaginal discharge but often asymptomatic in female.
b. May be passed to fetus during birth ( opthalmia neonatorum and sepsis )
c. Treatment : ceftriaxon (Rocephin), cefixime (Suprax), ciprofloxacin (Cipro),
ofloxacin (Floxin), doxycycline
d. All sexual partners must be treated.

2. Chlamydia (C. trachomatis)

a. Cervical or vaginal discharge ( similar to gonorrhea )
b. Fetal transmission at birth ( Opthalmia neonatorum )
c. Treatment :, Doxycycline, Azithromycin, Prophylactic treatment of infant’s
eyes
d. Untreated : Pelvic Inflammatory Disease
 VULVOVAGINAL INFECTIONS
3.Trichomoniasis (Trichomonas vaginalis)
a. Caused by protozoan
b. Profuse foamy white to greenish irritating discharge
c. Treatment : Metronidazole ( Flagyl ) for woman and all sexual partners
for 7 days
d. Alcohol ingestion with Flagyl causes severe GIT upset

4. Candidiasis (Candida albicans)

a. Caused by yeast transmitted from GI tract to vagina
b. Overgrowth with pregnancy, diabetes and with steroid and antibiotic therapy
c. Vaginal examination : Thick, white, cheesy patches on vaginal walls
d. Causes oral thrush in the newborn thru direct contact in the birth canal.
e. Treatment : topical application of clotrimazole and nystatin

5. Bacterial Vaginitis
a. Caused by other bacteria invading the vagina
b. Foul and Fishy smelling discharge
c. Treatment if specific to causative agent and includes sexual partners
 VULVOVAGINAL INFECTIONS
6. Genital Warts (Human Papilloma Virus)
a. Most common STD
b. Strains
1. Strains 6 and 11
- associated with condylomata on the vulva
- associated with low risk for cervical cancer
2. Strains 16, 18, 31, 33, 35, 45
- affect the cervix
- associated with a higher risk for cervical cancer
c. Incidence is high in young, sexually active women
d. Risk factors
1. Sexually active
2. Having multiple partners
3. Having a partner who has or has had multiple partner
 VULVOVAGINAL INFECTIONS
6. Genital warts
e. Treatments:
1. Topical application of
- trichloroacetic acid
- podophyllin
- podofilox
2. Electrocautery
3. Having regular Pap smear every 6 months for several years
7. Genital herpes (Herpes simplex virus 2 or HSV – 2)
a. Recurrent, life-long viral infection
b. Transmitted primarily through sexual contact but may be transferred
asexually (wet surfaces or self-transmission)
 VULVOVAGINAL INFECTIONS
7. Genital Herpes
c. Recurrence is associated with
1. Stress
2. Sunburn
3. Inadequate rest and nutrition
d. Manifestations
1. Appearance of blisters usually
- in the labia and perianal areas (females)
- glans penis, foreskin, and penile shaft (males)
2. Influenza-like symptoms after 3 – 4 days after appearance of blisters
3. Other manifestations
- inguinal lymphadenopathy
- myalgia
- minor temperature elevation
e. Treatment: acyclovir (Zovirax) , valacyclovir (Valtrex), famciclovir (Famvir)
 NURSING CARE MANAGEMENT FOR
VULVOVAGINAL INFECTIONS

1.Assessment ( Health History and Physical Examination )

a. No douching prior to examination
b.Area is observed for erythema, edema, excoriation and discharge.
c. Adequate description of discharges and symptoms.
d. Risk factors for Vulvovaginal Infections
1. Physical and Chemical Factors
2. Psychogenic Factors
3. Medical conditions and Endocrine Factors
4. Use of Medications
5. New sex partner, multiple sex partners, previous vaginal infection
6. Hygiene Practices
7. Use or non-use of Condoms
8. Use of Chemicals
 NURSING CARE MANAGEMENT FOR
VOLVOVAGINAL INFECTIONS
2.Nursing Diagnosis
a. Discomfort related to burning, odor or itching from infectious process.
b. Anxiety related to stressful symptoms, anticipated stigmatization, prognosis
c. Risk for infection or spread of infection.
d. Knowledge deficit about proper hygiene and preventive measures.
3. Nursing Goals
a. Relief of discomforts.
b. Reduction of anxiety.
c. Prevention of reinfection or infection of sexual partner.
d. Acquisition of knowledge about methods for prevention of vulvovaginal infections
and self-care
 NURSING INTERVENTIONS FOR
VULVOVAGINAL INFECTIONS
1. Sitz bath and use of cornstarch powder to relieve discomfort and irritation.
2. Adequate explanation of symptoms and ways to prevent recurrence of
vulvovaginal infections.
3. Proper information regarding related risk and adequate treatment not
only
for patient but partner as well.
4. Abstinence from sexual intercourse during infection
5. Proper hygienic practices relating to bathing, voiding, defecation and
proper clothing.
6. Importance of proper handwashing before and after administration of
medication and strict compliance to medication regimen.
 PATIENTS WITH BREAST PROBLEMS
1.Mastitis
a. Inflammation or infection of breast tissue ( breastfeeding women )
b. Result from transfer of microorganism to the breast of a patient’s hand or those of
others or from a breastfed infant with an oral, eye or skin infection.
c. Caused by blood borne microorganisms.
d. Treatment by antibiotics and application of local heat.

2. Fibrocystic Breast Changes (30-50 years old and regresses after menopause)
a. Ducts dilate and cysts form due to estrogen factor
b. Cysts are larger premenstrually and smaller postmenstrually because of retention
of fluid prior to menstruation.
c. Symptoms: breast pain ( intermittent/dull ache or shooting ) due to hormonal
fluctuations and effect on breast tissue; from stimulation of nerve in
chest wall due to an activity ( weight training )
 PATIENTS WITH BREAST PROBLEMS
2. Fibrocystic Breast Changes

d. Nursing Management
1. Wearing of supportive bra both day and night except bathing.
2. Decrease salt and caffeine intake
3. Take analgesics.
4. Take vitamin E supplements or oil of primrose

3. Fibroadenomas (Teens to menopause)

1. Firm, round, movable, usually single benign tumors of the breasts
2. Usually nontender and removed for diagnostic certainty.
 CANCER OF THE BREASTS
1.Most common neoplasm among women

2. Assessment Findings
a. Palpation of lump c. Asymmetry of the breasts
b. Dimpling of breast skin d. Surgical biopsy provides definitive
diagnosis

3. Risk Factors
a. Genetics f. Late menopause
b. Increasing Age g. Obesity
c. Personal or Family History h. HRT
d. Early menarche i. Alcohol Intake
e. Nulliparity and late maternal age at first
birth
 NURSING CARE MANAGEMENT FOR
PATIENTS WITH BREAST CANCER
1. Assessment
a. How is the patient coping?
b. What coping mechanisms does she find most helpful?
c. What psychological or emotional supports does she have and use?
d. Is there a partner? Family member or available person to assist her in making
treatment choices?
e. What are the most important areas of information she needs?
f. Is the patient experiencing any discomfort?
2. Nursing Diagnosis
a. Knowledge deficit about breast cancer and treatment options.
b. Anxiety related to cancer diagnosis.
c. Fear related to specific treatments, body image changes or possible death.
d. Risk for ineffective coping ( individual or family ) related to diagnosis of breast
cancer and related treatment options.
e. Decisional conflicts related to treatment options.
 NURSING CARE MANAGEMENT FOR
PATIENTS WITH BREAST CANCER
3. Postoperative Nursing Diagnosis
a. Acute Pain related to surgical procedure.
b. Impaired skin integrity related to surgical incision.
c. Risk for infection related to surgical incision and presence of surgical drain.
d. Disturbed body image related to loss or alteration of the breast secondary to
surgical procedure.
e. Risk for impaired adjustment related to diagnosis of cancer, surgical treatment
and fear of death.
f. Self-care deficit related to partial immobility of upper extremity on operative side.
g. Disturbed sensory perception related to sensations in affected arm, breasts, or
chest wall.
h. Risk for sexual dysfunction related to loss of body part, change in self-image and
fear of partner’s response.
I. Knowledge deficit related to drain management after breast surgery.
NURSING CARE MANAGEMENT FOR
PATIENTS WITH BREAST CANCER
4. Nursing Goals
a. Increased knowledge about the disease and treatment.
b. Reduction of preoperative and postoperative fears, anxiety
and emotional stress.
c. Improvement of decision making ability.
d. Pain management
e. Maintenance of skin integrity
f. Improved sexual function
g. Improved self-concept
h. Absence of complications
 NURSING INTERVENTIONS FOR
BREAST CANCER
1. Explaining breast cancer and treatment options
2. Reducing fear and anxiety and improving coping ability
3. Promoting decision-making ability
4. Relieving pain and discomfort
5. Maintaining skin integrity and prevention of infection
6. Promoting positive body image
7. Promoting positive adjustment and coping
8. Promoting participation in care
9. Managing postoperative sensations
10. Improving sexual functions
11. Monitoring and managing potential complications
 STRUCTURAL DISORDERS
1. Fistulas
a. Abnormal, tortuous opening between two internal hollow
organs or between an internal hollow organ and exterior of
the body
b. Causes: Trauma (obstetric, surgical, radiation)
c. Common fistulas
1. Vesicovaginal fistula
2. Ureterovaginal fistula
3. Rectovaginal fistula
4. Urethrovaginal fistula
d. Assessment and diagnostic findings
1. History taking of symptoms experienced
2. Methylene blue dye/indigo carmine test
3. Cystoscopy and IVP
 STRUCTURAL DISORDERS
1. Fistulas
d. Management
1. Eliminate fistula
2. Relieve discomfort
3. Improved patient’s self-concept and self-care abilities

2. Cystocele/Rectocele
a. Cystocele – downward displacement of the bladder toward the vaginal orifice
resulting from damage to the anterior vaginal support structures.
b. Rectocele – downward displacement of the rectum toward the vaginal orifice
resulting from damage to the posterior vaginal support structures.
b. Causes:
1. Injury and strain during childbirth
2. Genital atrophy associated with aging
 STRUCTURAL DISORDERS
2. Cystocele/Rectocele
c. Manifestations
1. Cystocele:
- Pelvic pressure
- Incontinence
- Urinary frequency and urgency
- Back pain and pelvic pain
- Dyspareunia
2. Rectocele:
- Rectal pressure
- Constipation
- Uncontrollable gas
- Fecal incontinenence (if complete tear occurs)
- Dyspareunia
 STRUCTURAL DISORDERS
2. Cystocele/Rectocele
d. Management
1. Kegel’s exercise
- strengthen and maintain the tone of the pubococcygeal muscle
- reduce or prevent stress incontinence and uterine prolapse
- enhance sensation during sexual intercourse
- hasten postpartum healing
2. Use of pessaries
- plastic or rubber device fitted by a gynecologist into the vagina
to keep an organ aligned
- removed, examined, and cleaned by health care provider at
prescribed intervals
3. Surgery (Colporrhaphy)
STRUCTURAL DISORDERS